Multisite Exploration of Clinical Decision Making for Antibiotic Use by Emergency Medicine Providers Using Quantitative and Qualitative Methods

作者：May Larissa^*; Gudger Glencora; Armstrong Paige; Brooks Gillian; Hinds Pamela; Bhat Rahul; Moran Gregory J; Schwartz Lisa; Cosgrove Sara E; Klein Eili Y; Rothman Richard E; Rand Cynthia

来源：Infection Control and Hospital Epidemiology, 2014, 35(9): 1114-1125.

DOI：10.1086/677637

OBJECTIVES. To explore current practices and decision making regarding antimicrobial prescribing among emergency department (ED) clinical providers. %26lt;br%26gt;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. %26lt;br%26gt;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. %26lt;br%26gt;CONCLUSIONS. Patient, provider, and healthcare system factors should be considered when designing interventions to improve antimicrobial stewardship in the ED setting.

• 出版日期2014-9