The MITIGATE (A Multifaceted Intervention to Improve Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Department and Urgent Care Settings) toolkit is intended as a "gold standard," step by step implementation guide for healthcare providers and administrators interested in designing quality improvement programs in antimicrobial stewardship in emergency department (ED) and urgent care healthcare settings. When implemented as written, the toolkit will fulfill the CDC Core Elements of Outpatient Antibiotic Stewardship.

The MITIGATE Tool Kit is a systematically adapted antibiotic stewardship program developed for use in emergency department and urgent care settings in collaboration with physicians, administrators, nurses, and patients. MITIGATE also includes specific strategies for pediatric settings. The recommendations in this toolkit were based on a multicenter randomized comparative effectiveness trial in emergency department and urgent care settings using an implementation science approach to adapt existing evidence on behavioral economics approaches in outpatient settings and materials to the ED and urgent care setting, and was developed as requested by focus groups of those working in episodic acute care settings. The authors include experts in emergency medicine, pediatric emergency medicine, antibiotic stewardship, implementation science, and behavioral economics.

Effective stewardship strategies need to be adapted to ED and urgent care settings in order to be feasible. Providers in these settings are faced with unique challenges to rational decision making such as frequent interruptions, high-volume care, a need for rapid decisions with limited information, variation in staff over different shifts, and concerns with immediate patient satisfaction. This tool kit's implementation strategies are built on research into how to create effective programs amid these challenges.

The authors recognize the full implementation guide may not be immediately feasible for all sites and settings. Facilities may choose to implement portions of the toolkit incrementally based on resources and capabilities.

For questions or comments pertaining to this toolkit, please contact Dr. Larissa May.

View PDF