# Improving Antibiotic Stewardship During The Treatment of Skin and Soft Tissue Infections in The Emergency Department: A Human Factors and Systems Engineering Approach

> **NIH AHRQ K08** · UNIVERSITY OF WISCONSIN-MADISON · 2020 · $160,164

## Abstract

Project Summary/Abstract
This career development proposal is designed to provide Dr. Michael Pulia, an Emergency Medicine specialist
at the University of Wisconsin School of Medicine and Public Health, with the training required for success as
an independent, physician-scientist researching interventions to improve the care of infectious diseases in the
emergency department (ED). Inappropriate use of antibiotics in healthcare settings is a global public health
threat due to an association with increasing rates of antibiotic resistant bacterial infections. Additionally,
antibiotic overuse poses a significant patient safety concern due to the risk of serious adverse drug events
such as anaphylaxis and Clostridium difficile diarrhea. The ED increasingly functions as the de facto center of
the healthcare system and antibiotics prescribed here have significant downstream effects in both inpatient and
outpatient settings. The ED has also been identified as the clinical environment with the highest rates of
inappropriate antibiotic use. For example, antibiotic use for common skin and soft tissue infections, such as
abscesses and cellulitis, in the ED fails to adhere to best practice guidelines in up to 90% of cases.
Unfortunately, there are significant gaps in knowledge regarding the barriers to and facilitators of appropriate
antibiotic use in the ED. This lack of understanding is reflected by the absence of antibiotic stewardship
interventions tailored for the ED. The overall objective of the proposed research is to develop an evidence-
based intervention bundle that improves guideline adherent antibiotic use for ED patients with skin and soft
tissue infections. Given the complex nature of this clinical dilemma, the research approach will be guided by an
innovative conceptual framework which has demonstrated success in other healthcare safety and quality
improvement initiatives, the Systems Engineering Initiative for Patient Safety (SEIPS). The SEIPS model is
designed to systematically identify all elements of the healthcare system that impact care delivery and patient
outcomes. To achieve the overall goal, a mixed methods approach will be applied to address the following
specific aims:1) Identify high impact barriers and facilitators to guideline adherent antibiotic use for the
treatment of skin and soft tissue infections in the ED; 2) Design an ED antibiotic stewardship intervention
bundle targeted to high impact barriers and facilitators then refine it using input from expert key stakeholders;
3) Implement an antibiotic stewardship intervention bundle and measure its impact on guideline adherent
antibiotic use for skin and soft tissue infections in an academic ED. As a junior faculty member at an institution
with extensive infrastructure to support early stage investigators, Dr. Pulia is in an ideal environment to
complete the proposed research and pursue advanced training. His career development plan includes both
coursework and mentored training ...

## Key facts

- **NIH application ID:** 9965902
- **Project number:** 5K08HS024342-05
- **Recipient organization:** UNIVERSITY OF WISCONSIN-MADISON
- **Principal Investigator:** Michael Santino Pulia
- **Activity code:** K08 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $160,164
- **Award type:** 5
- **Project period:** 2016-07-06 → 2021-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9965902

## Citation

> US National Institutes of Health, RePORTER application 9965902, Improving Antibiotic Stewardship During The Treatment of Skin and Soft Tissue Infections in The Emergency Department: A Human Factors and Systems Engineering Approach (5K08HS024342-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9965902. Licensed CC0.

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