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A tale of two digital hospitals: A qualitative study of antimicrobial stewardship teams
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  • Bethany Van Dort,
  • Angus Ritchie,
  • Jonathan Penm,
  • Timothy Gray,
  • Amrita Ronnachit,
  • Melissa Baysari
Bethany Van Dort
The University of Sydney Faculty of Medicine and Health

Corresponding Author:bethany.vandort@sydney.edu.au

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Angus Ritchie
Sydney Local Health District
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Jonathan Penm
The University of Sydney
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Timothy Gray
Concord Repatriation General Hospital
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Amrita Ronnachit
Royal Prince Alfred Hospital
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Melissa Baysari
The University of Sydney Faculty of Medicine and Health
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Abstract

Aim: To examine and understand the work processes of AMS teams across two hospitals that use the same digital intervention, and to identify the challenges and enablers to effective AMS in each setting. Methods: Employing a contextual inquiry approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS) model, observations and semi-structured interviews were conducted with AMS team members (n=15) in two Australian hospitals. Qualitative data analysis was conducted, mapping themes to the SEIPS framework. Results: Both hospitals utilised similar systems, however, they displayed variations in AMS processes, particularly in post-prescription review, interdepartmental AMS meetings, and the utilisation of digital tools. An antimicrobial dashboard was available at both hospitals but was utilised more at the hospital where the AMS team members were involved in the dashboard’s development, and there were user champions. At the hospital where the dashboard was utilised less, participants were unaware of key features, and interoperability issues were observed. Establishing strong relationships between the AMS team and prescribers emerged as key to effective AMS at both hospitals. However, organisational and cultural differences were found, with one hospital reporting insufficient support from executive leadership, increased prescriber autonomy, and resource constraints. Conclusion: Organisational and cultural elements, such as executive support, resource allocation, and interdepartmental relationships, played a crucial role in achieving AMS goals. System interoperability and user champions further promoted the adoption of digital tools, potentially improving AMS outcomes through increased user engagement and acceptance.
24 Oct 2023Submitted to British Journal of Clinical Pharmacology
25 Oct 2023Submission Checks Completed
25 Oct 2023Assigned to Editor
25 Oct 2023Review(s) Completed, Editorial Evaluation Pending
25 Oct 2023Reviewer(s) Assigned
14 Nov 2023Editorial Decision: Revise Major