Title | Vignettes Identify Variation in Antibiotic Use for Suspected Early Onset Sepsis. |
Publication Type | Journal Article |
Year of Publication | 2021 |
Authors | Payton KSE, Wirtschafter D, Bennett MV, Benitz WE, Lee HC, Kristensen-Cabrera A, Nisbet CC, Gould J, Parker C, Sharek PJ |
Journal | Hosp Pediatr |
Volume | 11 |
Issue | 7 |
Pagination | 770-774 |
Date Published | 2021 07 |
ISSN | 2154-1671 |
Keywords | Anti-Bacterial Agents, Antimicrobial Stewardship, Female, Humans, Infant, Newborn, Intensive Care Units, Neonatal, Neonatal Sepsis, Pregnancy, Sepsis |
Abstract | 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. |
DOI | 10.1542/hpeds.2020-000448 |
Alternate Journal | Hosp Pediatr |
PubMed ID | 34083354 |