scholarly journals Multisite Exploration of Clinical Decision Making for Antibiotic Use by Emergency Medicine Providers Using Quantitative and Qualitative Methods

2014 ◽  
Vol 35 (9) ◽  
pp. 1114-1125 ◽  
Author(s):  
Larissa May ◽  
Glencora Gudger ◽  
Paige Armstrong ◽  
Gillian Brooks ◽  
Pamela Hinds ◽  
...  
Keyword(s):  
Decision Making ◽  
Observational Study ◽  
Clinical Decision Making ◽  
A Priori ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
Knowledge Generation ◽  
Clinical Inertia ◽  
Antibiotic Prescribing ◽  
Individual Interviews

Objectives.To explore current practices and decision making regarding antimicrobial prescribing among emergency department (ED) clinical providers.MethodsWe conducted a survey of ED providers recruited from 8 sites in 3 cities. Using purposeful sampling, we then recruited 21 providers for in-depth interviews. Additionally, we observed 10 patient-provider interactions at one of the ED sites. SAS 9.3 was used for descriptive and predictive statistics. Interviews were audio recorded, transcribed, and analyzed using a thematic, constructivist approach with consensus coding using NVivo 10.0. Field and interview notes collected during the observational study were aligned with themes identified through individual interviews.ResultsOf 150 survey respondents, 76% agreed or strongly agreed that antibiotics are overused in the ED, while half believed they personally did not overprescribe. Eighty-nine percent used a smartphone or tablet in the ED for antibiotic prescribing decisions. Several significant differences were found between attending and resident physicians. Interview analysis identified 42 codes aggregated into the following themes: (1) resource and environmental factors that affect care; (2) access to and quality of care received outside of the ED consult; (3) patient-provider relationships; (4) clinical inertia; and (5) local knowledge generation. The observational study revealed limited patient understanding of antibiotic use. Providers relied heavily upon diagnostics and provided limited education to patients. Most patients denied a priori expectations of being prescribed antibiotics.ConclusionsPatient, provider, and healthcare system factors should be considered when designing interventions to improve antimicrobial stewardship in the ED setting.Infect Control Hosp Epidemiol 2014;35(9):1114-1125

scholarly journals 106. Impact and Evaluation of BioFire® FilmArray® Respiratory Panel on Clinical Decision Making and Antibiotic Prescribing

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S67-S68
Author(s):  
Jenna J Manatrey-Lancaster ◽  
Amanda Bushman ◽  
Meagan Caliguri ◽  
Rossana Rosa Espinoza
Keyword(s):  
Decision Making ◽  
Influenza Virus ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
Influenza Viruses ◽  
Antibiotic Prescribing ◽  
Adjusted Analysis ◽  
Days Of Therapy ◽  
The Impact

Abstract Background The BioFire® FilmArray® respiratory panel (RFA) has been proposed as a tool for timely diagnosis and treatment of respiratory tract infections. However, the impact of the RFA on clinical decision making, most notably antibiotic prescribing, de-escalation and duration has been varied. Methods We aimed to determine the impact of RFA results on antibiotic days of therapy (DOT) depending on patient disposition. We conducted a retrospective chart review of adults who had an RFA performed within 48 hours of admission or presentation to the emergency departments (ED) of 3 hospitals in Des Moines, Iowa, between March 3 and March 16, 2019. Patients were excluded if they had a non-respiratory infection with defined indication for antibiotics. RFA results were categorized as influenza, non-influenza virus or negative. Negative binomial regression models were used to calculate rate ratios (RR) for the association between RFA result and DOT. Results A total of 486 total patients were included. Patients were divided according to disposition status, with 243 patients admitted and 243 discharged from the ED. Among inpatients, the median DOT was 2 (IQR 0–7). The results of the adjusted analysis for inpatient are shown on Table 1. In this group, RFA result was not associated with DOT (p=0.598 for non-influenza viruses and 0.706 for negative RFA), while having a urine culture done was independently associated with higher rate ratio of DOT (RR 1.85, 95% CI 1.32–2.59; p< 0.001). Among patients discharged from the ED, the median DOT was 0 (0–8). The results of the adjusted analysis for this group are shown on Table 2. Compared to patients with influenza, those with non-influenza viruses had a RR for DOT of 4.18 (95% CI 1.16–14.9; p=0.028) and those with a negative RFA had an RR for DOT of 5.24 (95% CI 1.99–13.8; p= 0.028). Adjusted analysis for the association between Respiratory Film Array results and Days of Therapy among hospitalized patients Adjusted analysis for the association between Respiratory Film Array Results and Days of Therapy among patients discharged from the ED Conclusion Among inpatients, RFA results did not impact DOT, and in this group, antibiotic use was driven by urine cultures. In contrast, among patients discharged from the ED, a non-influenza virus or a negative RFA was associated with much higher rates of DOT. Our results suggest that different strategies need deployment in the ED compared to inpatient services in order to guide utilization of rapid molecular tests and antibiotic use. Disclosures All Authors: No reported disclosures

scholarly journals Routine Follow-Up Radiographs for Ankle Fractures Seldom Add Value to Clinical Decision-Making: A Retrospective, Observational Study

