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

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Citation: Infection Control & Hospital Epidemiology. 35(9):1114-25, 2014 Sep.PMID: 25111919Institution: MedStar Washington Hospital CenterDepartment: Emergency MedicineForm of publication: Journal ArticleMedline article type(s): Journal Article | Observational Study | Research Support, N.I.H., ExtramuralSubject headings: *Anti-Bacterial Agents | *Attitude of Health Personnel | *Decision Making | *Emergency Service, Hospital/sn [Statistics & Numerical Data] | *Inappropriate Prescribing/px [Psychology] | *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] | Adult | Aged | Decision Support Techniques | Female | Health Care Surveys | Health Knowledge, Attitudes, Practice | Humans | Inappropriate Prescribing/sn [Statistics & Numerical Data] | Interviews as Topic | Male | Middle Aged | Physician-Patient Relations | Qualitative Research | United StatesYear: 2014 Local holdings: Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006ISSN:

1559-6834

Name of journal: Infection control and hospital epidemiologyAbstract: 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.All authors: Armstrong P, Bhat R, Brooks G, Cosgrove SE, Gudger G, Hinds P, Klein EY, May L, Moran GJ, Rand C, Rothman RE, Schwartz LFiscal year: FY2015Digital Object Identifier:

http://dx.doi.org/10.1086/677637

Date added to catalog: 2016-01-15

Holdings ( 1 )
Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	25111919	Available		25111919

Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006

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.

English