Exploring Ward Team Handoffs of Overnight Admissions: Key Lessons from Field Observations

Choi, Justin J.; Osterberg, Lars G.; Record, Janet D.

doi:10.1007/s11606-023-08549-x

J GEN INTERN MED

2023

DOI: 10.1007/s11606-023-08549-x

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Exploring Ward Team Handoffs of Overnight Admissions: Key Lessons from Field Observations

Justin J. Choi,

Lars G. Osterberg,

Janet D. Record

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2024

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Cited by 2 publications

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The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support

Taber,

Weir,

Zickmund

et al. 2024

BMC Med Inform Decis Mak

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Background This study sought to understand the process of clinical decision-making for suspected pneumonia by emergency departments (ED) providers in Veterans Affairs (VA) Medical Centers. The long-term goal of this work is to create clinical decision support tools to reduce unwarranted variation in diagnosis and treatment of suspected pneumonia. Methods Semi-structured qualitative interviews were conducted with 16 ED clinicians from 9 VA facilities demonstrating variation in antibiotic and hospitalization decisions. Interviews of ED providers focused on understanding decision making for provider-selected pneumonia cases and providers’ organizational contexts. Results Thematic analysis identified four salient themes: i) ED decision-making for suspected pneumonia is a social process; ii) the “diagnosis drives treatment” paradigm is poorly suited to pneumonia decision-making in the ED; iii) The unpredictability of the ED requires deliberate and effortful information management by providers in CAP decision-making; and iv) the emotional stakes and high uncertainty of pneumonia care drive conservative decision making. Conclusions Ensuring CDS reflects the realities of clinical work as a socially organized process with high uncertainty may ultimately improve communication between ED and admitting providers, continuity of care and patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-024-02805-8.

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The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support

Taber,

Weir,

Zickmund

et al. 2024

BMC Med Inform Decis Mak

View full text Add to dashboard Cite

show abstract

What is diagnostic safety? A review of safety science paradigms and rethinking paths to improving diagnosis

Choi

2024

Diagnosis

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Diagnostic errors in health care are a global threat to patient safety. Researchers have traditionally focused diagnostic safety efforts on identifying errors and their causes with the goal of reducing diagnostic error rates. More recently, complementary approaches to diagnostic errors have focused on improving diagnostic performance drawn from the safety sciences. These approaches have been called Safety-II and Safety-III, which apply resilience engineering and system safety principles, respectively. This review explores the safety science paradigms and their implications for analyzing diagnostic errors, highlighting their distinct yet complementary perspectives. The integration of Safety-I, Safety-II, and Safety-III paradigms presents a promising pathway for improving diagnosis. Diagnostic researchers not yet familiar with the various approaches and potential paradigm shift in diagnostic safety research may use this review as a starting point for considering Safety-I, Safety-II, and Safety-III in their efforts to both reduce diagnostic errors and improve diagnostic performance.

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Exploring Ward Team Handoffs of Overnight Admissions: Key Lessons from Field Observations

Cited by 2 publications

References 33 publications

The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support

The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support

What is diagnostic safety? A review of safety science paradigms and rethinking paths to improving diagnosis

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