Improving Antimicrobial Stewardship in Urgent Care: A Quality Improvement Initiative Using an Evidence-Based Protocol and Provider Education

Introduction: Antibiotic overprescription in ambulatory care is a major patient safety and quality concern, particularly for upper respiratory tract infections. This project aimed to implement an evidence-based protocol for managing acute bronchitis and acute sinusitis in adults at Provo Revere Health Urgent Care. Methods: This quality improvement initiative used a mixed-methods design guided by the COM-B framework and Plan-Do-Study-Act cycles. Baseline data on antibiotic prescribing rates and patient satisfaction were collected from December 2024 to February 2025. An evidence-based protocol aligned with national guidelines was implemented alongside provider education. Post-intervention data were collected from December 2025 to February 2026. Outcomes included antibiotic prescribing rates and provider-reported capability, opportunity, and motivation. Process measures included provider participation. Patient satisfaction served as the balancing measure. Results: A total of 305 baseline and 318 post-intervention encounters met inclusion criteria. Antibiotic prescribing for acute bronchitis decreased significantly from 81% to 44% (p = .001). Prescribing for acute sinusitis decreased from 62% to 58% but was not statistically significant (p = .471). Provider surveys demonstrated increased motivation to follow evidence-based practices, with minimal changes in capability and opportunity. Patient satisfaction remained stable. Discussion: Implementation of an evidence-based protocol was associated with a significant reduction in antibiotic prescribing for acute bronchitis, minimal change for acute sinusitis, and no negative impact on patient satisfaction. Findings support the feasibility of protocol-driven antimicrobial stewardship in urgent care settings. Further study is needed to evaluate long-term sustainability and broader impact.