Beyond the eConsult platform: an implementation science perspective on tele-antimicrobial stewardship

Abstract

We read with great interest the study by Itoh et al evaluating an electronic consultation (eConsult)-based tele-antimicrobial stew-ardship program using the ExpertTWIN system. 1 The reduction in carbapenem use they report is encouraging. Consistent with the authors ’ description of an integrated program, we suggest interpreting these findings primarily as support for a model that incorporates remote infectious diseases expertise into an existing stewardship workflow. The study does not isolate the contribution of the platform itself. The intervention evaluatedin this study was not the ExpertTWIN platform alone. Pharmacists identified patients receiving prolonged carbapenem therapy, off-site infectious diseases specialists reviewed individual cases and generated recommendations, the local antimicrobial stewardship team then vetted those recommendations, and pharmacists communicated them to treating physicians. 1 ExpertTWIN provided the infrastructure through which this process occurred. The observed reduction therefore reflects this combined process rather than the platform in isolation. From an implementation science perspective, the platform ’ s contribution should be considered alongside specialist review, local case selection, and feedback delivery, consistent with implementation guidance emphasizing the integration of remote infectious diseases support with local personnel and organizational processes. 2