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

项目摘要/摘要 这份职业发展提案旨在为急诊医学专家迈克尔·普利亚博士提供 在威斯康星大学医学院和公共卫生学院，成功所需的培训 一位独立的内科医生兼科学家，研究干预措施以改善美国对传染病的护理 急诊科(ED)。在医疗保健环境中不适当地使用抗生素是一种全球公共卫生 由于抗生素耐药性细菌感染率的增加而造成的威胁。另外， 由于严重不良药物事件的风险，抗生素的过度使用对患者的安全构成了重大的担忧。 如过敏反应和艰难梭菌腹泻。教育署愈来愈成为 这里开出的医疗保健系统和抗生素对住院患者和 门诊设置。急诊室也被确定为临床环境中发病率最高的 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ED中，脓肿和蜂窝织炎在高达90%的情况下没有遵守最佳实践指南。 不幸的是，在对适当的障碍和促进者的认识上存在很大差距。 急诊科的抗生素使用情况。这种缺乏理解反映在缺乏抗生素的管理上 为ED量身定做的干预措施。拟议研究的总体目标是开发证据-- 基于干预捆绑包改善皮肤和软组织ED患者指南依从性抗生素的使用 组织感染。鉴于这一临床难题的复杂性，研究方法将以 创新的概念框架，在其他医疗安全和质量方面取得了成功 改善措施，患者安全系统工程计划(SEIPS)。SEIPS模型是 旨在系统地确定影响医疗服务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，将采用混合方法来解决以下问题 具体目标：1)确定高影响障碍和促进者，以指导坚持使用抗生素 急诊室皮肤软组织感染的治疗；2)制定急诊室抗生素管理干预方案 针对高影响障碍和促进者的捆绑，然后利用专家关键利益攸关方的投入进行改进； 3)实施抗生素管理干预捆绑，并衡量其对指南依从者的影响 在学术教育中使用抗生素治疗皮肤和软组织感染。作为一家机构的初级教员 拥有广泛的基础设施来支持早期调查人员，普利亚博士处于理想的环境中 完成建议的研究并继续进行高级培训。他的职业发展计划包括这两项 在人的因素和医疗保健系统工程领域的课程工作和指导培训， 定性方法、干预性卫生服务和领导/变革管理。为了确保成功， 他已经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.