1024. Provider Attitudes and Behaviors for Antibiotic Prescribing in the Emergency Department (ED)
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C

The Emergency Department (ED) is a critical site to address reducing inappropriate antimicrobial use.  Targeted messaging and decision support tools may promote adherence to clinical practice guidelines; however, there is a paucity of literature on ED provider knowledge, attitudes and behaviors (KAB) regarding antimicrobial prescribing.  We sought to assess ED provider KAB for antimicrobial prescribing.


A survey-based study of ED clinicians (attending physicians, emergency medicine residents, and midlevel providers) recruited from seven academic sites. The survey instrument was modified from prior surveys on antimicrobial stewardship[1],[2] and administered via RedCap, a secure web application. SAS 9.2 was used for all analyses.
One hundred seven providers (32%) responded. Eighty nine percent of attendings and 56% of residents felt antibiotics were overused in the ED.  Although 48% of ED physicians did not think they overprescribe antibiotics, 71% felt they did not get feedback on their prescribing patterns and outcomes.  A greater proportion of residents (88% vs 55% of attendings) use a Smartphone for drug selection.  Only 33% use antibiograms to make decisions.  Fifty one percent would definitely use an online decision support tool for antibiotic selection if available and 47% would use it if embedded in the EHR. 

ED attending physicians are more aware of the problem of antibiotic overuse and resistance than residents. Most clinicians in the ED support the use of electronic decision-making tools for antibiotic selection.  Differences in how trainees access information may necessitate multiple strategies to reduce inappropriate prescribing in academic EDs. Further research should focus on ED- tailored interventions to address antibiotic overuse. 


[1] Srinivasan A, Song X, Richards A, Sinkowitz-Cochran R, Cardo D, Rand C. A survey of knowledge, attitudes, and beliefs of house staff physicians from various specialties concerning antimicrobial use and resistance.  Arch Intern Med. 2004 Jul 12;164(13):1451-6.

[2] Abbo L, Sinkowitz-Cochran R, Smith L, Ariza-Heredia E, Gómez-Marín O, Srinivasan A, Hooton TM.  Faculty and resident physicians' attitudes, perceptions, and knowledge about antimicrobial use and resistance.Infect Control Hosp Epidemiol. 2011;32(7):714-8.

Larissa May, MD, MSPH1, Gillian Brooks2, Paige Armstrong, MD, MS1, Rahul Bhat, MD3, Gregory Moran, MD4, Kristen Breslin, MD, MPH5, Lisa Schwartz, EdD6, Sara Cosgrove, MD, MS, FIDSA, FSHEA7, Richard Rothman, MD, PhD8 and Cynthia Rand, PhD9, (1)Emergency Medicine, The George Washington University, Washington, DC, (2)The George Washington University, Washington, DC, (3)Emergency Medicine, Georgetown University, Washington, DC, (4)David Geffen School of Medicine at UCLA, Los Angeles, CA, (5)Emergency Medicine, Children's National Medical Center, Washington, DC, (6)Health Sciences, The George Washington University, Washington, DC, (7)The Johns Hopkins Medical Institutions, Baltimore, MD, (8)Johns Hopkins Medical Institute, Baltimore, MD, (9)Johns Hopkins University, Baltimore, DC


L. May, None

G. Brooks, None

P. Armstrong, None

R. Bhat, None

G. Moran, None

K. Breslin, None

L. Schwartz, None

S. Cosgrove, Novartis: Consultant, Consulting fee
Cubist: Grant Investigator, Research grant
AdvanDx: Grant Investigator, Research grant
Pfizer/The Joint Commission: Grant Investigator, Grant recipient

R. Rothman, None

C. Rand, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.