Citation: Infection Control & Hospital Epidemiology. 35(9):1114-25, 2014 Sep..Journal: Infection control and hospital epidemiology.ISSN: 1559-6834.Full author list: May L; Gudger G; Armstrong P; Brooks G; Hinds P; Bhat R; Moran GJ; Schwartz L; Cosgrove SE; Klein EY; Rothman RE; Rand C.UI/PMID: 25111919.Subject(s): Adult | Aged | *Anti-Bacterial Agents | *Attitude of Health Personnel | *Decision Making | Decision Support Techniques | *Emergency Service, Hospital/sn [Statistics & Numerical Data] | Female | Health Care Surveys | Health Knowledge, Attitudes, Practice | Humans | *Inappropriate Prescribing/px [Psychology] | Inappropriate Prescribing/sn [Statistics & Numerical Data] | Interviews as Topic | Male | Middle Aged | Physician-Patient Relations | *Practice Patterns, Physicians'/sn [Statistics & Numerical Data] | Qualitative Research | United StatesInstitution(s): MedStar Washington Hospital CenterDepartment(s): Emergency MedicineActivity type: Journal Article.Medline article type(s): Journal Article | Observational Study | Research Support, N.I.H., ExtramuralDigital Object Identifier: http://dx.doi.org/10.1086/677637 (Click here)Abbreviated citation: Infect Control Hosp Epidemiol. 35(9):1114-25, 2014 Sep.Local Holdings: Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006.Abstract: OBJECTIVES: To explore current practices and decision making regarding antimicrobial prescribing among emergency department (ED) clinical providers.Abstract: 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.Abstract: 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.Abstract: CONCLUSIONS: Patient, provider, and healthcare system factors should be considered when designing interventions to improve antimicrobial stewardship in the ED setting.