Improving antimicrobial stewardship in an Acute Medical Unit (AMU) during patient discharge following introduction of an antimicrobial information card

Abstract

Background: Patients who initially present to the emergency department are often streamlined to an Acute Medical Unit (AMU). A quality improvement project was developed to introduce a new "Antibiotic Information Card" for patients discharged home from the AMU. Aims were to reduce 30-day readmission and reattendance rates due to the same infection after initial discharge by 75%, as well as improving patient education regarding their antibiotic prescription to 75%.

Methods: Two Plan Do Study Act cycles were implemented in a busy AMU. Data were collected using electronic discharge software and patient records, as well as individual patient telephone questionnaires. Statistical analysis used run chart analysis.

Results: Baseline findings showed a variable level of patient knowledge on their antibiotic prescriptions (14%-70%) and fluctuations in 30-day reattendance rates (0%-50%). After the initial introduction of the Antibiotic Information Card, run chart analysis showed a shift in patient knowledge, significantly increasing to over 75%, and special cause variation which was not sustained.

Discussion: There were no significant changes in 30-day hospital reattendance and readmission rates throughout the intervention; however, there was a significant improvement in patient knowledge of their antibiotic prescription and management.

Conclusions: Staff engagement is encouraged for sustainability of quality improvement changes to promote antimicrobial stewardship within the AMU.

Keywords: Antibiotics; Hospital readmission; Hospital reattendance; Patient education; Quality improvement.