A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

Zatorski, Catherine; Zocchi, Mark S.; Cosgrove, Sara E.; Rańd, Cynthia S.; Brooks, Gillian; May, Larissa

doi:10.1186/s12879-016-1972-6

Cited by 35 publications

(19 citation statements)

References 29 publications

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“…Even though admission to hospital with a UTI is common, adherence to antibiotic guidelines around the world is comparable. A 2016 US study in Washington DC prospectively reviewed 103 admissions to an emergency department and found that 36.9% of cases of cystitis and pyelonephritis received guideline‐adherent treatment . Similar results were found in a study conducted in Denmark in 2017, which found 37.5% adherence among 96 patients…”

Section: Discussionsupporting

confidence: 56%

Diagnostic accuracy and adherence to treatment guidelines in adult inpatients with urinary tract infections in a tertiary hospital

Chen

Duffy

Ritchie

et al. 2019

Pharmacy Practice and Res

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Background: Antibiotic prescribing for patients with urinary tract infections (UTIs) is often inconsistent with published guidelines. Pharmacists have a key role in the multidisciplinary team to improve the prescribing of antibiotics. Aim: This study determined the reasons for low guideline adherence and investigated the effects of a pharmacist-led, non-confrontational, inexpensive educational intervention on guideline adherence in adult inpatients with UTIs. Methods: The study was performed in three general medical wards in Auckland City Hospital (ACH), New Zealand, during March-September 2015. All patients treated for UTIs were identified by ward pharmacists. A pre-intervention observation period was followed by an intervention period in which ward pharmacists placed a simple diagnostic and treatment algorithm in the clinical records of all patients being treated for a UTI. Clinical and laboratory data available at the time initial antibiotic therapy was prescribed were used to determine a retrospective diagnosis for each patient. The initial antibiotic therapy was evaluated for adherence to the ACH antibiotic guidelines in relation to both the prescriber's and retrospective diagnosis. Results: Overall, the prescriber's diagnosis was concordant with the retrospective diagnosis in only 48 of 141 episodes (34%). Treatment was adherent to guidelines in 27% pre-intervention and 33% intervention episodes (p = 0.5). Conclusion: Inaccurate clinical diagnosis in patients with UTIs was a common reason for antibiotic treatment to be non-adherent to guidelines. The study failed to find an association between the educational intervention and an effect on guideline adherence. Passive interventions are unlikely to be effective and further interventions should consider codesign with users.UTIs: diagnostic accuracy and adherence to treatment guidelines c 'Other' diagnosis includes cellulitis, collapse, dehydration, shingles and upper respiratory tract infection.

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Section: Discussionsupporting

confidence: 56%

Diagnostic accuracy and adherence to treatment guidelines in adult inpatients with urinary tract infections in a tertiary hospital

Chen

Duffy

Ritchie

et al. 2019

Pharmacy Practice and Res

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“…La mayoría de los estudios acerca de la adecuación del tratamiento antibiótico se han realizado en el paciente hospitalizado. Según estos estudios previos, se considera que entre el 20% y el 50% de las prescripciones antibióticas en el paciente hospitalizado son inapropiadas o innecesarias [16]. Otros trabajos realizados en esta área demuestran, además, que la no adherencia a guías de práctica clínica, el uso de antimicrobianos con un espectro más amplio del necesitado y la duración excesiva de tratamientos son frecuentes [6,7].…”

Section: Discussionunclassified

Adequacy of the special category antibiotics prescriptions in the Emergency Department of a third level urban Hospital

Osorio¹,

Fresco²,

Monclús³

et al. 2020

Rev Esp Quimioter

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Objective. The aim of the study was to analyze the adequacy of the special category antibiotics prescriptions in the Emergency Department (ED) of a third level urban Hospital. Material and methods. A random sample of 100 different patients who were started with a special category antibiotic along 2018 in the ED was selected. The research team reviewed the medical history of the emergency and admission episode. The independent factors associated with the degree of adequacy of the treatment were determined by logistic regression. Results. A total of 97 prescriptions were analyzed of which 66 (68%) met the criteria of adequate prescription, 23 (24%) adequate prescription, but with equally recommended alternatives and 8 (8%) were inappropriate prescriptions. The degree of adequacy was 70% if the infection was related to healthcare and 75% if the patient had risk factors for multiresistant (MR) microorganisms' infection. The percentage of adequacy was higher in the cases in which the focus of the infection (72%) and the severity of the episode (73%) were specified. The independent variables that were associated with an adequate prescription were: the presence of risk factors for MR microorganisms' infection (OR: 2.35 95% CI: 1.65-3.17 p: 0.01), if the focus of the infection (OR: 3.79 95% CI: 1.72-4.22 p: 0.02) and the severity of the episode (OR: 3.09 95% CI: 1.12-3.09 p: 0.03) were specified. Conclusions. The prescription of special category antibiotics in ED is appropriate if the clinical guidelines are followed and if the setting of infection acquisition, the risk factors of MR microorganisms, the focus and the severity of infection are taken into account in clinical picture.

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“…19 This shows that physicians in the pediatric ED tend to deviate from recommendations within CPGs. 15,20,21…”

Section: Introductionmentioning

confidence: 99%

“…19 This shows that physicians in the pediatric ED tend to deviate from recommendations within CPGs. 15,20,21 Multiple publications have evaluated the impact of the AAP bronchiolitis guideline on diagnostic testing and therapeutic management of bronchiolitis at a systemic, resource intensive, intrahospital level through chart review. However, there are a limited number of studies that evaluate physicians' attitudes and beliefs in relation to compliance with bronchiolitis guidelines, or the barriers that preclude their successful use.…”

Section: Introductionmentioning

confidence: 99%

Physician Compliance With Bronchiolitis Guidelines in Pediatric Emergency Departments

Rivera-Sepúlveda

Rebmann

Gerard

et al. 2019

Clin Pediatr (Phila)

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An online survey was administered through the American Academy of Pediatrics (AAP) Section of Emergency Medicine Survey Listserv in Fall, 2017. Overall compliance was measured as never using chest X-rays, viral testing, bronchodilators, or systemic steroids. Practice compliance was measured as never using those modalities in a clinical vignette. Chi-square tests assessed differences in compliance between modalities. t tests assessed differences on agreement with each AAP statement. Multivariate logistic regression determined factors associated with overall compliance. Response rate was 47%. A third (35%) agreed with all 7 AAP statements. There was less compliance with ordering a bronchodilator compared with chest X-ray, viral testing, or systemic steroid. There was no association between compliance and either knowledge or agreement with the guideline. Physicians with institutional bronchiolitis guidelines were more likely to be practice compliant. Few physicians were compliant with the AAP bronchiolitis guideline, with bronchodilator misuse being most pronounced. Institutional bronchiolitis guidelines were associated with physician compliance.

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A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

Cited by 35 publications

References 29 publications

Diagnostic accuracy and adherence to treatment guidelines in adult inpatients with urinary tract infections in a tertiary hospital

Diagnostic accuracy and adherence to treatment guidelines in adult inpatients with urinary tract infections in a tertiary hospital

Adequacy of the special category antibiotics prescriptions in the Emergency Department of a third level urban Hospital

Physician Compliance With Bronchiolitis Guidelines in Pediatric Emergency Departments

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