Document Type


Publication Date




The Centers for Disease Control and Prevention (CDC) have outlined core elements of effective antimicrobial stewardship programs (ASPs). However, many smaller community and “critical access hospitals” (CAHs) lack resources necessary to fully implement these programs. Tele-antimicrobial stewardship is highlighted in the Federal Register as a potential solution for such situations.


In January 2017 we implemented UW-TASP/ECHO, a remotely-based electronic answer to the problem of limited resources for ASPs at CAHs. This interdisciplinary collaboration involves infectious diseases (ID) faculty and fellows, ID pharmacists, and microbiologists from UW Medicine; epidemiologists from Washington State Department of Health (WA-DOH); program/technical support staff; and ASP teams from participating institutions, forming one large ASP working across Washington State. The team meets weekly using the ECHO model. These meetings provide CME via didactic sessions and facilitate interactive case reviews in a peer-to-peer fashion (and never “top-down”). Policies, procedures, and protocols are shared freely. Site visits to each participating location allow us to understand their workflow, and customize interventions.


13 of 39 CAHs in WA participate. Gap analysis for the CDC Core Elements has revealed areas for improvement at many sites, and specific remediation plans are being formulated. Participants share their antibiotic formularies and antibiograms where available, and discuss challenges unique to CAHs. Providers report a high degree of satisfaction with the program, both due to ASP improvements, and because of the community and enhanced inter-professional communication it provides these relatively isolated facilities. Public health benefits include improved local data sharing, and national data reporting to NHSN’s antibiotic use and resistance options is encouraged. Impact on antimicrobial use and resistance is being tracked, although it is too early to measure effect via traditional outcomes.


We have engaged 33% of Washington State’s CAHs through tele-antimicrobial stewardship. This innovative model effectively supports ASPs in smaller hospitals across large geographic regions.