Antibiotic Stewardship for Acute Respiratory Infections: The Milstein Toolkit for Ambulatory Care Practices

In late 2018, UHF completed the second stage of a grant initiative to promote outpatient antibiotic stewardship, focusing on adult patients with acute respiratory infections. While many organizations have concentrated on the overuse and misuse of antibiotics in the inpatient setting, attention to antibiotic stewardship in the outpatient setting has been very limited—even in those organizations with robust inpatient programs. Working with over 30 hospital-owned outpatient practices, UHF helped develop assessment tools and interventions to decrease inappropriate antibiotic prescribing. Our aggregate findings demonstrated a statistically significant decline in antibiotic prescribing based on our pre- and post-intervention data. (Read the related press release.)

UHF is pleased to share Antibiotic Stewardship for Acute Respiratory Infections—The Milstein Toolkit for Ambulatory Care Practices. Howard P. Milstein provided support for the toolkit, which contains the data collection tools and surveys that were used to establish baseline information on antibiotic prescribing practices, factors influencing provider prescribing, and existing stewardship activities. It also features a patient survey, translated into six languages, that can be used to assess patient knowledge of antibiotic resistance and proper antibiotic use. Also included in the toolkit are helpful hints for using the various assessment tools.

In addition, the toolkit contains an overview of the interventions developed and implemented by the practices, lessons learned, and other available resources for organizations to use as they begin to develop outpatient antibiotic stewardship programs. 

The full report, with appendices and all tools in English, may be downloaded as a pdf from the box to the right. The following tools and templates may also be downloaded as pdfs: an Assessment of Antibiotic Stewardship Practices; a Provider Survey; a Chart Abstraction Tool; Data Report Templates; and Patient Surveys in English, Bengali, French Creole, Korean, Mandarin, Russian, and Spanish. Note that the patient surveys also include an answer key in the same language.

Additional links: 

For further information, please contact Joan Guzik.

Note: The strategies, recommendations, and tools included in this publication are intended to provide a basic framework for improving outpatient antibiotic prescribing practices that can be customized to meet the needs of individual practices regardless of size, academic teaching status, staffing model, patient population, or available resources. United Hospital Fund makes no representations or warranties of any kind regarding the toolkit, including, without limitation, as to the accuracy of the information provided. The information provided is not medical or legal advice and should not be relied upon as such, nor should the information be used as a substitute for clinical or legal judgment. UHF does not assume liability for any damage or injury from the use or misuse of any information provided herein. We ask that you please acknowledge United Hospital Fund in the use of this resource, even if you modify or adapt it. Any use, modification, or adaptation of this resource is done at the user’s discretion and the user assumes responsibility for the outcome. 

Funds for this toolkit were provided consistent with multidrug resistant research activities of the Milstein Programs in chemical biology and medicinal chemistry directed by Dr. Carl Nathan at Weill Cornell Medical College.