Background: Inappropriate use of antibiotics can lead to resistance, increased cost, and adverse outcomes and complications (Clostridium difficile infection, intravenous catheter-related, etc.). Procalcitonin (PCT) is a biomarker that has shown specificity for bacterial infection and its utility has been demonstrated when guiding antibiotic therapy in clinical algorithms for respiratory infections, sepsis, postoperative infections, and ventilator-associated pneumonia. However, cost effective use of this tool requires proper application by providers, and little is known regarding the attitudes and knowledge of providers using the test. Such insight can inform educational efforts and design of decision tools, such as order sets and bundles.
Methods: We evaluated our experience at the University of Michigan (UM) with PCT after initial deployment in October 2013 to identify deficiencies in providers’ knowledge of PCT result interpretation and application. We used internal electronic mailing lists to send a survey to UM providers among multiple specialties and training levels and included the survey link in a prominent location on patient care workstations. We provided incentive in the form of a lottery for prizes of nominal cash value.
Results: There were 284 survey responses—180 (63%) of responses were from faculty and approximately half of responses were from providers in the Department of Internal Medicine. Only 17 (6%) respondents had never heard of PCT, and 61 (21%) had heard of but had not used it.
There were 205 (72%) respondents who had previously ordered a PCT. 154 (76%) respondents felt that PCT availability improved patient care, and 183 (90%) were likely to order PCT again. They were split fairly evenly regarding the cost effectiveness of PCT. Knowledge varied, with only 53 (26%) of users answering all three knowledge based questions correctly. Even among respondents who answered 0/3 knowledge based questions correctly, 14 (7%) plan on ordering PCT in the future.
Conclusions: Procalcitonin is a useful tool for guiding the management of infections, with implications for antimicrobial stewardship and the cost of healthcare. Provider knowledge regarding the use of procalcitonin was variable, and these results can inform targeted interventions to improve awareness and appropriate utilization.