Quality Improvement Initiative to Decrease Excessive Testing for Streptococcal Pharyngitis in Adults in an Outpatient Clinic Setting

Author

Hana Roussey, Belmont UniversityFollow

Abstract

Project Title: Quality Improvement Initiative to Decrease Excessive Testing for Streptococcal Pharyngitis in Adults in an Outpatient Clinic Setting

Background and Rationale: Current guidelines recommend utilization of a clinical decision-making tool, like the Centor score, in conjunction with confirmatory diagnostic methods, such as a throat culture or rapid test, rather than either method alone. The existing practice at the clinic site was to test most adults with upper respiratory infection symptoms (e.g., sore throat, cough, fever, sinus congestion) with little discretion. With the reported prevalence of streptococcal pharyngitis or “strep throat” in adults being 5-15%, universally testing adult patients could result in a positive test due to being a carrier, despite the causative organism of pharyngitis likely being viral. This contributes to antibiotic misuse and potentially antimicrobial resistance.

SMART Aim: The aim of this project was to decrease unnecessary rapid testing for Group A pharyngitis by 40% in patients over the age of 18 who present with upper respiratory symptoms to a primary care clinic in Murfreesboro, Tennessee, by December 13, 2024.

Methods: The protocol for the QI initiative called for the provider to calculate a Centor score prior to performing a rapid test for strep throat and to document the score in the encounter note. Ideally, a rapid strep test should only be performed for a Centor score ≥ 2. Data collection and compliance rates were completed by a chart review during implementation.

Outcomes: This QI initiative resulted in a 56% reduction in unnecessary testing for streptococcal pharyngitis. Also, antibiotic prescriptions were reduced by 20%. There was no significant change in the length of visit in minutes or significant increase in point-of-care testing for other URIs, such as Covid-19 or Influenza A & B. There were no missed cases of strep throat during the implementation.

Date

Spring 4-27-2025

First Advisor

Dr. Jennifer Sternberg

Second Advisor

Dr. David Phillippi

Department

Nursing, School of

College

Health Sciences & Nursing, Gordon E. Inman College of

Document Type

Scholarly Project

Degree

<-- Please Select One -->

Degree Level

Doctoral

Degree Grantor

Belmont University

Keywords

streptococcal pharyngitis; strep throat; antibiotic stewardship; diagnostic stewardship; Center score; GABHS; outpatient; family medicine; point of care testing; quality improvement

Recommended Citation

Roussey, Hana, "Quality Improvement Initiative to Decrease Excessive Testing for Streptococcal Pharyngitis in Adults in an Outpatient Clinic Setting" (2025). DNP Scholarly Projects. 110.
https://repository.belmont.edu/dnpscholarlyprojects/110