552. Communication Structures and Clinical Sustainability in Pediatric Antimicrobial Stewardship Teams
Authors: Malone Sara , Newland Jason , Carothers Bobbi , Luke Douglas 
Published: December 2022

Abstract

Background
In order to have impact, ASP programs must be able to sustain evidence-based practices that they implement. Understanding communication networks, an aspect of organizational structure, can shape our understanding of how these teams function. The objective of this study was to construct communication networks and evaluate how they influence the sustainability of ASP work in surgical prescribing.

Methods
A network study of communication patterns and sustainability capacity was conducted. Data were collected through two surveys: the Clinical Sustainability Assessment Tool (CSAT) and a network survey. The CSAT consists of 7 domains with a scale of 1 to 7 where a higher score indicates greater capacity for sustainability. The ASP and surgeon champions at 9 pediatric hospitals assessed their surgical prescribing sustainability capacity. All members of the ASPs and surgical teams were recruited to complete the network survey which helped measure how individuals are connected (density), how hierarchical the networks are (betweenness centralization), and which clinicians were the targets of information seeking (prestige). The network characteristics of the 9 programs were correlated to CSAT scores.

Results
342 participants (38% response rate) completed the network survey. The overall contact networks have moderate connections between clinicians. The sites have different prominence of ASPs (Figure 1). Individuals from surgical teams had a higher prestige, meaning they were more often targets of information seeking when compared to the ASP team. The hospital CSAT scores range from 4.55 to 5.49. There is a moderate positive relationship between the density (instances of contact) of the networks and the CSAT score (0.35) (Figure 2). Betweenness centralization, representing hierarchy in communication, varies across the nine sites (range .10-.23). There is a moderate, negative correlation across all networks betweenness centralization and CSAT score (Figure 3). Figure 1Network analysis of three sites with high density, representing high numbers of connections between team members.
Figure 2 Association of total CSAT score to contact density network for each site.
Figure 3 Relationship illustrating hierarchy (betweenness centralization) for information seeking and overall CSAT score, suggesting more hierarchy results in less capacity to sustain an evidence based practice.

Conclusion
This study found that communication networks vary based on the site. ASPs have different levels of prestige across hospitals. This study suggests that there is a relationship between the network connections and the communication hierarchy in a hospital and the capacity to sustain evidence-based practices.

Disclosures
Sara Malone, PhD, LCSW, AHRQ: Grant/Research Support|NIH: Grant/Research Support Jason Newland, MD, AHRQ: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|PEW Charitable Trust: Grant/Research Support|Pfizer: Grant/Research Support.