Emergency Department Clinicians' Needs for User-Centered Antibiotic Guideline: Insights from a Focus Group Interview

Institution-specific antibiotic guidelines are core components of effective antibiotic stewardship programs; however, their practical use in emergency departments (EDs), where empirical antibiotic decisions are made under time pressure and diagnostic uncertainty, remains limited. This study explored ED clinicians' perspectives on antibiotic prescribing and identified key elements for developing ED-specific antibiotic guidelines.

Focus group interviews were conducted between October 12 and October 26, 2022, at four tertiary hospitals in Korea. A total of 16 physicians participating directly in ED antibiotic prescribing were enrolled including Emergency medicine and internal medicine physicians. Interviews were recorded, transcribed and analyzed using thematic analysis by two infectious disease specialists.

Clinicians reported substantial challenges in prescribing empirical antibiotics, including diagnostic uncertainty, complex clinical scenarios, and practical prescribing issues such as dosing and administration details. Antibiotic decision-making was influenced by patient-related factors and institutional culture, including department-specific prescribing preferences. Existing antibiotic guidelines were infrequently used due to poor usability and limited applicability to real-world ED practice. Participants emphasized the need for concise, algorithm-based guidelines incorporating practical prescribing information and better integration into clinical workflows.

ED clinicians perceived existing antibiotic guidelines as poorly aligned with ED practice. User-centered, institution-specific antibiotic guidelines may enhance applicability and support appropriate empirical antibiotic prescribing in the ED.