Audit and Feedback: A Quality Improvement Study to Improve Antimicrobial Stewardship

Many antibiotics prescribed in an outpatient setting may be inappropriate, and by some estimates, half of the antibiotic prescriptions for acute bronchitis may be inappropriate. This quality improvement study aimed to decrease the rate of potentially inappropriate (not guideline concordant) antibiotic prescribing in acute bronchitis.

This program used an audit and feedback approach. Clinicians received education coupled with audit and feedback, which are components of the Centers of Disease Control and Prevention framework for an effective antimicrobial stewardship program. Antibiotic prescribing rates in patients with acute bronchitis without underlying chronic lung disease or evidence of bacterial infection were compared over two 9-month periods. The baseline period was October 1, 2017 to June 30, 2018 and the posteducation period was October 1, 2018 to June 30, 2019.

Potentially inappropriate antibiotic prescribing dropped from 75% (160/213) at baseline to 60% (107/177) posteducation (95% CI 0.05, 0.24; P < .01, 2-sample binomial test). Rates were lower for 7 health care providers (HCPs), unchanged for 1 HCP, and slightly increased for 1 HCP between study periods (P = .02, Wilcoxon signed rank test for paired data).

Study findings show a decline in potentially inappropriate antibiotic prescribing and a resulting improvement in clinic antimicrobial stewardship efforts.