St. Joseph’s Healthcare Hamilton



Antibiotic Stewardship Program: Improving Patient Care by Optimizing Antimicrobial Usage 


Project Lead: Dr. Philippe El-Helou

Other Team Members: Dr. Tammy Packer, Jennifer Lee, Carmine Nieuwstra


A targeted approach to ensuring appropriate and timely cessation and/or reduction in antibiotic usage. A pilot target population of General Internal Medicine (teaching unit) patients will receive 3 day antibiotic reviews with recommendations pertaining to optimizing treatment with antimicrobials. This approach will be audited and metrics of DDD (defined daily dosage) as well as day 3 decision/interventions will be tracked. The approach will be refined and subsequently rolled out to additional high gain areas.



Promoting Appropriate In-Hospital Laboratory Test Utilization


Project Lead: Dr. Tony Chetty and Dr. Tammy Packer

Other Team Members: David Langstaff, John Neary, Mark Crowther, Denise Legeard, Alistair Ingram, Jenny Legassie


Three areas of perceived excess testing have been identified, and strategies implemented, to address more appropriate in-hospital lab usage at St. Joseph’s Healthcare of Hamilton. The identified areas of excess testing are the follow:

  • Removal of bicarbonate from routine electrolytes order; the test will still be available but has to be ordered separately (St. Joe’s will be assessing pre and post ordering metrics after 6 months)
  • Removal of fecal occult blood tests (FOBT) from the Emergency Departments (ED) as a Point of Care (POC) test; It will be provided and processed in labs only (utilization monitoring has yet to occur)
  • High-sensitivity C-reactive protein (Hs CRP) is being promoted as a more accurate and timely test than erythrocyte sedimentation rate (ESR) for Inflammatory disorders. It is automated, faster turn around time and less susceptible to pre-analytical factors. ESR testing will still be available for those with appropriate pre-test conditions

Baseline data has been collected and analyzed, and St. Joe’s is currently analyzing 3 months of data for ordering patterns of CBC and TSH in the general medical and surgical wards. Feedback will be provided to “outlier” physicians. We are looking specifically at variations in ordering practices, ensuring clinicians at St. Joe’s are aware of their level of ordering.