Delayed antibiotic prescribing to reduce antibiotic use: an urgent care practice change

BACKGROUND: Antibiotic overuse threatens global health, food security and human development through the development of antibiotic resistance. Antibiotic resistance is associated with worse clinical outcomes and increased healthcare costs. Studies suggest urgent cares exceed the national average for inappropriate antibiotic use associated with maintaining patient satisfaction. LOCAL PROBLEM: Chart audits from an urgent care clinic in the southwest region of the USA revealed that antibiotics were prescribed for upper respiratory infections (URIs) routinely and without patient instruction on methods to reduce their antibiotic use. Further review, exposed that most urgent care sites do not have an Antibiotic Stewardship Plan (ASP) and little-to-no ASP training for medical staff. METHODS: A quantitative quality improvement project was implemented to determine the impact of delayed antibiotic prescribing on antibiotic usage rates for adult patients with URI symptoms at an urgent care clinic in central Arizona over 4 weeks. INTERVENTIONS: Implementing the Centers for Disease Control and Prevention’s URI adult treatment guidelines for antibiotic use with follow-up phone calls 10 days post-discharge to evaluate the patient’s decision-making. RESULTS: Antibiotic usage rates decreased by 12% in 30 days, N=927, n=598 in the comparative and n=330 in the implementation group. A Mann-Whitney U test demonstrated a statistically and clinically significant reduction in antibiotic usage rates between groups (U=247, p=0.023). CONCLUSION: Success in meeting the goal was a result of team and patient engagement strategies that reduced outpatient antibiotic use while maintaining high levels of patient satisfaction.