How Clinicians Decide? Exploring Complexity of Antibiotic Prescribing in Emergency Departments Using Video-Reflexive Ethnography

Bibliographic Data

ID4645033
AuthorsMila Obucina (0000-0001-5155-1310, Gold Coast Health, corresponding author), Laura Hamill (0000-0002-8829-9224, Gold Coast Health), Ronald Huynh (0000-0001-8759-7425, Gold Coast Health), Kylie Alcorn (0000-0002-4714-7830, Gold Coast Health), Jack Cro, Jack Cross (0000-0002-9244-8181, Gold Coast Health), Amy Sweeny (Gold Coast Health), Amy L Sweeny (0000-0001-8392-5612, Griffith University), Gerben Keijzers (0000-0003-1100-4552, Gold Coast Health)
Year2023
Volume33
Issue14
Pages1333-1348
Publication date2023-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueQualitative Health Research (JOURNAL)
Journal identifiersISSN: 1049-7323 • E-ISSN: 1552-7557
PublisherSAGE Publications Inc (PUBLISHER)
DOI10.1177/10497323231198144
PMID37870924
OpenAlexW4387873799
LanguageEN
Citations received1
References cited53

Antibiotic overprescribing is a global issue that significantly contributes to increased antimicrobial resistance. Strengthening antimicrobial prescribing practices should be considered a priority. The emergency department (ED) represents a setting where antibiotics are frequently prescribed, but the determinants that influence prescribing choices are complex and multifaceted. We conducted an exploratory qualitative study to investigate the contextual factors that influence antibiotic prescribing choices among clinicians in the ED. The study employed video-reflexive ethnography (VRE) to capture prospective clinical decision-making in situated practice. Data collection involved fieldwork observations, video observations, and delivery of facilitated group reflexive sessions, where clinicians viewed a selection of recorded video snippets relating to antibiotic prescribing. Study was conducted across two EDs within the same health service in Australia. A total of 29 clinical conversations focusing on antibiotic prescribing were recorded. Additionally, 34 clinicians participated in group reflexive sessions. Thematic analysis from the transcribed data yielded four themes: 'importance of clinical judgment', 'usability of prescribing guidelines', 'managing patient expectations', and 'context-dependent disruptions'. Our findings provide insights into the challenges faced by clinicians in navigating complex ED environment, utilising electronic decision-support tools and engaging in discussions about patient treatments with senior clinicians. The findings also indicate that VRE is useful in visualising full complexity of the ED setting, and in initiating meaningful discussions among clinical teams. Integrating the use of VRE in everyday clinical settings can potentially facilitate the implementation of pragmatic solutions for delivering effective antibiotic stewardship practices

Antibiotic resistance · Antibiotics · Antimicrobial stewardship · Exploratory research · Medical education · Qualitative research · Reflexivity · Sociology · Thematic analysis · Interprofessional Education and Collaboration · Medicine · Nursing · Patient Satisfaction in Healthcare · Patient-Provider Communication in Healthcare

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