A new study highlighting how clinicians’ beliefs can influence the application of rapid molecular diagnostics in intensive care has suggested a new ‘behaviourally intelligent’ approach to prescribing.
Clinicians acknowledged the importance of rapid molecular diagnostic testing, which can facilitate earlier refinement of antimicrobial therapy and improve antimicrobial stewardship.
However, the study showed that the results of the tests were often not acted on – a phenomenon the researchers described as following ‘mindlines’, which they said related to informal, experience-based knowledge rather than official guidelines.
The researchers found that the test had a limited impact on prescribing decisions. Clinicians reported concerns about the potential consequences of undertreatment to both the patient and prescriber. These concerns often outweigh antimicrobial stewardship considerations and sometimes led to ‘just-in-case’ antibiotic prescriptions.
The study was embedded within the INHALE trial, which examines the use of the BioFire FilmArray Pneumonia Panel (Pneumonia Panel) for antibiotic prescribing in hospital-acquired and ventilator-associated pneumonia (HAP/VAP) in UK intensive care units.
Rapid molecular diagnostics less effective
The researchers conducted semi-structured interviews with 20 intensive care clinicians to determine which factors affected antibiotic prescribing decisions.
Clinicians frequently prioritised personal experience and clinical judgment over test results, adopting an approach of ‘treat the patient, not the result’. Even when tests showed the de-escalation of antibiotics as appropriate, many clinicians took a cautious approach and maintained antibiotic coverage to mitigate perceived risks.
The findings illustrated a tension between prescribing guidelines and ‘mindlines’. They also highlighted the limitations of relying solely on technological solutions like rapid molecular diagnostics to influence prescribing.
The researchers suggested that a ‘technology plus’ approach that is ‘behaviourally intelligent’ would be more effective. The new approach would recognise that clinicians face challenges that can be both cognitive and systematic when applying technological solutions to patient care.
The study highlighted the complexities of clinical decision-making in intensive care units. While rapid molecular diagnostics can improve antimicrobial stewardship, the potential of such tests is constrained if clinicians’ beliefs, emotions and the wish to save lives – which are often key drivers of their antibiotic prescribing – are not understood or accounted for.
Successful implementation of this new approach requires that new technologies and guidelines be behaviourally intelligent and aligned with clinicians’ work methods, the researchers concluded.
Reference
Stewart, S.F. et al. Guidelines vs mindlines: a qualitative investigation of how clinicians’ beliefs influence the application of rapid molecular diagnostics in intensive care. Antimicrob Agents Chemother. 2025, Feb. 05: DOI: 10.1128/aac.01156-24.
