Objective This study was aimed to explore the intersection between organizational environment, workflow, and technology in pediatric emergency departments (EDs) and how these factors impact antibiotic prescribing decisions. Methods Semistructured interviews with 17 providers (1 fellow and 16 attending faculty), and observations of 21 providers (1 physician assistant, 5 residents, 3 fellows, and 12 attendings) were conducted at three EDs in the United States. We analyzed interview transcripts and observation notes using thematic analysis. Results Seven themes relating to antibiotic prescribing decisions emerged as follows: (1) professional judgement, (2) cognition as a critical individual resource, (3) decision support as a critical organizational resource, (4) patient management with imperfect information, (5) information-seeking as a primary task, (6) time management, and (7) broad process boundaries of antibiotic prescribing. Discussion The emerging interrelated themes identified in this study can be used as a blueprint to design, implement, and evaluate clinical decision support (CDS) systems that support antibiotic prescribing in EDs. The process boundaries of antibiotic prescribing are broader than the current boundaries covered by existing CDS systems. Incongruities between process boundaries and CDS can under-support clinicians and lead to suboptimal decisions. We identified two incongruities: (1) the lack of acknowledgment that the process boundaries go beyond the physical boundaries of the ED and (2) the lack of integration of information sources (e.g., accessibility to prior cultures on an individual patient outside of the organization). Conclusion Significant opportunities exist to improve appropriateness of antibiotic prescribing by considering process boundaries in the design, implementation, and evaluation of CDS systems.

The aim of this study is to enrich public health emergency management (PHEM) curricula and increase the workforce readiness of graduates through the implementation of an innovative curriculum structure centered around simulation and the creation of authentic learning experiences into a mastery-based Disaster Preparedness graduate certificate program launched in 2016 at the Colorado School of Public Health. Learners progress through a sequence of increasingly complex discussion and operations-based exercises designed to align with training methodologies used by future employers in the disaster response field, covering PHEM fundamentals and domestic and international disaster preparedness and response. Preliminary feedback is overwhelmingly positive, equating the experience to securing an internship. Embedding simulation-based exercises and authentic learning environments into graduate curricula exposes learners to diverse disaster scenarios, provides occasion for practicing critical thinking and dynamic problem solving, increases familiarity with anticipated emergency situations, and builds the confidence necessary for exercising judgment in a real-world situation. This novel curriculum should serve as a model for graduate programs wishing to enrich traditional training tactics using a typical school of public health support and alignment with community resources. (Disaster Med Public Health Preparedness. 2019;13:777–781)