Association of Tolerance of Uncertainty With Outcomes in a Quality Improvement Collaborative

Abstract

BACKGROUND: Tolerance of uncertainty may influence how physicians and other providers practice and make clinical decisions. We hypothesized that increased tolerance of uncertainty would be associated with an increased uptake of a quality improvement (QI) intervention. METHODS: We examined tolerance of uncertainty using the Physicians’ Reactions to Uncertainty Scale in the context of a national QI project in the Value in Inpatient Pediatrics network. The QI project aimed to increase exclusive isotonic fluid use and decrease laboratory draws. Exposure to the intervention was measured by using the stepped wedge design with sequential implementation across a diverse group of US hospitals. Multivariable analysis was conducted by using exposure to the intervention and tolerance of uncertainty as independent variables and exclusive isotonic fluid use or laboratory testing as the dependent variable. RESULTS: Of 106 participating hospitals, 97 contributed valid responses, with an overall mean reported tolerance of uncertainty of 3.39 (95% confidence interval: 3.27–3.50), with lower numbers on the 6-point scale indicating greater tolerance of uncertainty. Exposure to the QI intervention was significantly associated with exclusive isotonic fluid use (P <.001). Lower tolerance of uncertainty at baseline was associated with lower baseline isotonic fluid use and greater uptake of the use of isotonic fluids but not reduction in laboratory testing. CONCLUSIONS: Contrary to our hypothesis, lower tolerance of uncertainty was associated with greater uptake of the QI intervention for the outcome of isotonic fluids. This initial association warrants further study to evaluate how tolerance of uncertainty plays a role in quality improvement science.

Factors Associated With Inpatient Subspecialty Consultation Patterns Among Pediatric Hospitalists

“…However, we observed higher odds or consultation among physicians with 0 to 2 years of attending physician experience vs 3 to 10 years (odds ratio [OR], 1.42 [95% CI, 1.08-1.88]; P = .01), among male patients (OR, 1. 22…”

“…The instrument uses validated scales to measure physician tolerance of uncertainty that uses subscales to measure (1) anxiety due to uncertainty, (2) concern about bad outcomes, (3) reluctance to disclose uncertainty to patients, and (4) reluctance to disclose mistakes to physicians (eTable 1 in Supplement 1). As physician anxiety due to uncertainty was the construct among the PRU scales we conceptualized as most related to consultation use, we specifically evaluated responses to this construct, consistent with a prior study of uncertainty tolerance among pediatric hospitalists . The anxiety due to uncertainty scale ranges from 6 to 30, with higher scores indicating greater anxiety.…”

“…18,21 As physician anxiety due to uncertainty was the construct among the PRU scales we conceptualized as most related to consultation use, we specifically evaluated responses to this construct, consistent with a prior study of uncertainty tolerance among pediatric hospitalists. 22 The anxiety due to uncertainty scale ranges from 6 to 30, with higher scores indicating greater anxiety.…”