An Implementation Science Approach to Antibiotic Stewardship in Emergency Departments and Urgent Care Centers.
Background: Antibiotic stewardship efforts have expanded focus from inpatient to include outpatient settings. However, stewardship is urgently needed in acute care ambulatory settings: emergency departments (EDs) and urgent care centers (UCCs). Implementation of antibiotic stewardship in acute ambul...
| Publicado en: | Academic Emergency Medicine Vol. 27; no. 1; pp. 31 - 43 |
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| Autores principales: | , , , , |
| Formato: | research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Wiley-Blackwell
Jan2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=141190882&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 141190882 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10696563 Z27 jtl: Academic Emergency Medicine issn: 10696563 maglogo: Y pubinfo: dt: Jan2020 vid: 27 iid: 1 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 141190882 141190882 141190882 10.1111/acem.13873 141190882 ppf: 31 ppct: 12 formats: tig: atl: An Implementation Science Approach to Antibiotic Stewardship in Emergency Departments and Urgent Care Centers. aug: au: Yadav, Kabir Stahmer, Aubyn Mistry, Rakesh D. May, Larissa Carpenter, Christopher R. affil: Department of Emergency Medicine, Harbor‐UCLA Medical Center, Torrance CA sug: subj: Emergency Service Ambulatory Care Facilities Antimicrobial Stewardship Methods Implementation Science Substance Abuse Prevention and Control Inappropriate Prescribing Prevention and Control Human Program Implementation Medical Practice, Evidence-Based Conceptual Framework Randomized Controlled Trials Cluster Analysis Comparative Studies Pretest-Posttest Design Interviews Descriptive Statistics Random Assignment Patient Attitudes Practice Guidelines Attitude of Health Personnel Health Personnel Education Health Promotion Commitment Outpatient Service ab: Background: Antibiotic stewardship efforts have expanded focus from inpatient to include outpatient settings. However, stewardship is urgently needed in acute care ambulatory settings: emergency departments (EDs) and urgent care centers (UCCs). Implementation of antibiotic stewardship in acute ambulatory care settings has been limited. Two major barriers to effective implementation exist: 1) lack of adaptation of successful outpatient stewardship interventions to the acute care ambulatory setting and 2) absence of rigorous measurement of implementation processes in EDs and UCCs in a manner that informs future scale and spread. Objectives: Our objective was to apply an implementation science approach to address antibiotic overuse and inappropriate use in EDs and UCCs. Methods: This study was a redesign of an evidence‐based outpatient antibiotic stewardship intervention at participating EDs and UCCs using an innovative implementation science framework (dynamic adaptation process), adaptable for local clinical workflow and local champion provision. We evaluated multiple implementation outcome metrics throughout a cluster‐randomized comparative effectiveness clinical trial of two approaches to the adapted antibiotic stewardship interventions. Results: Our preimplementation phase included 21 in‐depth interviews and online provider surveys (52% response rate). For the postimplementation survey, we had a 39% response rate. We identified common themes including patient expectations, lack of knowledge of existing guidelines, and maintenance of education over time. Additional themes indicated differences in modifications needed by type of clinical setting. Adoption of public commitment was high, with 79% of providers signing a commitment log, and 84% received public commitment flair. Signing of public commitment posters rate was 62%, as several sites chose not to use this component. Acceptability, fidelity, and appropriateness were also measured. Conclusions: We demonstrate that implementation science approaches can help address the problem of unnecessary antibiotic use in EDs and UCCs with high acceptability and adoption. Similar approaches could be used to tailor quality improvement interventions in these settings. pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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