Mustafa Ozkaynak1, Noel Metcalf1, Daniel M Cohen2, Larissa S May3, Peter S Dayan4, Rakesh D Mistry5. 1. College of Nursing, University of Colorado-Denver, Anschutz Medical Campus, Aurora, Colorado, United States. 2. Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States. 3. Department of Emergency Medicine, UC Davis Health, Davis, California, United States. 4. Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, United States. 5. Department of Pediatrics and Emergency Medicine, Section of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States.
Abstract
OBJECTIVE: This study was aimed to explore the intersection between organizational environment, workflow, and technology in pediatric emergency departments (EDs) and how these factors impact antibiotic prescribing decisions. METHODS: Semistructured interviews with 17 providers (1 fellow and 16 attending faculty), and observations of 21 providers (1 physician assistant, 5 residents, 3 fellows, and 12 attendings) were conducted at three EDs in the United States. We analyzed interview transcripts and observation notes using thematic analysis. RESULTS: Seven themes relating to antibiotic prescribing decisions emerged as follows: (1) professional judgement, (2) cognition as a critical individual resource, (3) decision support as a critical organizational resource, (4) patient management with imperfect information, (5) information-seeking as a primary task, (6) time management, and (7) broad process boundaries of antibiotic prescribing. DISCUSSION: The emerging interrelated themes identified in this study can be used as a blueprint to design, implement, and evaluate clinical decision support (CDS) systems that support antibiotic prescribing in EDs. The process boundaries of antibiotic prescribing are broader than the current boundaries covered by existing CDS systems. Incongruities between process boundaries and CDS can under-support clinicians and lead to suboptimal decisions. We identified two incongruities: (1) the lack of acknowledgment that the process boundaries go beyond the physical boundaries of the ED and (2) the lack of integration of information sources (e.g., accessibility to prior cultures on an individual patient outside of the organization). CONCLUSION: Significant opportunities exist to improve appropriateness of antibiotic prescribing by considering process boundaries in the design, implementation, and evaluation of CDS systems. Georg Thieme Verlag KG Stuttgart · New York.
OBJECTIVE: This study was aimed to explore the intersection between organizational environment, workflow, and technology in pediatric emergency departments (EDs) and how these factors impact antibiotic prescribing decisions. METHODS: Semistructured interviews with 17 providers (1 fellow and 16 attending faculty), and observations of 21 providers (1 physician assistant, 5 residents, 3 fellows, and 12 attendings) were conducted at three EDs in the United States. We analyzed interview transcripts and observation notes using thematic analysis. RESULTS: Seven themes relating to antibiotic prescribing decisions emerged as follows: (1) professional judgement, (2) cognition as a critical individual resource, (3) decision support as a critical organizational resource, (4) patient management with imperfect information, (5) information-seeking as a primary task, (6) time management, and (7) broad process boundaries of antibiotic prescribing. DISCUSSION: The emerging interrelated themes identified in this study can be used as a blueprint to design, implement, and evaluate clinical decision support (CDS) systems that support antibiotic prescribing in EDs. The process boundaries of antibiotic prescribing are broader than the current boundaries covered by existing CDS systems. Incongruities between process boundaries and CDS can under-support clinicians and lead to suboptimal decisions. We identified two incongruities: (1) the lack of acknowledgment that the process boundaries go beyond the physical boundaries of the ED and (2) the lack of integration of information sources (e.g., accessibility to prior cultures on an individual patient outside of the organization). CONCLUSION: Significant opportunities exist to improve appropriateness of antibiotic prescribing by considering process boundaries in the design, implementation, and evaluation of CDS systems. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Edina Avdic; Lisa A Cushinotto; Andrew H Hughes; Amanda R Hansen; Leigh E Efird; John G Bartlett; Sara E Cosgrove Journal: Clin Infect Dis Date: 2012-04-10 Impact factor: 9.079
Authors: Brad Spellberg; Martin Blaser; Robert J Guidos; Helen W Boucher; John S Bradley; Barry I Eisenstein; Dale Gerding; Ruth Lynfield; L Barth Reller; John Rex; David Schwartz; Edward Septimus; Fred C Tenover; David N Gilbert Journal: Clin Infect Dis Date: 2011-05 Impact factor: 9.079
Authors: Jeffrey S Gerber; Priya A Prasad; Alexander G Fiks; A Russell Localio; Louis M Bell; Ron Keren; Theoklis E Zaoutis Journal: JAMA Date: 2014-12-17 Impact factor: 56.272
Authors: David Vyles; Asriani Chiu; John Routes; Mariana Castells; Elizabeth J Phillips; Jennifer Kibicho; David C Brousseau Journal: Pediatrics Date: 2018-05 Impact factor: 7.124
Authors: Jacob K Greenberg; Ayodamola Otun; Pyi Theim Kyaw; Christopher R Carpenter; Ross C Brownson; Nathan Kuppermann; David D Limbrick; Randi E Foraker; Po-Yin Yen Journal: Appl Clin Inform Date: 2022-04-27 Impact factor: 2.342
Authors: Dean F Sittig; Carolyn Petersen; Stephen M Downs; Jenna S Lehmann; Christoph U Lehmann Journal: Appl Clin Inform Date: 2022-03-09 Impact factor: 2.342