Inappropriate use of antibiotics in health care settings has been identified as a global public health threat due to an association with increasing rates of antibiotic resistant bacterial infections. In the emergency department (ED), antibiotics are the second most commonly prescribed type of medication and research continues to identify high rates of inappropriate prescribing in this setting.

Dr. Michael Pulia, assistant professor of emergency medicine

This also poses a great health threat to one of Wisconsin’s most vulnerable populations, residents of long-term care facilities (LTCF), many of whom seek care in the ED each year.

Dr. Michael Pulia, assistant professor of emergency medicine at the University of Wisconsin School of Medicine and Public Health, is examining how improving antibiotic stewardship in the emergency department can help lessen the threat of antibiotic resistance here in Wisconsin as well as reduce related health risks for residents in long-term care facilities.

Pulia, a recipient of a 2015 New Investigator Program award from the Wisconsin Partnership Program at the UW School of Medicine and Public Health, is drawing on his own experience as an emergency medicine clinician and the challenges both he and his colleagues face.

If our project can support ED providers by getting them the right tools, we will improve patient safety and reduce unnecessary antibiotic use, which will have a wide spectrum of impact on the health of Wisconsin residents.

Patients from long-term care facilities often seek emergency care due to serious bacterial infections such as pneumonia, urinary tract infections and sepsis. These patients are generally age 65 or over and have other health risk factors as well.

“From the clinician’s standpoint, these are often challenging encounters. We need to make important decisions with limited information,” said Pulia. “This can put LTCF patients at risk for less than ideal antibiotic use due to the lack of information and limited health history we receive upon their arrival.”

Compounded with that, there is often no streamlined process for information exchange during the transfer of care from the ED back to the long-term care facility.

“This poses even greater health and safety risks as this population is particularly vulnerable to complications like drug interactions, side effects from medication and serious infections like Clostridium difficile,” Pulia said.

Pulia’s project aims to improve antibiotic stewardship in the emergency department by creating an intervention toolkit that will improve prescribing, enhance information sharing during the transfer of care and help manage post-discharge antibiotic use. Through the use of qualitative interviews of ED and long-term care facility staff throughout the state, the project will obtain a wide range of perspectives on the processes taking place around antibiotic use both in the ED and the long-term care facilities.

Using this data, a conceptual model will be created to show how a resident in a long-term care facility moves through the ED and where gaps in information and care exist. The model will be used to design an intervention toolkit that will be tested at the UW Health Emergency Department and the respective long-term care facilities.

The toolkit will focus on a standardized transfer of data when antibiotics are used and provide clinical decision support through an electronic health record to improve decision making and antibiotic appropriateness. The project’s final recommendations and intervention toolkit is intended to be shared with other Wisconsin emergency departments.

Improved antibiotic use will improve the health of residents in long-term care facilities and their entire communities.

“LTCFs tend to be reservoirs of resistance,” said Pulia. “In fact, outbreaks within communities can often be traced back to these facilities. By lessening antibiotic resistance in these settings, we will be one step closer to reducing the antibiotic threat to everyone.”

The project’s goal is to assist the emergency department providers as well.

“If our project can support ED providers by getting them the right tools, we will improve patient safety and reduce unnecessary antibiotic use, which will have a wide spectrum of impact on the health of Wisconsin residents.”