How the Availability of Observation Status Affects Emergency Physician Decisionmaking - 19/09/18
, Graham P. Martin, PhD b, Azeemuddin Ahmed, MD, MBA c, Jay Banerjee, MBBS, MEd d, Suzanne Mason, MBBS, MD f, Damian Roland, MBBS, PhD eAbstract |
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.
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| Please see page 402 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: David L. Schriger, MD, MPH |
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| Author contributions: BW, GPM, JB, and DR conceived the study and obtained research funding. AA, JB, SM, and DR recruited study participants. BW and GPM conducted the interviews and analyzed the data. BW drafted the article, and all authors contributed substantially to its revision. BW takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. This study was supported by a University of Iowa College of Public Health Faculty Development Grant for Global Public Health Research. Dr. Martin was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands. |
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| The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health. The funding sources had no role in this study. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 72 - N° 4
P. 401-409 - octobre 2018 Retour au numéro
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