What is a potential topic for a 6-month minor project thesis at a hospital?

Antimicrobial Stewardship Program Implementation: An Ideal 6-Month Hospital Project

For a compelling 6-month minor thesis project, I strongly recommend implementing and evaluating a hospital antimicrobial stewardship program (ASP) with prospective audit and feedback, focusing on measurable clinical outcomes including Clostridium difficile infection rates, antimicrobial resistance patterns, and Days of Therapy per 1,000 patient-days. This topic directly impacts patient mortality, morbidity from healthcare-associated infections, and quality of life while addressing one of the most pressing global health threats 1, 2.

Why This Topic is Clinically Significant and Feasible

Antimicrobial stewardship programs reduce C. difficile infections, decrease nosocomial infections from resistant organisms, and improve cure rates without negatively impacting mortality 2. The inappropriate use of antibiotics directly increases Clostridium difficile infections, healthcare-associated infections with resistant organisms, and adverse drug events that harm patients 2. This makes ASP implementation a high-impact intervention with measurable outcomes within your 6-month timeframe.

Current Relevance and Urgency

• Antimicrobial resistance represents a critical global health threat, with many hospitals lacking formal stewardship programs despite consensus recommendations 1.
• The World Health Organization recommends selecting the narrowest-spectrum antibiotic effective against likely pathogens based on local antibiograms and resistance patterns 2.
• Recent evidence demonstrates that prospective audit and feedback programs achieve 22% reductions in broad-spectrum antibiotic use over 7-year periods while improving patient outcomes 2.

Specific Project Components for Your 6-Month Timeline

Phase 1: Baseline Assessment (Weeks 1-4)

• Conduct point prevalence surveys using the Global-PPS methodology to measure baseline antimicrobial use prevalence 3.
• Collect baseline data on antimicrobial documentation quality, specifically the presence of documented reasons for treatment and stop/review dates 3.
• Analyze hospital antibiogram data and local resistance patterns, removing duplicates to inform prescribers and policies 1.
• Survey prescribers regarding current antimicrobial prescribing practices and barriers to optimal use 4.

Phase 2: Intervention Development (Weeks 5-8)

• Establish a multidisciplinary antimicrobial stewardship team with an infectious diseases physician and clinical pharmacist with infectious diseases expertise as core members 2, 5.
• Develop facility-specific clinical practice guidelines for the three most common infections in your hospital based on local epidemiology 2, 6.
• Create an antimicrobial documentation policy requiring documented indication, planned duration, and stop/review date for all antimicrobial prescriptions 3.
• Design a prospective audit and feedback system that reviews antimicrobial prescriptions 24-48 hours after initiation with recommendations to optimize therapy 2, 5.

Phase 3: Implementation (Weeks 9-20)

• Implement prospective audit and feedback as the primary stewardship strategy, which maintains prescriber autonomy while providing educational benefit 2, 5.
• Conduct multimodal physician education on antimicrobial stewardship best practices, including enhanced documentation requirements and local clinical guidelines 4.
• Introduce a 72-hour antimicrobial "timeout" where prescribers reassess the need for continued therapy, which results in optimization or discontinuation of antimicrobials in 30% of cases 4.
• Provide real-time performance feedback to prescribers using Business Intelligence methods and visual impact algorithms 7.

Phase 4: Evaluation (Weeks 21-24)

• Repeat point prevalence surveys every 4-6 weeks to measure trends in antimicrobial use prevalence 3.
• Monitor antimicrobial consumption using Days of Therapy (DOTs) per 1,000 patient-days as the preferred metric 2.
• Track clinical outcomes including length of stay, hospital readmission rates within the first month, and mortality for infections 7.
• Measure microbiological outcomes including Clostridium difficile colitis incidence and changes in resistance patterns for alert organisms 7.
• Assess documentation quality indicators including percentage of prescriptions with documented indication and stop/review dates 3.

Expected Measurable Outcomes

Based on recent implementation studies, you can expect to demonstrate:

• Significant improvement in antimicrobial documentation from baseline levels of 4-8% to 51-65% complete documentation 4.
• Reduction in hospital-wide antimicrobial use prevalence with a statistically significant decreasing trend 3.
• Decrease in Clostridium difficile colitis incidence by approximately 9% 7.
• Reduction in length of stay by 0.2-0.3 days on average 7.
• Decrease in hospital readmission rates within the first month by approximately 19% 7.

Key Implementation Facilitators

• Engage hospitalists and frontline prescribers early in the process rather than imposing top-down mandates 4.
• Collect real-time data and provide individualized performance feedback to prescribers 4.
• Appropriately limit the scope of initial interventions to avoid overwhelming prescribers with overly broad changes 4.
• Secure administrative support and compensation for core team members before beginning implementation 5.

Common Pitfalls to Avoid

• Variability in physician practice styles can undermine standardization efforts; address this through consensus-building rather than mandates 4.
• Lack of awareness among prescribers regarding stewardship importance requires ongoing education rather than one-time training 4.
• Perceived loss of autonomy in clinical decision-making creates resistance; prospective audit and feedback preserves autonomy better than formulary restriction 5.
• Education alone produces non-sustainable improvements; integrate stewardship principles into daily clinical workflows with audit and feedback mechanisms 2.

Alternative High-Impact Topics

If antimicrobial stewardship is already well-established at your institution, consider these related high-impact alternatives:

• Development and implementation of audit and feedback systems using gamification to improve hand hygiene compliance, which directly reduces healthcare-associated infections 1.
• Implementation of infection control bundles for catheter-associated urinary tract infections with monthly performance feedback, addressing one of the four high-volume harms in hospitals 1.
• Evaluation of diagnostic stewardship interventions to optimize microbiological testing and reduce unnecessary antimicrobial use 1.