Spread and Sustainability of an Antimicrobial Stewardship Initiative Within a Pediatric Network

BACKGROUND Projects employing performance feedback with education have been used to improve antimicrobial prescribing practices, but improvements may not be sustainable after the active intervention. We sought to determine whether ongoing clinical decision support (CDS) could sustain improvements achieved through initial feedback and education in prescribing shorter durations of treatment for skin and soft tissue infections (SSTI). METHODS As a follow-up to a site-randomized trial, we provided performance feedback and education for 3 months along with an ongoing CDS alert operating at the point of care within a large statewide cohort of pediatricians. Following the initial period of feedback and education, we continued to deploy the alert and monitored outcomes over a 24-month period. RESULTS The proportion of skin and soft tissue infection cases treated for 7 days or fewer rose from 62.5% (3299/5275) to 88.5% (14 740/16 662), with an immediate change in the level of performance at the outset of the intervention (P < .001). After the 3-month active phase of feedback and education ceased, there was no degradation in the effect over the ensuing 21-month period (slope +0.2% per month). CONCLUSION In this follow-up to a site-randomized trial that encouraged shorter duration of antibiotic treatment for SSTI in children, the use of initial feedback with education accompanied by an ongoing alert operating at the point of care resulted in long-term maintenance of improvements over 24 months. This approach provides a framework strategy for achieving and maintaining gains that could be applied to other improvement projects.