Delaware success stories

DE Success StoriesQuality improvement endeavors can often feel overwhelming, but chances are, you can learn from the experiences that another physician, hospital or nursing home has had in a similar situation. Coupled with support from Quality Insights Quality Innovation Network, learning what has worked for others — and what didn't — is a valuable strategic planning component. 

We encourage you to read the success stories, contact us for more information, and also let us know if you have a Quality Insights' success story to share.

Urgent Care Centers Target Antibiotic Stewardship

Dr. Harold Kramer is the lead physician for Christiana Care Health System’s five medical aid units in Wilmington, Delaware. When his team identified a need to improve antibiotic prescribing in urgent care settings, his supervisor suggested he seek Quality Insights’ assistance.
“We set out to improve and measure antibiotic use, to improve patient outcomes and minimize harm,” says Dr. Kramer. Specifically, the team wanted to implement antibiotic stewardship in their urgent care centers, reducing antibiotic utilization by 15 percent and reducing total azithromycin utilization by 15 percent.
Although the Christiana team had clear goals, determining baseline data proved to be a challenge. Due to a change with the system’s electronic medical record, no data was available prior to November 2016. The team performed manual chart audits in order to provide feedback, but the process proved labor intensive.  

“Patient perceptions and expectations of antibiotic use were initially a barrier,” explains Dr. Kramer. “Also, we identified a barrier of limited time for provider and patient conversations on appropriate antibiotic use.”
In early 2017, Dr. Kramer’s team began a multi-faceted educational approach with providers and patients focused on antibiotic utilization. Leadership within the center provided staff support when antibiotics were not indicated. Additionally, based on the manual chart audits, leadership delivered direct feedback to providers regarding their antibiotic prescribing activities.
Throughout this process, the Christiana team worked with Quality Insights Project Coordinator Jami Jones.
“Jami was not only a knowledgeable resource, but soon became a friend,” says Dr. Kramer. “We frequently communicated. She kept us on track and provided feedback on how we were doing. No efforts were wasted as Jami had a clear vision and defined goals to reach.”

So far, results have been promising. Christiana’s analysis from January 2017 until December 2018, showed a 34 percent decrease in antibiotic utilization and a 73 percent decrease for azithromycin utilization.

Moving forward, Christiana’s team will continue to monitor antibiotic utilization data, expand antibiotic stewardship efforts to primary care practices, develop specific guidelines for common respiratory infections and create an electronic medical record pathway to foster appropriate antibiotic utilization.

Dr. Kramer credits teamwork and collaboration as two key ingredients for Christiana’s success.
“Quality Insights’ support was vital from the start and played a key role to guide us along this journey,” says Dr. Kramer.