Decision-making on the fly: a qualitative study of physicians in out-of-hospital emergency medical services

Abstract

Background Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. Methods Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. Results Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs, but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. Conclusions The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians’ journey from novice to expert.

Optimal Event-Enhanced Heterogeneous Dynamic Knowledge Graph construction for patient clinical pathway analysis

“…Clinical measures and the patient's medical history are two important clinical elements that the emergency physician considers when making decisions in hospital emergencies [10]. A comprehensive understanding of the patient's medical history allows physicians to properly customize their treatment plans.…”

Decision Fatigue in Emergency Medicine: An Exploration of Its Validity

“…Several studies and reviews have reported correlations between decision fatigue and clinical outcomes or decision quality in emergency medicine. These investigations provide quantitative data that suggests potential links between the mental strain associated with decision-making and its impact on healthcare providers and patients [27][28][29][30][31][32][33].…”