Vignettes Identify Variation in Antibiotic Use for Suspected Early Onset Sepsis.
Vignettes Identify Variation in Antibiotic Use for Suspected Early Onset Sepsis.
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DOI：
10.1542/hpeds.2020-000448
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发表时间：
2021-07-01
影响因子：
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通讯作者：
Sharek, Paul J
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文献类型：
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作者：
Payton, Kurlen S E;Wirtschafter, David;Sharek, Paul J
背景和目的：在新生儿重症监护病房中存在广泛的无正当理由的抗生素使用和较大的个体提供者抗生素使用差异。基于维内特的研究方法提供了一种独特的方法来研究个体提供者决策的变化。本研究的目的是使用基于小插曲的调查，以确定在评估新生儿早发性败血症时提供者抗生素使用变化的特定区域。方法：本研究是由围产期质量改进协作组织领导的全州多中心新生儿抗生素管理质量改进项目的一部分。一项基于网络的小插曲调查被用于确定在早发性败血症病例中开始和停止使用抗生素的决定的变化。结果：6例小插曲病例中有3例变异最大。这些病例强调了以下方面的差异：(1)表现良好但有危险因素和c反应蛋白升高的新生儿决定开始使用抗生素；(2)有危险因素且出生时有轻微呼吸体征的新生儿决定开始使用抗生素；(3)有脓毒症危险因素史和轻度临床呼吸体征的新生儿在72小时后消失时决定停止使用抗生素。结论：临床小片段评估确定了疑似早发性败血症病例中个体提供者抗生素使用决策的特定变异区域。小插曲是一种有价值的方法来描述个体提供者的变化和突出抗生素管理改进的机会在新生儿重症监护病房。
BACKGROUND AND OBJECTIVES: There is widespread unwarranted antibiotic use and large individual provider variation in antibiotic use in NICUs. Vignette-based research methodology offers a unique method of studying variation in individual provider decisions. The objective with this study was to use a vignette-based survey to identify specific areas of provider antibiotic use variation in newborns being evaluated for early onset sepsis.METHODS: This study was undertaken as part of a statewide multicenter neonatal antibiotic stewardship quality improvement project led by a perinatal quality improvement collaborative. A web-based vignette survey was administered to identify variation in decisions to start and discontinue antibiotics in cases of early onset sepsis.RESULTS: The largest variation was noted in 3 of the 6 vignette cases. These cases highlighted variation in (1) decisions to start antibiotics in a case describing a well-appearing newborn with risk factors and an elevated C-reactive protein, (2) decisions to start antibiotics in the case of a newborn with risk factors plus mild respiratory signs at birth, and (3) decisions to stop antibiotics in the case of the newborn with a history of sepsis risk factors and mild clinical respiratory signs that resolved after 72 hours.CONCLUSIONS: Clinical vignette assessment identified specific areas of variation in individual provider antibiotic use decisions in cases of suspected early onset sepsis. Vignettes are a valuable method of describing individual provider variation and highlighting antibiotic stewardship improvement opportunities in NICUs.