Bringing Antibiotic Stewardship to Hospital Outpatient Sites

May 2, 2018

The United Hospital Fund (UHF) grant initiative on outpatient antibiotic stewardship, which engages 35 outpatient clinics from seven hospital and health systems, has been actively working to improve antibiotic prescribing for the past two years. Participants are building on interventions and lessons learned from the first phase of the UHF initiative to address the misuse and overuse of antibiotics for acute respiratory infections.

The hospital outpatient teams focused on the following: electronic health record (EHR) tools and modifications, patient education, provider education, and provider feedback. While most teams have developed interventions to address each key area, their efforts have been tailored to the outpatient site based on the teams’ knowledge of staffing, workflow, and resources.

UHF hosted two in-person meetings; the first to highlight early planning for implementing interventions and reviewing the core elements of antibiotic stewardship, including a framework developed by the Centers for Disease Control and Prevention (CDC) to promote successful antibiotic stewardship. Dr. Katherine Fleming-Dutra, a medical epidemiologist with the Office of Antibiotic Stewardship at the CDC, discussed the core elements and provided examples of evidence-based interventions for each.

The second meeting highlighted troubleshooting specific challenges and included developing and disseminating provider feedback reports and creating modifications to EHRs. Dr. Rita Mangione-Smith, division chief of general pediatrics and hospital medicine at the University of Washington and the director of the quality of care research fellowship at the Seattle Children’s Hospital, discussed via webinar a four-part communication strategy for clinicians to use when discussing antibiotic prescribing with patients with acute respiratory infections.

Next Steps

Hospital outpatient teams will begin collecting post-intervention data on prescribing practices, which UHF will use to compare to data from the initiative’s initial stage to track progress. UHF will also engage teams on how best to sustain their antibiotic stewardship efforts. A final meeting will be planned for early June, and a report on the findings will be produced along with a tool kit that can be broadly disseminated.