Antimicrobial Stewardship Across Three Brisbane Hospitals
Antimicrobial resistance is a growing threat to safe, effective healthcare. When bacteria, viruses, fungi, or parasites no longer respond reliably to medicines, routine infections can become harder to treat, hospital stays may lengthen, and patients may face more complex recovery pathways. Hospitals therefore have a central role in protecting the effectiveness of antibiotics and other antimicrobial medicines.
A coordinated program across Brisbane hospitals can turn responsible prescribing into a shared clinical practice rather than an isolated activity. It brings infectious diseases specialists, pharmacists, microbiologists, nurses, medical teams, researchers, patients, and health service leaders into the same quality improvement effort.
For Brisbane Diamantina Health Partners, this work reflects the value of health translation: research evidence is adapted to local services, tested in practice, measured carefully, and refined with the people who deliver and receive care.
Why Resistance Requires A Network
Antibiotic use varies between wards, hospitals, specialties, and patient groups. Emergency departments may need to treat severe infection before test results are available, while intensive care teams manage patients with multiple risks and previous exposure to broad-spectrum drugs. Surgical services also depend on timely prophylaxis, but unnecessary continuation after an operation can increase selection pressure.
A three-hospital network can identify these patterns collectively. Shared surveillance reveals whether a rise in resistant organisms is localised or connected to patient transfers, referral pathways, prescribing habits, or community transmission. It also allows each hospital to contribute its strengths while working toward common standards.
The program should address antimicrobial use alongside infection prevention, diagnostic stewardship, vaccination, environmental cleaning, and communication at discharge. Psychological support can matter for patients recovering from serious infections or prolonged admissions, and models described in trauma recovery care provide useful context for embedding emotional wellbeing into complex hospital pathways.
Designing One Program Across Three Hospitals
The program needs a clear governance structure with executive sponsorship, a clinical steering group, and local antimicrobial stewardship teams. Each hospital can appoint a physician lead, an infectious diseases or microbiology representative, a pharmacist, a nurse champion, an infection prevention professional, and a data or quality specialist.
A common framework should set expectations for prescribing, review, documentation, escalation, and education. Local adaptation remains essential because hospitals differ in bed capacity, patient demographics, referral patterns, available diagnostics, and specialist services. The goal is consistency in principles, not identical workflows.
Core policies should include an indication for every antimicrobial order, dose adjustment for kidney or liver function, allergy verification, specimen collection before treatment where clinically safe, and a scheduled review at 48 to 72 hours. At that point, the team can stop, narrow, switch to oral therapy, or continue treatment with a documented rationale.
Turning Data Into Safer Prescribing
Measurement gives clinicians a practical way to see whether stewardship is improving care. Useful indicators include antimicrobial consumption, days of therapy per 1,000 occupied bed-days, use of restricted agents, time to effective treatment for sepsis, guideline concordance, and the proportion of prescriptions reviewed within the expected timeframe.
Outcome measures should sit beside process measures. The network can monitor rates of resistant infections, Clostridioides difficile infection, readmissions, length of stay, adverse drug reactions, and mortality for relevant conditions. Data should be stratified by ward and clinical service so that teams can distinguish a system problem from a specific workflow issue.
| Program element | Shared network approach | Local hospital responsibility |
|---|---|---|
| Prescribing guidelines | Common evidence-based standards | Adaptation to formulary and patient mix |
| Review process | 48–72-hour antimicrobial timeout | Ward-based prompts and escalation |
| Surveillance | Standard definitions and reporting | Accurate, timely data capture |
| Education | Shared learning resources | Bedside coaching and orientation |
| Evaluation | Network-level outcomes | Action plans for local gaps |
Dashboards should be designed for action rather than surveillance alone. A surgical unit might need feedback on prophylaxis duration, while an emergency department may benefit from rapid diagnostic access or decision support for suspected urinary and respiratory infections.
Supporting Clinicians, Patients, And Carers
Prescribers are more likely to change practice when stewardship advice is timely, respectful, and relevant to the clinical decision in front of them. Pharmacist-led review, peer comparison, case-based teaching, and brief feedback can be more effective than occasional mandatory lectures. Senior clinicians should model appropriate prescribing and explain decisions during ward rounds.
Patients and carers also need clear information. An antibiotic may be unnecessary when an illness is viral, or a shorter course may be safer when evidence supports it. Communication should explain expected recovery, warning signs, when to seek review, and why saving antibiotics for a confirmed or strongly suspected bacterial infection protects the wider community.
Discharge documentation is particularly important. It should state the diagnosis, medicine, dose, intended duration, changes made during admission, and follow-up requirements. Community pharmacists, general practitioners, residential aged-care providers, and families need enough information to prevent duplication, premature continuation, or accidental interruption.
Using Innovation To Improve Practice
Technology can make good stewardship easier at the moment of prescribing. Electronic order sets may prompt indication selection, allergy checks, renal dose review, and stop dates. Laboratory systems can deliver susceptibility results directly to treating teams, while clinical decision support can recommend narrower agents when cultures identify a pathogen.
Innovation should be co-designed with the people who use it. The experience of a clinician moving between wards differs from that of a pharmacist reviewing hundreds of orders, and both differ from the needs of a patient managing medicines at home. A clinical innovation hub approach can help engineers, doctors, nurses, and patients test practical solutions before wider implementation.
Research partners can evaluate whether an intervention changes prescribing without delaying urgent treatment or increasing workload. Pilot projects might include rapid molecular diagnostics, electronic antimicrobial timeouts, automated feedback, or virtual infectious diseases consultation between hospitals. Successful tools can then be translated across the network with documented training and support.
Priorities For Sustained Impact
A stewardship program should be treated as a long-term clinical improvement strategy, not a short campaign. The following priorities can help maintain momentum:
- Establish shared antimicrobial guidelines with scheduled review against local resistance data.
- Fund dedicated pharmacist, infectious diseases, microbiology, nursing, data, and implementation expertise.
- Build antimicrobial review prompts into electronic prescribing and handover systems.
- Report meaningful results to ward teams, executives, researchers, patients, and community partners.
- Recognise improvement work through education, professional development, and clinical leadership pathways.
The network should also make equity a measured outcome. People in rural and remote areas, Aboriginal and Torres Strait Islander communities, older adults, children, and patients with disability may encounter different barriers to diagnosis, follow-up, or medicine management. Culturally safe communication and accessible services strengthen both antimicrobial safety and broader health outcomes.
Evaluation should combine numbers with experience. Interviews, focus groups, prescribing audits, and patient feedback can explain why a guideline is difficult to follow or why a digital prompt is being bypassed. This learning allows Brisbane hospitals to improve the program without placing responsibility solely on individual clinicians.
Antimicrobial resistance cannot be solved by a single specialty or hospital. A connected Brisbane partnership can protect patients today while preserving effective treatment for future generations. Health services, universities, research institutes, clinicians, and communities can begin by aligning their data, testing practical interventions, and making every antimicrobial decision deliberate, documented, and evidence-informed.
