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Published on: August 30, 2018
Decision-making regarding antibiotic therapy duration: An observational study of multidisciplinary meetings in the
Robin M E Janssen1, Anke J M Oerlemans2, Johannes G van der Hoeven3
1Radboud university medical center, Department of Intensive Care Medicine, Nijmegen, the Netherlands; Radboud university medical center, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands; Radboud university medical center, Radboud Center for Infectious Diseases (RCI), Nijmegen, the Netherlands.
Purpose:
Antibiotic therapy is commonly prescribed longer than recommended in intensive care patients (ICU). We aimed to provide insight into the decision-making process on antibiotic therapy duration in the ICU.
Methods:
A qualitative study was conducted, involving direct observations of antibiotic decision-making during multidisciplinary meetings in four Dutch ICUs. The study used an observation guide, audio recordings, and detailed field notes to gather information about the discussions on antibiotic therapy duration. We described the participants' roles in the decision-making process and focused on arguments contributing to decision-making.
Results:
We observed 121 discussions on antibiotic therapy duration in sixty multidisciplinary meetings. 24.8% of discussions led to a decision to stop antibiotics immediately. In 37.2%, a prospective stop date was determined. Arguments for decisions were most often brought forward by intensivists (35.5%) and clinical microbiologists (22.3%). In 28.9% of discussions, multiple healthcare professionals participated equally in the decision. We identified 13 main argument categories. While intensivists mostly used arguments based on clinical status, clinical microbiologists used diagnostic results in the discussion.
Conclusions:
Multidisciplinary decision-making regarding the duration of antibiotic therapy is a complex but valuable process, involving different healthcare professionals, using a variety of argument-types to determine the duration of antibiotic therapy. To optimize the decision-making process, structured discussions, involvement of relevant specialties, and clear communication and documentation of the antibiotic plan are recommended.
Insights
Antibiotic duration decisions in intensive care units (ICUs) are complex. Multidisciplinary teams use various arguments, but structured discussions and clear communication are key to optimizing antibiotic therapy duration.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Health Services Research
Background:
- Antibiotic therapy is frequently prolonged beyond recommendations for intensive care unit (ICU) patients.
- Understanding the decision-making process for antibiotic duration is crucial for optimizing patient care and antimicrobial stewardship.
Purpose of the Study:
- To gain insight into the decision-making processes surrounding antibiotic therapy duration in the intensive care unit (ICU).
- To identify the roles of different healthcare professionals and the types of arguments used in determining antibiotic treatment length.
Main Methods:
- A qualitative study involving direct observations of multidisciplinary meetings in four Dutch ICUs.
- Data collection included observation guides, audio recordings, and detailed field notes focusing on discussions about antibiotic duration.
Main Results:
- 121 discussions on antibiotic duration were observed; 24.8% resulted in immediate cessation and 37.2% in a prospective stop date.
- Intensivists and clinical microbiologists were primary contributors, using clinical status and diagnostic results respectively.
- 28.9% of discussions involved equal participation from multiple healthcare professionals.
Conclusions:
- Multidisciplinary decision-making for antibiotic duration is complex, involving diverse professionals and arguments.
- Optimizing this process requires structured discussions, interdisciplinary collaboration, and clear documentation of antibiotic plans.
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