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

Rawson, Timothy Miles, Charani, Esmita, Prockter Moore, Luke Stephen, Hernandez, Bernard, Castro-Sánchez, Enrique ORCID:, Herrero, Pau, Georgiou, Pantelis and Holmes, Alison Helen (2016) Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: a qualitative study. BMC Medicine, 14 (1).

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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.

Item Type: Article
Identifier: 10.1186/s12916-016-0751-y
Keywords: Antimicrobial stewardship, Sepsis, Antibiotics, Prescriber, Grounded-theory
Subjects: Medicine and health > Health promotion and public health > Infection prevention
Related URLs:
Depositing User: Enrique Castro Sanchez
Date Deposited: 30 Mar 2022 15:37
Last Modified: 06 Feb 2024 16:09


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