Decision Making by Emergency Room Physicians and Residents

Abstract

Clinical decision-making is complex and uncertain and is dependent on accurate and timely information that is typically managed through Information Technology (IT) solutions. One particular class of IT solution that is becoming increasingly prevalent in the medical community is Clinical Decision Support Systems (CDSS). Decision models in CDSS are typically constructed from expert knowledge and are often reliant on inputs that are difficult to obtain and are reliant on tacit knowledge that only experienced clinicians possess. Research described in this paper uses empirical results from a clinical trial of a CDSS with a decision model based on expert knowledge to show that there are differences in how clinician groups of the same specialty, but different level of expertise, elicit necessary CDSS input variables and use said variables in their clinical decisions. Using kappa analysis and logistic regression this paper reports that novice clinicians have difficulty eliciting CDSS input variables that require physical examination, yet they still use these incorrectly elicited variables in making their clinical decisions. Implications for the design of CDSS are discussed.