Vignettes Identify Variation in Antibiotic Use for Suspected Early Onset Sepsis

Author:

Payton Kurlen S. E.12,Wirtschafter David3,Bennett Mihoko V.24,Benitz William E.4,Lee Henry C.24,Kristensen-Cabrera Alexandria2,Nisbet Courtney C.2,Gould Jeffrey24,Parker Colin5,Sharek Paul J.267

Affiliation:

1. Division of Neonatology, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California;

2. California Perinatal Quality Care, Collaborative, Stanford, California;

3. Perinatal Quality Improvement Panel Research Committee, Stanford, California;

4. Divisions of Neonatology and

5. David Geffen School of Medicine, University of California Los Angeles, Los Angeles California; and

6. Hospitalist Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford California;

7. Division of General Pediatrics and Hospital Medicine, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington

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.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics,General Medicine,Pediatrics, Perinatology, and Child Health

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