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Understanding antibiotic decision making in surgery - a qualitative analysis

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journal contribution
posted on 21.04.2017, 14:12 by E. Charani, Carolyn Tarrant, K. Moorthy, N. Sevdalis, L. Brennan, A. H. Holmes
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 three month period: 1) thirty ward rounds (WRs) (100 hours) were observed, 2) face-to-face follow up interviews took place with thirteen key informants, 3) multidisciplinary meetings on the management of surgical patients and daily practice on wards were observed. Applying these methods provided rich data for characterising 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 means 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 improve patient level outcomes and optimise decision making.

History

Citation

Clinical Microbiology and Infection, 2017, doi: 10.1016/j.cmi.2017.03.013.

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Health Sciences

Version

AM (Accepted Manuscript)

Published in

Clinical Microbiology and Infection

Publisher

Elsevier for European Society of Clinical Microbiology and Infectious Diseases

issn

1198-743X

eissn

1469-0691

Acceptance date

16/03/2017

Copyright date

2017

Available date

21/03/2018

Publisher version

http://www.sciencedirect.com/science/article/pii/S1198743X17301829

Notes

The file associated with this record is embargoed until 12 months after the date of publication. The final published version may be available through the links above.

Language

en