Current Studies

The EC-ID research program is currently conducting a number of ongoing studies funded by internal and external grants and awards:

Characterizing the ImPact of COVID-19 on Antibiotic PreScribing in AcutE Care and IDentifying Resilient Stewardship Strategies (POISED)

Funding:  AHRQ R01 $2.4 million

The POISED study will measure the impact of COVID-19 on overall and condition-specific antibiotic prescribing and bacterial resistance patterns in acute care settings using data from a diverse, nationally representative group of approximately 300 U.S. hospitals. Then, using a systems engineering-guided approach, the team will interview frontline healthcare providers and stewardship teams to characterize the factors underlying observed hospital antibiotic prescribing patterns and trends. These results will be used to develop an implementation toolkit for U.S.-based hospitals that will outline effective strategies to enhance antibiotic stewardship resiliency during operational upheaval.

To make this project successful, Dr. Pulia will partner with an interdisciplinary team of accomplished co-investigators and collaborators:

• Dr. Arjun Srinivasan, Associate Director for Healthcare-Associated Infections Prevention Programs, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Prevention and Control
• Dr. Melinda Neuhauser, Pharmacist and Acute Care Lead, Office of Antibiotic Stewardship, Centers for Disease Prevention and Control
• Dr. Peter Lindenauer, Director, Institute for Healthcare Delivery and Population Science at the University of Massachusetts-Baystate
• Dr. Penny Pekow, Supervisor of Biostatistics and Research Support, Baystate Medical Center
• Dr. Nicole Werner, Director, University of Wisconsin Institute for Healthcare Systems Engineering
• Dr. Aurora Pop-Vicas, Assistant Professor, University of Wisconsin Department of Medicine, Division of Infectious Diseases
• Dr. Lucas Schulz, Clinical Coordinator for Infectious Diseases, UW Health

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

Funding: AHRQ K08

Emergency department encounters for abscesses and cellulitis, the most commonly encountered skin and soft tissue infections, have more than tripled in the past two decades accounting for nearly 4 million visits annually. This increase coincides with the widespread emergence of infections caused by methicillin-resistant Staphylococcus aureus (MRSA), which are estimated to impose an annual economic burden of up to $13.8 billion in the U.S. Emergency department antibiotic use in the treatment of skin and soft tissue infections often fails to adhere to best practice clinical guidelines due to diagnostic errors (overuse) and incorrect selection (inappropriate use).

The overall objective of this project is to develop and test interventions that improves guideline adherent antibiotic use for ED patients with skin and soft tissue infections. This will be achieved using a mixed methods approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS), a human factors and systems engineering framework.

Improving Antibiotic Stewardship for Long Term Care Facility Residents Treated in the Emergency Department

Funding: Wisconsin Partnership Program new investigator grant

Residents of long-term care facilities (LTCFs) (primarily those > 65 years old with several comorbidities) have been identified as a priority population by the Agency for Healthcare Research and Quality (AHRQ) in part because they are particularly vulnerable to harm related to suboptimal medical care. Each year, over 2.5 million LTCF residents receive care in the ED, often for serious bacterial infections such as pneumonia, urinary tract infections and sepsis. Estimates of inappropriate antibiotic use in this patient population are as high as 75%. Atypical presentations, lack of definitions for infections, and inadequate data exchange during transitions of care may explain the suboptimal antibiotic use observed in this vulnerable population.

The overall objective of this project is to develop an intervention that can improve public health in Wisconsin by reducing inappropriate antibiotic use for LTCF patients in the ED. Given the complex nature of this clinical dilemma, we propose using a mixed methods approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS) framework to identify barriers and facilitators to appropriate antibiotic use for LTCF residents in the ED. This will effectively test our hypothesis that an evidence-based intervention can improve antibiotic for this vulnerable population.

The Role of Aspiration in Community Acquired Pneumonia

Funding: UW Office of the Vice Chancellor for Research and Graduate Education

Pneumonia is the most common infectious cause of mortality in older adults. Standard practice for older adults with pneumonia involves hospitalization and antibiotics. However, recent studies suggest that a significant portion of suspected community-acquired bacterial pneumonia cases may actually be due to distinct, dysphagia-related aspiration syndromes (e.g. aspiration pneumonia, pneumonitis). This study will utilize diagnostic imaging to generate a prevalence estimate for aspiration in older adults diagnosed with pneumonia or with suspected pneumonia for dysphagia, as well as determine rates of recurrent pneumonia in this population.

This study is being conducted in collaboration with Nicole Rogus-Pulia, PhD, CCC-SLP, Director of the Swallowing and Salivary Bioscience Laboratory within the UW Department of Medicine Division of Geriatrics.

Enhancing U.S. Surveillance of Laboratory Confirmed SARS-CoV-2, Influenza, and Other Respiratory Viruses through a Network of Emergency Departments

Funding: CDC / Wayne State University School of Medicine

This emergency department (ED) surveillance network led by Wayne State University School of Medicine is a national study on viral infections that present in emergency departments across the county. It comprises 24 nodes represented by site investigators at hospital systems in 21 states and the District of Columbia, and 100 hospitals for surveillance of viral infections. This work is funded by a contract from the Centers for Disease Control totaling $15.88 million with Wayne State as the prime.

The goal of the network is to identify patients who present with acute respiratory illness (e.g. cough or fever). The network report demographic data, vaccination status as identified in the medical record, medical history, viral and other laboratory testing results as well as admission and 30 day outcomes. The research team aims to determine the frequency of testing symptomatic patients for viral infections, such as COVID-19, the results of those tests, the outcomes and diagnoses of patients with known or suspected viral infections, and the associations of outcomes with vaccine status.

The study is based on the Registry of suspected COVID-19 in Emergency Care, or RECOVER, a large clinical registry of patients from 155 emergency departments in 27 states tested for SARS-CoV-2 from March to September 2020, in which Dr. Michael Pulia served as Site PI.

The project will run now through August 2024.