Intermountain implemented a large-scale antibiotic stewardship initiative across our 38 urgent care clinics in June 2019. The goal: reduce the number of antibiotics given for acute respiratory illnesses, which is among the most common illnesses diagnosed in the urgent care setting.
At the time, more than 50 percent of patients with a respiratory illness were given an antibiotic, even though antibiotics often weren’t warranted. This was troubling since overprescribing antibiotics can lead to growing resistance to these important drugs, with sometimes severe side-effects to patients.
As of July 2020, Intermountain urgent care clinics are now prescribing antibiotics to only 29 percent of patients with respiratory complaints — a 42 percent reduction. More than 32,000 unnecessary antibiotic prescriptions weren’t written in the last year, resulting in more than 225,000 days of antibiotic therapy avoided.
“Our urgent care clinics have done an amazing job incorporating antibiotic stewardship best practices into their workflow, leading to these quite frankly stunning results,” says Eddie Stenehjem, MD, Intermountain’s medical director of antibiotic stewardship.
It’s one of the largest reductions in antibiotic prescribing ever seen in an antibiotic stewardship program anywhere, he adds.
“Because of the hard work of our urgent care teams, our community will be safer and ultimately healthier,” says Dr. Stenehjem. “This is a win all around.”
Antibiotic stewardship posters like this one are on display in Intermountain InstaCares
Intermountain’s Stewardship in Community Outpatient Settings - Resource and Engagement - Urgent Care (SCORE-UC) initiative, funded partially by the Centers for Disease Control and Prevention, focused on urgent care clinics first because of the increased role these healthcare settings are playing in treating sick Americans.
Nationally, between 2008 and 2015, visits for low-acuity events jumped 140 percent in these treatment settings, while ED visits dropped by 36 percent in the same time period. At the same time, urgent care centers were prescribing antibiotics 45 percent of the time for low-acuity encounters where antibiotics are not warranted, much more than in medical offices (17 percent) or retail clinics (14 percent).
Urgent care facilities are also on the front lines of care, treating patients who don’t think they need to go to the ED but don’t want to wait for an appointment with a general practitioner —a demand that has only increased during the COVID-19 pandemic.
In a previous study, Dr. Stenehjem and colleagues found significant variability in antibiotic prescribing for respiratory encounters at both the clinic and clinician level. The variability at the clinician level was most severe with antibiotic prescribing rates ranging from 10 percent to 90 percent.
Prescribing antibiotics aren’t without consequences. In addition to speeding up community resistance to these drugs, antibiotics can also cause severe gastrointestinal issues, allergic reactions, and make patients sicker than what they came into the doctor’s office for.
The SCORE-UC initiative got those urgent care prescription rates down through multiple channels.
First, the team educated clinicians about updated guidelines for respiratory conditions to make sure all staff were up to date with current data on dosage and formulary options. This education heavily emphasized delayed prescriptions and focused on the reasoning behind those kinds of decisions.
The team also taught the patients using a new, over-the-counter symptomatic checklist. It’s a document reviewed by both the clinician and patient together to create a personalized prescription for over-the-counter remedies. Dr. Stenehjem says this has been crucial to the initiative’s success because it showed patients their concerns had been heard and a treatment tailor-made for them.
Second, Intermountain worked with media partners to share information about smart antibiotic use through social media, physical banners and posters, and traditional media interviews and press.
“We wanted patients to hear about our dedication to antibiotic stewardship before they saw the clinician,” says Dr. Stenehjem.
Third, transparent, antibiotic prescribing clinician dashboards were developed to allow clinicians to see how their prescribing practices compared to their peers across the network. Lastly, in collaboration with CTIS, electronic tools were developed to allow for delayed antibiotic prescribing and improve the prescribing experience.
“Our frontline urgent care clinicians have been through a lot this year,” says Anthony Wallin, MD, Intermountain’s medical director of urgent care. “A major practice change with antibiotic stewardship and now being on the frontlines of the COVID pandemic. We all owe them a debt of gratitude and thanks for the work they’ve done to improve our patient’s safety and the health of the community.”