2018 ◽  
Vol 57 (5) ◽  
pp. 957-960 ◽  
Author(s):  
Pieter van Gerven ◽  
Nikki L. Weil ◽  
Marco F. Termaat ◽  
Sidney M. Rubinstein ◽  
Mostafa El Moumni ◽  
...  
Keyword(s):  
Decision Making ◽  
Observational Study ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Ankle Fractures ◽  
Retrospective Observational Study

scholarly journals An Electronic Clinical Decision-Making Tool for Patients with Suspected Colorectal Cancer—Preliminary Evaluation in Patients Presenting with Rectal Bleeding

2019 ◽  
Vol 3 (5) ◽  
pp. 204-209
Author(s):  
Nauzer Forbes ◽  
Mohan Cooray ◽  
Michael Hackett ◽  
Nishwa Shah ◽  
Yuhong Yuan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Rectal Bleeding ◽  
Test Performance ◽  
Clinical Decision Making ◽  
A Priori ◽  
Clinical Decision ◽  
Preliminary Evaluation ◽  
Clinical Criteria ◽  
Urgent Referral

Abstract Background and Objectives The CarePath-CRC electronic clinical decision-making application was designed to assist physicians with evaluation of patients with suspected colorectal cancer (CRC). The physician completes an interactive checklist of evidence-based clinical parameters, and a recommended referral urgency is generated based on the post-test probability of CRC. This study aimed toward validation of the tool in symptomatic patients presenting with rectal bleeding. Methods The medical records of a sample of patients with histologically confirmed CRC from 2010 to 2014 were reviewed. The CarePath-CRC tool was applied retrospectively to all patients who initially presented with rectal bleeding, to determine its sensitivity for detecting CRC in this population. A generated recommendation of ‘immediate referral’ (referral ≤24 hours, expected endoscopy ≤2 weeks) or ‘urgent referral’ (expected consultation and endoscopy ≤4 and ≤8 weeks) was considered a positive test result. An a priori sensitivity of 90% was deemed adequate, based on test characteristics of the tool’s individual clinical criteria. Results The tool was applied to 281 patients. A total of 69 (24.6%) and 211 (75.1%) patients met criteria for immediate and urgent referral, respectively. The remaining patient (0.4%) met criteria for ‘possible priority referral’, while none met criteria for ‘no specific action recommended’. This resulted in a calculated sensitivity of 99.6% (95% confidence interval 98.0 to 99.9%). Conclusions The CarePath-CRC tool is sensitive in the prediction of CRC in patients presenting with rectal bleeding. A prospective cohort study is being designed to allow for acquisition of comprehensive test performance characteristics and full validation of the instrument.

scholarly journals Role of point-of-care tests in the management of febrile children: a qualitative study of hospital-based doctors and nurses in England

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044510
Author(s):  
Edmond Li ◽  
Juan Emmanuel Dewez ◽  
Queena Luu ◽  
Marieke Emonts ◽  
Ian Maconochie ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Antibiotic Prescribing ◽  
Point Of Care Tests ◽  
University Teaching Hospitals ◽  
Doctors And Nurses

ObjectivesThe use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers’ views about their use in febrile children. The aim of this study was to explore the perceptions of hospital-based doctors and nurses regarding the use of POCTs in England.Study designQualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically.SettingTwo university teaching hospitals in London and Newcastle.Participants24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses).ResultsThere were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1–2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely.ConclusionIn this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinicians in different settings will be critical in ensuring the optimal design and deployment of current and future tests.

Is a nudge all we need to promote deliberate clinical inertia and thoughtful clinical decision making?

