1. Antibiotic Stewardship of Acute Respiratory Infections in the Emergency Department Acute respiratory infections are a common conditions encountered in the Emergency Department (ED) Viruses cause the vast majority of cases, rendering antibiotics unnecessary and possibly harmful in the treatment of acute bronchitis Patients using antibiotics are at risk for yeast infections, allergic reactions, and diarrhea as well as C. difficile colitis Furthermore, inappropriate antibiotic use can contribute to antibiotic resistance Our primary aim was to evaluate the efficacy of a quality improvement initiative to decrease the rate of inappropriate antibiotic prescription in patients with acute respiratory infections Background Results Limitations Conclusions Our study was limited to a single center in an urban, tertiary care ED Rates of antibiotic prescription in the pre-intervention group were already lower than published rates in literature The individual impact of the patient education materials were unable to be analyzed separately Prescriber feedback was limited to a select group of physicians for the two-tailed, paired t-test and those that were not present in both intervention periods were excluded, which may underestimate the effect of the intervention 2276 patients were included in the study, with 1040 (46%) in the pre-intervention group and 1236 (54%) in the post-intervention group 226 (22%) patients were prescribed antibiotics in the pre-intervention groups compared to 167 (14%) in the post-intervention group There was a significant difference between the rates of prescription between pre and post-intervention groups (X 2 (1)=26.7, p<0.0001) Antibiotics were almost twice as likely to be prescribed before intervention compared to after intervention (OR 1.8, 95%CI [1.4 – 2.2]) A two-tailed, paired t-test revealed a significant reduction in the rate of antibiotic prescription (t(35)=2.28, p=0.03) with a 5.3% reduction in prescription rates after intervention (95%CI [0.7%–9.9%]) This relatively simple intervention may help decrease inappropriate antibiotic prescriptions for acute respiratory infections in the ED Interventions such as patient education and personalized prescriber feedback can be effective, low cost strategies to implement Using these types of interventions may help lead to fewer antibiotic-related side effects and antibiotic resistance Christie Sun MD 1 ; Michael Nitzberg MD 1 ; Daniel Herzberg MD 1 ; Rahul Bhat MD 1,2 Disclosures 1 Georgetown University Hospital/Washington Hospital Center Emergency Medicine Residency; 2 Georgetown University School of Medicine Methods Prospective observational study of patients with acute respiratory infections in an urban, tertiary care, academic ED from November 2013 to February 2014 (pre-intervention period) and November 2014 to February 2015 (post- intervention period) Antibiotic prescription rates during the defined time periods was collected for adults with a diagnosis of cough, upper respiratory illness, acute bronchitis, or common cold Interventions included educational materials for patients about antibiotic side-effects as well as monthly reminder emails, including personalized physician feedback about prescribing habits Patients with another diagnosis warranting antibiotics as determined by investigator consensus were considered appropriate The rate of reduction after intervention was calculated and analyzed with a chi-square test. A two-tailed, paired t-test and an odds ratio were calculated between the two groups Patient Educational Poster Discussion The majority of acute respiratory infections are self- limited conditions Due to the potential for harm from antibiotics, guidelines from various organizations have issued a call to limit the number of prescriptions for these conditions Multiple strategies have been developed to decrease the rates of antibiotic prescription, including provider and patient education, decision algorithms, and electronic decision aids This relatively simple intervention supports previously published data that specific provider feedback can be an effective method in reducing these prescriptions Perhaps a dynamic and interactive strategy is the key to limiting antibiotic side-effects and resistance The authors have no conflicts of interest or sources of funding to disclose.