Antibiotic decision making in surgical intensive care: a qualitative analysis.
BACKGROUND
Antibiotic use in hospitals is high, particularly in surgical specialty and intensive care units. Antimicrobial stewardship programmes (ASPs) are increasingly intervening in antibiotic use by surgeons and intensivists. However, there is limited information on the features which characterize antibiotic decision making in the surgical intensive care unit (SICU), an area in hospital practice where critically ill surgery patients can be kept under close observation.


AIM
To explore the features which characterize antibiotic decision making in the SICU.


METHODS
A total of 160 h of ethnographic observation and 10 semi-structured interviews were conducted at two teaching hospitals in the USA. Data were analysed using thematic coding.


FINDINGS
Three key characteristics of SICU practice with regard to antibiotic use were identified: (1) physical proximity makes SICU clinicians acutely aware of changes in patient status; (2) communication of patient status relies on active involvement by SICU clinicians; (3) SICU clinicians have contested and variable autonomy over antibiotic decisions.


CONCLUSIONS
Antibiotic decision making in the SICU is a complex process involving multiple clinician teams with varying levels of physical proximity to and autonomy over patient cases. This study found that the SICU clinician team has increased physical proximity to patient cases but little autonomy over antibiotic decisions. If these characteristics are not considered, antimicrobial stewardship (AMS) interventions may have diminished success in addressing high levels of the antibiotic use in the SICU.
['Rynkiewich|K|K|', 'Schwartz|D|D|', 'Won|S|S|', 'Stoner|B|B|']
D000900:Anti-Bacterial Agents D000073602:Antimicrobial Stewardship D001291:Attitude of Health Personnel D003422:Critical Care D003657:Decision Making D006784:Hospitals, Teaching D006801:Humans D007407:Interviews as Topic D015146:Midwestern United States D010820:Physicians D017009:Professional Autonomy D036301:Qualitative Research
Antibiotic decision making Antimicrobial stewardship SICU Clinician autonomy