2021 ◽  
Author(s):  
Mieke Foster ◽  
Diana Egerton‐Warburton ◽  
Louise Cullen ◽  
Daniel M Fatovich ◽  
Gerben Keijzers
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Clinical Inertia

scholarly journals Application of an Artificial Intelligence Trilogy to Accelerate Processing of Suspected Patients With SARS-CoV-2 at a Smart Quarantine Station: Observational Study

10.2196/19878 ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. e19878
Author(s):  
Ping-Yen Liu ◽  
Yi-Shan Tsai ◽  
Po-Lin Chen ◽  
Huey-Pin Tsai ◽  
Ling-Wei Hsu ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Observational Study ◽  
Processing Time ◽  
Clinical Decision Making ◽  
Image Interpretation ◽  
Clinical Decision ◽  
Tablet Computer ◽  
X Rays ◽  
Quarantine Station

Background As the COVID-19 epidemic increases in severity, the burden of quarantine stations outside emergency departments (EDs) at hospitals is increasing daily. To address the high screening workload at quarantine stations, all staff members with medical licenses are required to work shifts in these stations. Therefore, it is necessary to simplify the workflow and decision-making process for physicians and surgeons from all subspecialties. Objective The aim of this paper is to demonstrate how the National Cheng Kung University Hospital artificial intelligence (AI) trilogy of diversion to a smart quarantine station, AI-assisted image interpretation, and a built-in clinical decision-making algorithm improves medical care and reduces quarantine processing times. Methods This observational study on the emerging COVID-19 pandemic included 643 patients. An “AI trilogy” of diversion to a smart quarantine station, AI-assisted image interpretation, and a built-in clinical decision-making algorithm on a tablet computer was applied to shorten the quarantine survey process and reduce processing time during the COVID-19 pandemic. Results The use of the AI trilogy facilitated the processing of suspected cases of COVID-19 with or without symptoms; also, travel, occupation, contact, and clustering histories were obtained with the tablet computer device. A separate AI-mode function that could quickly recognize pulmonary infiltrates on chest x-rays was merged into the smart clinical assisting system (SCAS), and this model was subsequently trained with COVID-19 pneumonia cases from the GitHub open source data set. The detection rates for posteroanterior and anteroposterior chest x-rays were 55/59 (93%) and 5/11 (45%), respectively. The SCAS algorithm was continuously adjusted based on updates to the Taiwan Centers for Disease Control public safety guidelines for faster clinical decision making. Our ex vivo study demonstrated the efficiency of disinfecting the tablet computer surface by wiping it twice with 75% alcohol sanitizer. To further analyze the impact of the AI application in the quarantine station, we subdivided the station group into groups with or without AI. Compared with the conventional ED (n=281), the survey time at the quarantine station (n=1520) was significantly shortened; the median survey time at the ED was 153 minutes (95% CI 108.5-205.0), vs 35 minutes at the quarantine station (95% CI 24-56; P<.001). Furthermore, the use of the AI application in the quarantine station reduced the survey time in the quarantine station; the median survey time without AI was 101 minutes (95% CI 40-153), vs 34 minutes (95% CI 24-53) with AI in the quarantine station (P<.001). Conclusions The AI trilogy improved our medical care workflow by shortening the quarantine survey process and reducing the processing time, which is especially important during an emerging infectious disease epidemic.

A qualitative study of clinical decision-making in a multidisciplinary outpatient clinic for patients with atrial fibrillation - from the patient’s perspective

2018 ◽  
Vol 6 (4) ◽  
pp. 610
Author(s):  
Lars Thrysoee ◽  
Lisbeth Birkelund ◽  
Regner Birkelund
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Patient Involvement ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Making Process ◽  
International Studies ◽  
Design Data ◽  
Individual Interviews ◽  
European Guidelines

Background: International studies show that patient involvement in clinical decision-making has a positive effect on patients’ experiences of quality and on their adherence to the initiated treatment. Studies also demonstrate that patients are becoming more interested in engaging in decision-making processes. While patient involvement in decision-making plays an important role in the newest European guidelines for treatment of patients with atrial fibrillation, recent research points to the challenges associated with this ideal. The aim of the present study was to determine how patients with newly diagnosed atrial fibrillation experienced the clinical decision-making process in outpatient treatment courses.Methods: The study had a qualitative research design. Data were generated by means of fieldwork in which the researcher participated in outpatient consultations with participating patients. Field notes were supplemented with semi-structured individual interviews. Fourteen patients (7 women and 7 men) between the ages of 40 to 82 were included. The empirical data were analyzed and interpreted according to Ricoeur’s interpretation theory.Results: Three main themes were identified: (1) Lack of prerequisites for patient involvement in decision-making at the first consultation; (2) Limited patient involvement in the anticoagulant choice and (3) Lack of follow-up on the patient’s understanding of illness and treatment. Conclusion: The data showed that the medical aspects of the patients’ illness were most often the focus of attention, whereas the patients’ own experiences, needs and preferences were not systematically included in the decision-making process.

scholarly journals Ethnic bias and clinical decision-making among New Zealand medical students: an observational study

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Ricci Harris ◽  
Donna Cormack ◽  
James Stanley ◽  
Elana Curtis ◽  
Rhys Jones ◽  
...  
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Medical Students ◽  
Observational Study ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Ethnic Bias
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