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|Title:||Understanding antibiotic decision making in surgery - a qualitative analysis|
Holmes, A. H.
|Publisher:||Elsevier for European Society of Clinical Microbiology and Infectious Diseases|
|Citation:||Clinical Microbiology and Infection, 2017, doi: 10.1016/j.cmi.2017.03.013.|
|Abstract:||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.|
|Embargo on file until:||21-Mar-2018|
|Rights:||Copyright © the authors, 2017. This article is distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.|
|Description:||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.|
|Appears in Collections:||Published Articles, Dept. of Health Sciences|
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