Collaborative strategies for improving clinical resource utilization: how pharmacists can make a difference.

BACKGROUND Ventilator-associated pneumonia (VAP) is associated with substantial health care costs that place a significant burden on scarce hospital resources. Preventative measures and appropriate management strategies can be effective in reducing the incidence of VAP and in improving VAPrelated resource utilization. OBJECTIVE To provide an overview of the economic costs associated with VAP and of strategies that can be used to meet the goals of improving the efficiency of resource utilization without negatively impacting clinical outcomes. SUMMARY The substantial costs attributed to VAP are mainly due to the prolonged hospital length of stay (LOS) associated with these patients. Initial appropriate antimicrobial therapy is critical in achieving successful outcomes-including reducing LOS, mechanical ventilation days, and mortality. Initial treatment includes combination therapy when a multidrug-resistant pathogen or Pseudomonas aeruginosa is suspected. Once microbiologic results are available, de-escalation of therapy should be considered to reduce the unnecessary use of antimicrobials without impacting clinical outcomes. VAP prevention programs can also be an effective means to improve resource utilization in hospitals, although it is important to adopt a multidisciplinary team approach for acceptance of such programs and adherence to them. CONCLUSION In the current health care environment of increased transparency and accountability, renewed efforts must be made to not only prevent VAP but also to appropriately manage patients with VAP. All health care personnel involved in the management of patients with VAP must take a proactive role in reducing its incidence.