Opportunistic decision making and complexity in emergency care

Abstract

In critical care environments such as the emergency department (ED), many activities and decisions are not planned. In this study, we developed a new methodology for systematically studying what are these unplanned activities and decisions. This methodology expands the traditional naturalistic decision making (NDM) frameworks by explicitly identifying the role of environmental factors in decision making. We focused on decisions made by ED physicians as they transitioned between tasks. Through ethnographic data collection, we developed a taxonomy of decision types. The empirical data provide important insight to the complexity of the ED environment by highlighting adaptive behavior in this intricate milieu. Our results show that half of decisions in the ED we studied are not planned, rather decisions are opportunistic decision (34%) or influenced by interruptions or distractions (21%). What impacts these unplanned decisions have on the quality, safety, and efficiency in the ED environment are important research topics for future investigation.

Decision-making at the sharp end: a survey of literature related to decision-making in humanitarian contexts

“…All of these behaviours will have (largely) detrimental effects on their ability to make decisionsand particularly the ability to create and choose between a wide range of options. At the same time, the physical element of stress (including effects on sleep, nutrition, and self-care) can affect the ability to make decisions over a period (Zhang et al 2002;Franklin et al 2011;Coombs et al 2016;Comes 2016) and lead to emergency managers 'collaps[ing] from exhaustion or becom[ing] inefficient in their decision-making and other areas of responsibility' (Quarantelli 1988: 380).…”

Clinical Reasoning: Implications and Strategies for Postgraduate Medical Education

“…Studies also identify practitioner workload, resource demand and team communication as influencing clinical decisions, particularly in critical care settings. The sequence and nature of decisions can even be influenced by factors such as the physical layout of the unit and the availability of other team members [22,23]. Trainers also need to be aware that the supervisor-trainee relationship impacts on clinical decisions.…”

Toward the modelling of safety violations in healthcare systems

“…Direct observation in the emergency department (ED)61 found that only about 45% of the decisions were planned, with the rest being opportunistic or forced by interruptions. Moreover, decisions were not being made about individual patients alone, but their care within the wider view of the ED as a whole, and situational factors that defined the local, immediate demands for resources.…”