Multisite exploration of clinical decision making for antibiotic use by emergency medicine providers using quantitative and qualitative methods. 

 -  2014 
<br/><br/>Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006 
<br/><br/> CONCLUSIONS: Patient, provider, and healthcare system factors should be considered when designing interventions to improve antimicrobial stewardship in the ED setting.  METHODS: We conducted a survey of ED providers recruited from 8 sites in 3 cities. Using purposeful sampling, we then recruited 21 providers for in-depth interviews. Additionally, we observed 10 patient-provider interactions at one of the ED sites. SAS 9.3 was used for descriptive and predictive statistics. Interviews were audio recorded, transcribed, and analyzed using a thematic, constructivist approach with consensus coding using NVivo 10.0. Field and interview notes collected during the observational study were aligned with themes identified through individual interviews.  OBJECTIVES: To explore current practices and decision making regarding antimicrobial prescribing among emergency department (ED) clinical providers.  RESULTS: Of 150 survey respondents, 76% agreed or strongly agreed that antibiotics are overused in the ED, while half believed they personally did not overprescribe. Eighty-nine percent used a smartphone or tablet in the ED for antibiotic prescribing decisions. Several significant differences were found between attending and resident physicians. Interview analysis identified 42 codes aggregated into the following themes: (1) resource and environmental factors that affect care; (2) access to and quality of care received outside of the ED consult; (3) patient-provider relationships; (4) clinical inertia; and (5) local knowledge generation. The observational study revealed limited patient understanding of antibiotic use. Providers relied heavily upon diagnostics and provided limited education to patients. Most patients denied a priori expectations of being prescribed antibiotics. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1559-6834 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Anti-Bacterial Agents<br/>*Attitude of Health Personnel<br/>*Decision Making<br/>*Emergency Service, Hospital/sn [Statistics & Numerical Data]<br/>*Inappropriate Prescribing/px [Psychology]<br/>*Practice Patterns, Physicians'/sn [Statistics & Numerical Data]<br/>Adult<br/>Aged<br/>Decision Support Techniques<br/>Female<br/>Health Care Surveys<br/>Health Knowledge, Attitudes, Practice<br/>Humans<br/>Inappropriate Prescribing/sn [Statistics & Numerical Data]<br/>Interviews as Topic<br/>Male<br/>Middle Aged<br/>Physician-Patient Relations<br/>Qualitative Research<br/>United States
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Emergency Medicine
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article<br/>Observational Study<br/>Research Support, N.I.H., Extramural