Table 3

Supporting quotations for clinician perceptions theme

SubthemeSupporting quotations
Necessity to protect patients

1. “I mean she has already gone on meropenem. So, it might be that it was keeping something [infection] at bay. And then it has been stopped. And that infection has re-developed.” —P57, middle-grade trainee, hospital 3, VBI
2. “I think a four days’ course of antibiotics is going to lead to resistance if anything because he’s not completed a full course […] In this situation there’s not really been a bug, so I think a seven-day minimum [course] would be appropriate.” —P22, middle-grade trainee, hospital 3, VBI
3. “Maybe they’ve got a minor infection, it will self-resolve without any antibiotics, but maybe [with antibiotics] you’ll get an extra day or so where the patient is now considered safe for discharge. And so, you’ve accelerated the discharge and so there’s a whole process of flowing the patient through the hospital and progressing them. And ultimately not exposing them to an environment in which they are at risk of actually picking up a nosocomial infection.” —P43, consultant, hospital 1, VBI
Necessity to protect clinicians
4. “One of the questions that I was grilled on in the Coroner’s court last Monday was ‘Why are we stopping antibiotics? If he had such a bad infection, why did we stop the antibiotics?’” —P28, consultant, hospital 1, FG
5. “I don’t know if you’ve heard about the Sepsis Six? […] if you decided not to start antibiotics, I don’t know where you would stand, I don’t think you would have a leg to stand on at all.” —P10, consultant, hospital 2, FG
Antibiotic-related concerns not prioritised

6. “[…] when I have a patient, and the patient is deteriorating, I just focus on that patient. I don’t think, ‘What’s the impact of starting this or that antibiotic on the whole ecology of the unit?’ I don’t bother because, to be honest, my focus is that patient.” —P1, consultant, hospital 3, VBI
7. “[…] we’re creating our own monster [antimicrobial resistance] because we’re throwing around antibiotics.” —P11, consultant, hospital 1, FG
8. “I’d want them to have antibiotics. Despite the fact that there is this theoretical risk of resistance.” —P36, consultant, hospital 2, VBI
Being brave vs being burnt

9. “It can be, sometimes, more helpful to start with a more focused [narrower spectrum] antibiotic rather than muddle the picture with empirical antibiotics. But that takes a certain amount of bravery.” —P3, early-career trainee, hospital 1, VBI
10. “So, I, my gut feeling, so I’m 70% certain he doesn’t need antibiotics now.” —P6, consultant, hospital 3, VBI
11. “Maybe I’m not yet at the stage where I’d be brave enough to start nothing [no antibiotics]. I would like to be. I think we give far too many antibiotics. But I’m probably not at that stage yet. […] Probably, in this particular instance, I don’t think you’d be able to get away with not starting antibiotics at all. Because she’s become so unwell, she’s intubated. I think what makes you more brave in your decision-making is experience.” —P35, middle-grade trainee, hospital 2, VBI
12. “There’s definitely cases where you’re brave until you’re burnt and then you stop being brave. And you only have to have one, I had one recently where I just didn’t spot it as being sepsis and the guy died overnight.” —P48, consultant, hospital 1, FG
  • FG, focus group; VBI, vignette-based interview.