Brad Wright1, Graham P Martin2, Azeemuddin Ahmed3, Jay Banerjee4, Suzanne Mason5, Damian Roland6. 1. Department of Health Management and Policy, University of Iowa, Iowa City, IA. Electronic address: brad-wright@uiowa.edu. 2. SAPPHIRE Group, Department of Health Sciences, University of Leicester, Leicester, UK. 3. Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. 4. Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, UK. 5. School of Health and Related Research, University of Sheffield, Sheffield, UK. 6. Pediatric Emergency Medicine Academic Group, University Hospitals of Leicester NHS Trust, Leicester, UK.
Abstract
STUDY OBJECTIVE: This study seeks to understand how emergency physicians decide to use observation services, and how placing a patient under observation influences physicians' subsequent decisionmaking. METHODS: We conducted detailed semistructured interviews with 24 emergency physicians, including 10 from a hospital in the US Midwest, and 14 from 2 hospitals in central and northern England. Data were extracted from the interview transcripts with open coding and analyzed with axial coding. RESULTS: We found that physicians used a mix of intuitive and analytic thinking in initial decisions to admit, observe, or discharge patients, depending on the physician's individual level of risk aversion. Placing patients under observation made some physicians more systematic, whereas others cautioned against overreliance on observation services in the face of uncertainty. CONCLUSION: Emergency physicians routinely make decisions in a highly resource-constrained environment. Observation services can relax these constraints by providing physicians with additional time, but absent clear protocols and metacognitive reflection on physician practice patterns, this may hinder, rather than facilitate, decisionmaking.
STUDY OBJECTIVE: This study seeks to understand how emergency physicians decide to use observation services, and how placing a patient under observation influences physicians' subsequent decisionmaking. METHODS: We conducted detailed semistructured interviews with 24 emergency physicians, including 10 from a hospital in the US Midwest, and 14 from 2 hospitals in central and northern England. Data were extracted from the interview transcripts with open coding and analyzed with axial coding. RESULTS: We found that physicians used a mix of intuitive and analytic thinking in initial decisions to admit, observe, or discharge patients, depending on the physician's individual level of risk aversion. Placing patients under observation made some physicians more systematic, whereas others cautioned against overreliance on observation services in the face of uncertainty. CONCLUSION: Emergency physicians routinely make decisions in a highly resource-constrained environment. Observation services can relax these constraints by providing physicians with additional time, but absent clear protocols and metacognitive reflection on physician practice patterns, this may hinder, rather than facilitate, decisionmaking.
Authors: Arthur S Hong; Thomas Froehlich; Stephanie Clayton Hobbs; Simon J Craddock Lee; Ethan A Halm Journal: J Oncol Pract Date: 2019-04-25 Impact factor: 3.840