ArticleBMC medicine2016
Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: a qualitative study.
Article in BMC medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
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Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Strategies and outcomes of CDSS implementation for antimicrobial stewardship in hospital settings: a systematic review.Antimicrobial resistance and infection control · 2026Pooled it
- Evaluation of machine learning pipeline for blood culture outcome prediction on prospectively collected emergency department data.Journal of medical microbiology · 2026Article
- Patient and clinician views on inpatient antibiotic shared decision-making: a qualitative study.JAC-antimicrobial resistance · 2026Article
- Artificial intelligence for improving decision-making in bacterial infection management: a narrative review.The Journal of antimicrobial chemotherapy · 2026Review
- Supervised Machine Learning to Identify Hospital Inpatients Needing a Change of Antibiotic Therapy in Real Time: Preclinical Diagnostic Evaluation and Feasibility Study.Open forum infectious diseases · 2026Article
- A mixed methods evaluation of an antimicrobial prescribing clinical decision support system app.npj antimicrobials and resistance · 2025Article
- Barriers and facilitators to optimal sepsis care - a systematized review of healthcare professionals' perspectives.BMC health services research · 2025Review
- Factors associated with blood culture sampling for adult acute care hospital patients with suspected severe infection: a scoping review using a socioecological framework.JAC-antimicrobial resistance · 2025Review
- A qualitative analysis of the unwritten rules influencing antibiotic prescribing practices among French poultry veterinarians.JAC-antimicrobial resistance · 2024Article
- Understanding how diagnostics influence antimicrobial decision-making is key to successful clinical trial design.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2023Article
- Development of National Antimicrobial Intravenous-to-Oral Switch Criteria and Decision Aid.Journal of clinical medicine · 2023Article
- Management of Bacterial and Fungal Infections in the ICU: Diagnosis, Treatment, and Prevention Recommendations.Infection and drug resistance · 2023Review
- Antibiotic Stewardship: Dead Bugs do not Mutate.Journal of translational internal medicine · 2022Article
- Why we prescribe antibiotics for too long in the hospital setting: a systematic scoping review.The Journal of antimicrobial chemotherapy · 2022Article
- Ethics and antibiotic resistance.British medical bulletin · 2022Article
- Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework.BMJ quality & safety · 2022Article
- Developing a theory-based behavior change intervention to improve the prescription of surgical prophylaxis.International journal of clinical pharmacy · 2022Article
- Machine learning and synthetic outcome estimation for individualised antimicrobial cessation.Frontiers in digital health · 2022Article
- Optimizing antimicrobial use: challenges, advances and opportunities.Nature reviews. Microbiology · 2021Review
- Resistance Trend Estimation Using Regression Analysis to Enhance Antimicrobial Surveillance: A Multi-Centre Study in London 2009-2016.Antibiotics (Basel, Switzerland) · 2021Article
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Authors and funding
8 authors.
Funding
Abstract
backgroundThe 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.
methodsPhysicians 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.
resultsTwenty 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.
conclusionInterventions 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.
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