Trisha N Peel1, Eliza Watson1, Kelly Cairns2, Ho Yin Ashley Lam1, Heidi Zhangrong Li3, Ganan Ravindran4, Jayan Seneviratne4, David Daly5, Susan Liew6, David McGiffin7, Paul Myles5, Darshini Ayton3,8. 1. Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia. 2. Department of Pharmacy, Alfred Health, Melbourne, Victoria, Australia. 3. Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 4. Medical Students, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia. 5. Department of Anaesthesiology and Peri-operative Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia. 6. Department of Orthopaedic Surgery, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia. 7. Department of Cardiothoracic Surgery, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia. 8. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Abstract
OBJECTIVE: Antimicrobial use in the surgical setting is common and frequently inappropriate. Understanding the behavioral context of antimicrobial use is a critical step to developing stewardship programs. DESIGN: In this study, we employed qualitative methodologies to describe the phenomenon of antimicrobial use in 2 surgical units: orthopedic surgery and cardiothoracic surgery. SETTING: This study was conducted at a public, quaternary, university-affiliated hospital. PARTICIPANTS: Healthcare professionals from the 2 surgical unit teams participated in the study. METHODS: We used focused ethnographic and face-to-face semi-structured interviews to observe antimicrobial decision-making behaviors across the patient's journey from the preadmission clinic to the operating room to the postoperative ward. RESULTS: We identified 4 key themes influencing decision making in the surgical setting. Compartmentalized communication (theme 1) was observed with demarcated roles and defined pathways for communication (theme 2). Antimicrobial decisions in the operating room were driven by the most senior members of the team. These decisions, however, were delegated to more junior members of staff in the ward and clinic environment (theme 3). Throughout the patient's journey, communication with the patient about antimicrobial use was limited (theme 4). CONCLUSIONS: Approaches to decision making in surgery are highly structured. Although this structure appears to facilitate smooth flow of responsibility, more junior members of the staff may be disempowered. In addition, opportunities for shared decision making with patients were limited. Antimicrobial stewardship programs need to recognize the hierarchal structure as well as opportunities to engage the patient in shared decision making.
OBJECTIVE: Antimicrobial use in the surgical setting is common and frequently inappropriate. Understanding the behavioral context of antimicrobial use is a critical step to developing stewardship programs. DESIGN: In this study, we employed qualitative methodologies to describe the phenomenon of antimicrobial use in 2 surgical units: orthopedic surgery and cardiothoracic surgery. SETTING: This study was conducted at a public, quaternary, university-affiliated hospital. PARTICIPANTS: Healthcare professionals from the 2 surgical unit teams participated in the study. METHODS: We used focused ethnographic and face-to-face semi-structured interviews to observe antimicrobial decision-making behaviors across the patient's journey from the preadmission clinic to the operating room to the postoperative ward. RESULTS: We identified 4 key themes influencing decision making in the surgical setting. Compartmentalized communication (theme 1) was observed with demarcated roles and defined pathways for communication (theme 2). Antimicrobial decisions in the operating room were driven by the most senior members of the team. These decisions, however, were delegated to more junior members of staff in the ward and clinic environment (theme 3). Throughout the patient's journey, communication with the patient about antimicrobial use was limited (theme 4). CONCLUSIONS: Approaches to decision making in surgery are highly structured. Although this structure appears to facilitate smooth flow of responsibility, more junior members of the staff may be disempowered. In addition, opportunities for shared decision making with patients were limited. Antimicrobial stewardship programs need to recognize the hierarchal structure as well as opportunities to engage the patient in shared decision making.
Authors: Andre Leme Fleury; Sara Miriam Goldchmit; Maria Alice Gonzales; Rafaella Rogatto de Farias; Tiago Lazzaretti Fernandes Journal: Curr Rev Musculoskelet Med Date: 2022-03-14
Authors: Hazel Parker; Julia Frost; Jo Day; Rob Bethune; Anu Kajamaa; Kieran Hand; Sophie Robinson; Karen Mattick Journal: PLoS One Date: 2022-07-20 Impact factor: 3.752