Decision-making in crisis resolution and home treatment teams: The AWARE framework

Abstract

Aims and methodThe aim of the study is to improve patient safety by identifying factors influencing gatekeeping decisions by crisis resolution and home treatment teams. A theoretical sampling method was used to recruit clinicians. Semi-structured interviews to elicit various aspects of clinical decision-making were carried out. The transcripts were thematically analysed using a grounded theory approach.ResultsPatient needs (safety and treatment) was the primary driver behind decisions. The research also revealed that information gathered was processed using heuristics. We identified five key themes (anxiety, weighting, agenda, resource and experience), which were constructed into an acronym ‘AWARE’.Clinical implicationsAWARE provides a framework to make explicit drivers for decision-making that are often implicit. Incorporating these drivers into reflective practice will help staff be more mindful of undue influences and result in improved clinical decisions.Declaration of interestNone.

PROTECT: Relational safety based suicide prevention training frameworks

“…Managing the inherent tensions in decision‐making particularly between managing risk and supporting recovery is central to the model. As we will illustrate, it is supported by the literature in suicide research and work undertaken by our team on clinical decision‐making (KarRay et al , ; Lombardo et al , ). We now provide a critical appraisal of the key clinical challenges to contextualize the proposed solution and benefit realization from PROTECT.…”

“…In a previous qualitative study in the crisis resolution and home treatment team of 333, we conducted 18 interviews with frontline nurses and social workers immediately postassessment. We found that while during the assessment, clinicians collated considerable information, these assessment findings were not processed uniformly (Lombardo et al , ). Individuals with similar need and risk profiles got different treatments that varied from inpatient stay to signposting to nongovernmental agencies.…”

“…Our previous study showed that clinicians have a dual role in the assessment of suicidal crisis. The obvious one is to assess the risk, but the assessor is also expected to contain anxiety through instillation of hope and safety reassurances (Lombardo et al , ). The second role could be at cross‐purposes to risk exploration which often reveals anxiety increasing dynamic factors that are difficult to predict and manage.…”

“…Beyond the tipping point, anxiety was contained through conservative options such as inpatient stay in people with similar presentation to those receiving management in the community. The thinking behind these restrictive decisions revealed the converse justification process in which protective factors were minimized and perpetuating factors were maximized (Lombardo et al , ).…”

“…However, often before formulation, a hypothesis about appropriate response begins to emerge in the assessor's mind and at a certain point crystallizes as fact. From then on, all clinical activity gets unconsciously skewed to confirm the desired outcome (Lombardo et al , ). This might influence which questions the assessor asks and how answers are interpreted.…”