Admission Decisions in Emergency Department Chest Pain Patients at Low Risk for Myocardial Infarction: Patient Versus Physician Preferences

Davis, Mark A.; Keerbs, Amanda; Hoffman, Jerome R.; Baraff, Larry J.

doi:10.1016/s0196-0644(96)70081-1

Cited by 17 publications

(9 citation statements)

References 33 publications

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“…Patients' decisions are influenced by values and biases that may lead them to choose a course of action that is at odds with traditional scientific analyses of what is considered to be in their best interest, [10][11][12] and patients and physicians may disagree on preferred treatment options. 13…”

Section: Discussionmentioning

confidence: 99%

Impact of Patient Acuity on Preference for Information and Autonomy in Decision Making

Davis

Hoffman²,

Hsu

1999

Academic Emergency Medicine

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Abstract. Objectives:To test the hypotheses that ED patients' desires for medical information and for autonomy in decision making are inversely related to increasing acuity of illness, increasing age, and lower level of formal education. Methods: The authors conducted a prospective study of ED patients who presented for care during seven nonconsecutive 24-hour periods. Of 804 patients approached, 665 completed a questionnaire that was administered by a trained research assistant. Patients rated their desire for medical information, and for participation in medical decision making, on two 10-cm visual analog scales. Patient acuity level was determined in routine fashion by trained triage nurses, who were unaware of the nature of this study. Results: Desire for information was uniformly high, and did not vary statistically between triage groups (p = 0.41). The most acutely ill patients (level I) were more likely to be excluded by the research interviewer (p < 0.001). Of included level I patients, desire to participate was not decreased (p < 0.01). Higher level of formal education (p = 0.036) and younger age (p < 0.001) were associated with greater desire for autonomy in decision making. Conclusion: Among ED patients able to participate, higher acuity of illness was not associated with a decreased desire for medical information. Many very acutely ill patients preferred autonomy in medical decision making. Older patients and those with less formal education expressed a lesser desire for decision-making autonomy. Key words: patient acuity; patient preferences; autonomy; decision making; age; education. ACADEMIC EMERGENCY MEDICINE 1999; 6:781-785 P ATIENTS vary in their desire both to obtain information regarding their conditions and to participate in medical decision making.1-5 As physicians attempt to facilitate greater patient involvement in medical decision making, it is important to understand what factors influence patients' interest in being informed about, and being involved in, making such decisions.There is little information regarding integrating ED patient preferences into decisions about care. Although some believe that more acutely ill patients are less likely to desire medical information and decision-making autonomy than are less acutely ill patients, the impact of acuity of illness on patients' preference for involvement in medical decision making is in fact unknown. This study was designed to test the primary hypothesis that sicker patients would be less interested both in obtaining medical information and in participating in decision making. We also tested the secondary hy- METHODSStudy Design. This was a prospective study of ED patients' desire for medical information and autonomy in decision making. Eligible patients were administered a questionnaire that noted their desire for information and participation in decisions on a visual analog scale (VAS). The study was approved by the study hospital's Committee on Clinical Investigations. Study Population and Setting. Patients presenting for evaluati...

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Section: Discussionmentioning

confidence: 99%

Impact of Patient Acuity on Preference for Information and Autonomy in Decision Making

Davis

Hoffman²,

Hsu

1999

Academic Emergency Medicine

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“…This is highlighted by the perhaps surprising finding that when presented with relevant information, patients are often able to choose the path that is safest, involves the fewest procedures, and is least time‐consuming 16 . When asked about their preference and risk tolerance in a low‐risk chest pain scenario, 43% of patients preferred discharge compared to 3% of physicians 17 . Despite the clear preference of patients and parents of patients for topical anesthesia before peripheral IV placement, many clinicians do not provide this therapy, likely due to false perceptions of efficacy, patient preference, and delays in care 18 .…”

Section: Resultsmentioning

confidence: 99%

Interventions to Improve Patient-centered Care During Times of Emergency Department Crowding

Pham

Trueger

Hilton

et al. 2011

Academic Emergency Medicine

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Patient-centered care is defined by the Institute of Medicine (IOM) as care that is responsive to individual patient needs and values and that guides treatment decisions. This article is the result of a breakout session of the 2011 Academic Emergency Medicine consensus conference ''Interventions to Assure Quality in the Crowded Emergency Department'' and focuses on three broad domains of patient-centered care: patient satisfaction, patient involvement, and care related to patient needs.The working group provided background information and an overview of interventions that have been conducted in the domains of patient satisfaction, patient involvement (patients' preferences and values in decision-making), and patient needs (e.g., comfort, information, education). Participants in the breakout session discussed interventions reported in the medical literature as well as initiated at their institutions, discussed the effect of crowding on patient-centered care, and prioritized, in a two-step voting process, five areas of focus for establishing a research agenda for studying patient-centered care during times of crowding. The research priorities for enhancing patient-centered care in all three domains during periods of crowding are discussed. These include assessing the effect of other quality domains on patient satisfaction and determining the effects of changes in ED operations on patient satisfaction; enhancing patient involvement by determining the effect of digital records and health information technology (HIT); rapid assessment areas with focused patient-provider communication; and meeting patients' needs through flexible staffing, use of HIT to enhance patient communication, discharge instructions, and postdischarge telephone calls.

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“…In this study, if an undetectable presentation TnI had been used for decision making, four MI would have been missed (NPV 99.4% (98.4% to 99.8%)); however, approximately 60% of patients would have been eligible for early discharge. There is evidence of significant between-patient variation in risk tolerance for adverse events after ED chest pain assessment,14 of variation between physicians in risk tolerance15 and of mismatch between patient and physician risk tolerance 16. As 100% diagnostic accuracy is impossible and missed MI is among the most common malpractice claims in emergency medicine,17 building consensus about an acceptable level of risk would assist in developing effective and appropriate chest pain assessment pathways.…”

Section: Discussionmentioning

confidence: 99%

Does undetectable troponin I at presentation using a contemporary sensitive assay rule out myocardial infarction? A cohort study

Kelly

Klim²

2014

Emerg Med J

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Admission Decisions in Emergency Department Chest Pain Patients at Low Risk for Myocardial Infarction: Patient Versus Physician Preferences

Cited by 17 publications

References 33 publications

Impact of Patient Acuity on Preference for Information and Autonomy in Decision Making

Impact of Patient Acuity on Preference for Information and Autonomy in Decision Making

Interventions to Improve Patient-centered Care During Times of Emergency Department Crowding

Does undetectable troponin I at presentation using a contemporary sensitive assay rule out myocardial infarction? A cohort study

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