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Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: a qualitative study.

Rawson, T. M., Charani, E., Moore, L. S. P., Hernandez, B., Castro-Sanchez, E. ORCID: 0000-0002-3351-9496, Herrero, P., Georgiou, P. and Holmes, A. H. (2016). Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: a qualitative study.. BMC Med, 14(1), 208.. doi: 10.1186/s12916-016-0751-y

Abstract

BACKGROUND: The inappropriate use of antimicrobials drives antimicrobial resistance. We conducted a study to map physician decision-making processes for acute infection management in secondary care to identify potential targets for quality improvement interventions.

METHODS: Physicians newly qualified to consultant level participated in semi-structured interviews. Interviews were audio recorded and transcribed verbatim for analysis using NVIVO11.0 software. Grounded theory methodology was applied. Analytical categories were created using constant comparison approach to the data and participants were recruited to the study until thematic saturation was reached.

RESULTS: Twenty physicians were interviewed. The decision pathway for the management of acute infections follows a Bayesian-like step-wise approach, with information processed and systematically added to prior assumptions to guide management. The main emerging themes identified as determinants of the decision-making of individual physicians were (1) perceptions of providing 'optimal' care for the patient with infection by providing rapid and often intravenous therapy; (2) perceptions that stopping/de-escalating therapy was a senior doctor decision with junior trainees not expected to contribute; and (3) expectation of interactions with local guidelines and microbiology service advice. Feedback on review of junior doctor prescribing decisions was often lacking, causing frustration and confusion on appropriate practice within this cohort.

CONCLUSION: Interventions to improve infection management must incorporate mechanisms to promote distribution of responsibility for decisions made. The disparity between expectations of prescribers to start but not review/stop therapy must be urgently addressed with mechanisms to improve communication and feedback to junior prescribers to facilitate their continued development as prudent antimicrobial prescribers.

Publication Type: Article
Additional Information: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Publisher Keywords: Antimicrobial stewardship; Sepsis; Antibiotics; Prescriber; Grounded-theory
Subjects: Q Science > QR Microbiology
R Medicine
Departments: School of Health Sciences > Nursing
Date Deposited: 15 Jun 2020 09:40
URI: https://openaccess.city.ac.uk/id/eprint/24302
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