Antimicrobial Stewardship in the ED: The Buck Stops Here

From Urgent Matters:

Emergency physicians have a unique vantage point to affect antimicrobial stewardship in inpatient and outpatient settings.

The initial choice of antibiotic in the Emergency Department (ED) has important downstream implications. ED clinicians routinely prescribe antimicrobials for patients with skin and soft-tissue infections, urinary tract infections, bloodstream infections, as well as upper and lower respiratory infections. Broad-spectrum antibiotics are sometimes overused in EDs and other ambulatory settings, and in observational studies have shown significant overprescribing for acute bronchitis and other conditions.

Antimicrobial stewardship in ED settings is particularly challenging due to the high rates of ED crowding, the rapid rate of patient turnover, the need for quick decisions without consultation, the shift-based scheduling format of providers, and higher staff turnover rates than in other clinical settings. In addition, there are provider-centered factors that impact stewardship. This includes a perceived lack of efficacy, concerns about resource availability and reimbursement, as well as perceived hindrance to operational efficiency. Providers are also concerned about medical liability and patient satisfaction, which has shown to be an important facet of antibiotic prescription in the ED.

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