Improving Antibiotic Stewardship During The Treatment of Skin and Soft Tissue Infections in The Emergency Department: A Human Factors and Systems Engineering Approach

项目总结/摘要 此职业发展计划旨在为急诊医学专家Michael Pulia博士提供 在威斯康星州大学医学和公共卫生学院， 一个独立的，医生，科学家研究干预措施，以改善在传染病的护理， 急诊科（艾德）。在医疗机构中不适当使用抗生素是一个全球性的公共卫生问题 由于抗生素耐药性细菌感染率的增加，此外，本发明还 抗生素的过度使用由于严重的药物不良事件的风险而引起显著的患者安全性问题 如过敏反应和艰难梭菌腹泻。艾德越来越多地作为事实上的中心， 医疗保健系统和此处规定的抗生素对住院患者和 门诊设置。艾德也被确定为具有最高发生率的临床环境。 抗生素使用不当。例如，抗生素用于常见的皮肤和软组织感染，如 在艾德，高达90%的病例不能遵守最佳实践指南。 不幸的是，在适当的技术转让的障碍和促进因素方面， 这种缺乏了解反映在缺乏抗生素管理上 为ED量身定制的干预措施。拟议研究的总体目标是制定证据- 基于干预的捆绑包，改善了皮肤软组织艾德患者的指南依从性抗生素使用 组织感染鉴于这种临床困境的复杂性，研究方法将以 创新的概念框架，在其他医疗保健安全和质量方面取得了成功 患者安全系统工程倡议（SEIPS）。SEIPS模型是 旨在系统地识别影响护理提供和患者的医疗保健系统的所有要素 结果。为了实现总体目标，将采用混合方法处理以下问题 具体目标：1）确定高影响力的障碍和促进因素，以指导抗生素的依从性使用， 治疗艾德中的皮肤和软组织感染; 2）设计艾德抗生素管理干预 针对高影响力障碍和促进者进行捆绑，然后利用关键利益攸关方专家的投入进行完善; 3)实施抗生素管理干预捆绑包，并衡量其对指南依从性的影响 作为一个机构的初级教员， 凭借广泛的基础设施来支持早期研究人员，Pulia博士处于理想的环境中， 完成拟议的研究并接受高级培训。他的职业发展计划包括 在人为因素和医疗保健系统工程领域的课程和指导培训， 定性方法，干预性卫生服务和领导/变革管理。为了确保成功， 他在这些学科中找到了忠诚的专家导师，并为这项工作争取了受保护的时间。

Project Summary/Abstract This career development proposal is designed to provide Dr. Michael Pulia, an Emergency Medicine specialist at the University of Wisconsin School of Medicine and Public Health, with the training required for success as an independent, physician-scientist researching interventions to improve the care of infectious diseases in the emergency department (ED). Inappropriate use of antibiotics in healthcare settings is a global public health threat due to an association with increasing rates of antibiotic resistant bacterial infections. Additionally, antibiotic overuse poses a significant patient safety concern due to the risk of serious adverse drug events such as anaphylaxis and Clostridium difficile diarrhea. The ED increasingly functions as the de facto center of the healthcare system and antibiotics prescribed here have significant downstream effects in both inpatient and outpatient settings. The ED has also been identified as the clinical environment with the highest rates of inappropriate antibiotic use. For example, antibiotic use for common skin and soft tissue infections, such as abscesses and cellulitis, in the ED fails to adhere to best practice guidelines in up to 90% of cases. Unfortunately, there are significant gaps in knowledge regarding the barriers to and facilitators of appropriate antibiotic use in the ED. This lack of understanding is reflected by the absence of antibiotic stewardship interventions tailored for the ED. The overall objective of the proposed research is to develop an evidence- based intervention bundle that improves guideline adherent antibiotic use for ED patients with skin and soft tissue infections. Given the complex nature of this clinical dilemma, the research approach will be guided by an innovative conceptual framework which has demonstrated success in other healthcare safety and quality improvement initiatives, the Systems Engineering Initiative for Patient Safety (SEIPS). The SEIPS model is designed to systematically identify all elements of the healthcare system that impact care delivery and patient outcomes. To achieve the overall goal, a mixed methods approach will be applied to address the following specific aims:1) Identify high impact barriers and facilitators to guideline adherent antibiotic use for the treatment of skin and soft tissue infections in the ED; 2) Design an ED antibiotic stewardship intervention bundle targeted to high impact barriers and facilitators then refine it using input from expert key stakeholders; 3) Implement an antibiotic stewardship intervention bundle and measure its impact on guideline adherent antibiotic use for skin and soft tissue infections in an academic ED. As a junior faculty member at an institution with extensive infrastructure to support early stage investigators, Dr. Pulia is in an ideal environment to complete the proposed research and pursue advanced training. His career development plan includes both coursework and mentored training in the areas of human factors and healthcare systems engineering, qualitative methods, interventional health services, and leadership/change management. To ensure success, he has identified committed, expert mentors in these disciplines and secured protected time for this work.