Abstract

Introduction

Enhancing compliance with microbiological testing prior to antimicrobial therapy is fundamental to diagnostic stewardship, precision antimicrobial prescribing, and the containment of antimicrobial resistance—a key objective of national healthcare quality and safety initiatives. This study evaluated the effectiveness of the Find, Organize, Clarify, Understand, Select, Plan, Do, Check, Act (FOCUS-PDCA) cycle model as a quality improvement framework to improve adherence to microbiological testing protocols in hospitalized patients.

Materials and Methods

Baseline data were collected from hospitalized patients receiving antimicrobial therapy between January and December 2022 to evaluate three diagnostic stewardship indicators: (1) overall microbiological testing rate before antimicrobial therapy, (2) microbiological testing rate for hospital-acquired infection (HAI) diagnoses, and (3) submission rate before the concomitant use of key antimicrobials. From January to June 2023, the FOCUS-PDCA model was implemented, incorporating systematic problem identification, root cause analysis, targeted interventions, and subsequent evaluation of performance metrics to assess improvements in testing compliance.

Results

Implementation of the FOCUS-PDCA model led to statistically significant improvements across all indicators. The overall pre-antimicrobial testing rate increased from 44.29% to 69.94% post-intervention [odds ratio (OR): 0.64; 95% confidence interval (CI), 0.63–0.65; p<0.001). The HAI-related testing rate rose from 72.63% to 90.0% (OR: 0.81; 95% CI, 0.74–0.88; p<0.001), achieving the national target. The submission rate before concomitant use of key antimicrobials increased from 89.76% to 96.47% (OR: 0.91; 95% CI, 0.88–0.95; p<0.001), although it remained slightly below the national threshold of 100%. All observed differences were statistically significant (p<0.05).

Conclusion

The FOCUS-PDCA model effectively enhanced diagnostic stewardship by significantly increasing compliance with microbiological testing protocols prior to antimicrobial therapy in hospitalized patients. These findings underscore the value of structured quality improvement frameworks in antimicrobial stewardship programs to promote rational, evidence-based antimicrobial use.