Safety/Quality of Care

Physician champions key to successful quality improvement projects

Patients suffering from acute respiratory tract infections (ARIs) often expect their doctors to prescribe antibiotics, even though these drugs are ineffective in combating the viruses that typically cause these infections. The Improving Antibiotic Use in Acute Care Treatment (IMPAACT) study aimed to reduce inappropriate antibiotic prescribing in emergency departments. A followup study finds that enthusiastic physician champions play a key role in changing fellow physicians' behaviors like antibiotic prescribing.

After conducting focus groups and interviews with hospital staff who participated in the IMPAACT study, Ralph Gonzales, M.D., M.S.P.H., of the University of California, San Francisco, and coinvestigators pinpointed three recurring elements that led to a site's success or failure in appropriate antibiotic prescribing for ARIs: a physician champion, a previous history of implementing quality improvement initiatives, and an institution's attitude toward patient satisfaction. By far, the presence of an effective physician champion who trained and served as a consultant to other staff members caused the greatest reduction in prescriptions for unnecessary antibiotics. Institutions that want to change physician behaviors should search their ranks to find a passionate physician champion to build support for the quality improvement intervention, the authors suggest.

Previous history with bottom-up or top-down quality improvement initiatives did not readily ensure a hospital's success in the IMPAACT study. Additionally, although the authors first believed that hospitals placing a high value on patient satisfaction would have lower rates of success because staff would be reluctant to deny patients' demands for antibiotics, the reverse proved to be true. The authors suggest that those hospitals may have forestalled this problem by addressing tactics to counter it during staff training sessions. This study was funded in part by the Agency for Healthcare Research and Quality (HS13915).

See "Physician champions are key to improving antibiotic prescribing quality," by Eva M. Aagaard, M.D., Dr. Gonzales, Carlos A. Camargo, Jr., M.D., Dr.P.H., and others in the March 2010 The Joint Commission Journal on Quality and Patient Safety 36(3), pp. 109-116.

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