How Houston Methodist Reduced Mortality and Improved Time to Therapy

For the infectious diseases pharmacy team at Houston Methodist, having enough patient data wasn’t the problem. It was how long it took for that information to reach the right person.

Vital results from the microbiology lab – such as blood cultures, susceptibilities, and pathogen flags – were flowing into the electronic health record (EHR) with increasing speed and accuracy. But in many cases, there was a delay between when that information became available and when someone reviewed it and acted.

“That’s the gap we wanted to close,” said William Musick, Clinical Specialist in Infectious Diseases.

As part of a nationally ranked health system with eight hospitals across Greater Houston, the team operates in a high-volume, high-acuity environment where timing matters. Yet therapy decisions often followed a traditional schedule. Providers might check charts in the morning and again later in the day, but unless someone was actively watching for new data, even meaningful updates could sit unnoticed. Some results, like blood cultures positive for bacteria, were flagged and called in. But other opportunities, such as escalation or de-escalation of therapy, might wait 12 to 24 hours.

“Timely adjustments to antimicrobial therapy are associated with better outcomes for patients with serious infections,” Musick explained. Delays didn’t just slow the process, they made it harder to ensure care stayed aligned with the most up-to-date clinical information.

To address this challenge, Musick’s team piloted a manual process where the microbiology lab relayed key information to pharmacists, who assessed cases and notified the care team as needed. It worked but wasn’t scalable. “We had to find a way to take the data that was so important and get it to the person who needed to review it in near real time,” said Musick.

Building the infrastructure for a faster response

As the team looked for ways to make their pilot sustainable, they needed a system that could reliably surface new microbiology results and deliver them to the right clinician without adding manual steps. The goal was simple: turn EHR data into timely, actionable information.

This initiative required increased rules logic, greater flexibility, and a faster way to route alerts. Houston Methodist’s pharmacy implemented a surveillance solution to create and manage clinical rules that and continuously monitor lab data across the system. When new microbiology results or susceptibility updates met predefined criteria, alerts were automatically generated and delivered to the pharmacists responsible for reviewing them, eliminating the delays that came from waiting on lab callbacks or periodic chart checks.

“We’ve used the rules capabilities in two different EHRs over the years,” Musick said. “It had to be platform-agnostic to get information where it needed to be so we could review it in near real-time.”

Equally important, the system worked with their actual workflows. Rather than tethering staff to a screen, it lets them receive alerts by email, text, or pager so the care team could respond quickly wherever they were.

“The alerting capabilities allow us to do what we need to do and still get the necessary information we need,” Musick said.

By supporting mobility and multitasking, the system helped  the team ensure that new clinical insights reached pharmacists quickly – enabling timely, well-informed interventions across the organization.

Systemwide impact beyond the flagship hospital

Once the alerts were fully configured and implemented, the average time to optimal antibiotic therapy for bloodstream infections dropped from 81 hours to 23. Outcomes for patients with gram-negative bloodstream infections also improved, with mortality decreasing from 21% to 8.9%.

In addition, several hospitals in the system saw reductions in length of stay and overall cost of care for patients with bacterial infections.

And the program didn’t just work in one hospital – it worked across eight, with community hospitals seeing similar improvements. “We’ve demonstrated that these impacts exist not only in a 1,000-bed tertiary referral teaching hospital, but in a 400-bed community hospital,” Musick noted.

Behind those numbers was a shift in team dynamics. Infectious disease providers came to view alerts not as automated notifications, but as a signal that a pharmacist had actively reviewed new information and was prepared to collaborate on therapy decisions.

“It means someone who knows what they are doing is receiving that information in an active fashion,” Musick said. “We know what to do with it and can partner with them on the solution to the problem.”

Empowering pharmacy teams to adapt and lead

As the program scaled, its flexibility became a key factor in its success. Every hospital in the system had its own staffing model and processes. Instead of requiring a single approach on all of them, the surveillance software allowed each site to tailor its workflow to fit their specific local needs.

“The solution’s flexibility has allowed the workflow to adapt to the individual hospital, as opposed to forcing the hospital to adapt to a workflow,” Musick said.

That adaptability extended to the pharmacists themselves. With some training, pharmacists could build or refine clinical rules, adjust thresholds, and extract data for stewardship initiatives or quality improvement work without relying heavily on IT or analytics teams.

“If a question comes up like how many cases we’ve had with infection ‘x’ and patient type ‘y’ over the last year, I can get that information all by myself in a couple of hours and then quickly have it aggregated to discuss with the interested parties,” Musick explained.

Even with a large-scale operation, that kind of responsiveness – both technical and human – has helped fuel success. The system’s adaptability has supported not just faster interventions, but a more engaged and empowered care team.

Recognition for a life-saving program, and a look at what’s next

The impact of Houston Methodist’s blood culture surveillance program hasn’t gone unnoticed and in 2025 the pharmacy team was recognized for its sustained improvements in workflow efficiency and patient outcomes across the organization. For Musick, the acknowledgment reflects not only the success of the program but also the collaborative culture that made it possible.

“I’m proud to work for an organization that values the pharmacy department and the role pharmacists can play in healthcare and in infectious diseases,” he said.

The work is still evolving. Today, Musick is applying the same rules-based thinking to a new frontier: clinical research. As he shifts more of his time toward trials and protocol oversight, he sees untapped potential for near real-time alerting to improve patient identification.

He envisions a future where alerts don’t just surface infection risks but also match patients who may qualify for active research studies the moment they arrive. “I can definitely see the similar alerting and rules-based criteria letting us know about, ‘Hey, somebody just came into the ED that’s actually a pretty good fit for this protocol you have open,’” he said.

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