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

Larissa S May, Glencora Gudger, Paige Armstrong, Gillian Brooks, Pamela Hinds, Rahul Bhat, Gregory J. Moran, Lisa Schwartz, Sara E. Cosgrove, Eili Y. Klein, Richard E. Rothman, Cynthia Rand

Research output: Contribution to journalArticle

47 Scopus citations

Abstract

objectives. To explore current practices and decision making regarding antimicrobial prescribing among emergency department (ED) clinical providers. 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. 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. conclusions. Patient, provider, and healthcare system factors should be considered when designing interventions to improve antimicrobial stewardship in the ED setting.

Original languageEnglish (US)
Pages (from-to)1114-1125
Number of pages12
JournalInfection Control and Hospital Epidemiology
Volume35
Issue number9
DOIs
StatePublished - 2014
Externally publishedYes

ASJC Scopus subject areas

  • Microbiology (medical)
  • Epidemiology
  • Infectious Diseases
  • Medicine(all)

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    May, L. S., Gudger, G., Armstrong, P., Brooks, G., Hinds, P., Bhat, R., Moran, G. J., Schwartz, L., Cosgrove, S. E., Klein, E. Y., Rothman, R. E., & Rand, C. (2014). Multisite exploration of clinical decision making for antibiotic use by emergency medicine providers using quantitative and qualitative methods. Infection Control and Hospital Epidemiology, 35(9), 1114-1125. https://doi.org/10.1086/677637