Understanding antibiotic decision making in surgery-a qualitative analysis.
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
OBJECTIVE: To investigate the characteristics and culture of antibiotic decision making in the surgical specialty. METHODS: A qualitative study including ethnographic observation and face-to-face interviews with participants from six surgical teams at a teaching hospital in London was conducted. Over a 3-month period: (a) 30 ward rounds (WRs) (100 h) were observed, (b) face-to-face follow-up interviews took place with 13 key informants, (c) multidisciplinary meetings on the management of surgical patients and daily practice on wards were observed. Applying these methods provided rich data for characterizing the antibiotic decision making in surgery and enabled cross-validation and triangulation of the findings. Data from the interview transcripts and the observational notes were coded and analysed iteratively until saturation was reached. RESULTS: The surgical team is in a state of constant flux with individuals having to adjust to the context in which they work. The demands placed on the team to be in the operating room, and to address the surgical needs of the patient mean that the responsibility for antibiotic decision making is uncoordinated and diffuse. Antibiotic decision making is considered by surgeons as a secondary task, commonly delegated to junior members of their team and occurs in the context of disjointed communication. CONCLUSION: There is lack of clarity around medical decision making for treating infections in surgical patients. The result is sub-optimal and uncoordinated antimicrobial management. Developing the role of a perioperative clinician may help to improve patient-level outcomes and optimize decision making.
Date Issued
2017-03-21
Date Acceptance
2017-03-16
Citation
Clinical Microbiology and Infection, 2017, 23 (10), pp.752-760
ISSN
1469-0691
Publisher
Elsevier
Start Page
752
End Page
760
Journal / Book Title
Clinical Microbiology and Infection
Volume
23
Issue
10
Copyright Statement
© 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor
Helse Bergen HF
Helse Bergen HF
National Institute for Health Research
National Institute for Health Research
Identifier
PII: S1198-743X(17)30182-9
Grant Number
3827176
3827176
HPRU-2012-10047
HPRU-2012-10047
Subjects
Antibiotic decision making
Antibiotic stewardship
Infection management
Perioperative
Surgery
1103 Clinical Sciences
Microbiology
Publication Status
Published