The differences in antibiotic decision-making between acute surgical and acute medical teams: An ethnographic study of culture and team dynamics

摘要: Background Cultural and social determinants influence antibiotic decision-making in hospitals. We investigated compared cultural of acute medical surgical specialties. Methods An ethnographic observational study teams at a London teaching hospital was conducted (August 2015–May 2017). Data collection included 500 hours direct observations, face-to-face interviews with 23 key informants. A grounded theory approach, aided by Nvivo 11 software, analyzed the emerging themes. An iterative recursive process analysis ensured saturation The multiple modes enquiry enabled cross-validation triangulation findings. Results In medicine, accepted norms are characterized as collectivist (input from pharmacists, infectious disease, microbiology teams), rationalized, policy-informed, emphasis on de-escalation therapy. gaps medicine occur chiefly transition between emergency department inpatient teams, where ownership prescription is lost. In surgery, team priorities split 3 settings: operating room, outpatient clinic, ward. Senior surgeons often absent ward, leaving junior staff to make complex decisions. This results defensive decision-making, leading prolonged inappropriate use. Conclusions In legacy infection diagnosis made determines decision-making. perceived nonsurgical intervention that can be delegated or other specialties. Different, bespoke approaches optimize prescribing therefore needed address these specific challenges.