• Ann Emerg Med · Jun 2016

    Multicenter Study

    From Context Comes Expertise: How Do Expert Emergency Physicians Use Their Know-How to Make Decisions?

    • Thierry Pelaccia, Jacques Tardif, Emmanuel Triby, Christine Ammirati, Catherine Bertrand, Valérie Dory, and Bernard Charlin.
    • Centre for Training and Research in Health Sciences Education, Faculty of Medicine, University of Strasbourg, Strasbourg, France; Prehospital Emergency Care Service-Centre for Emergency Care Teaching, Strasbourg University Hospital, Strasbourg, France. Electronic address: pelaccia@unistra.fr.
    • Ann Emerg Med. 2016 Jun 1; 67 (6): 747-751.

    Study ObjectiveDecisionmaking is influenced by the environment in which it takes place. The objective of our study was to explore the influence of the specific features of the emergency department (ED) environment on decisionmaking. In this paper, we specifically report on the way emergency physicians use their knowledge of their collaborators to make their decisions.MethodsWe conducted a qualitative study on emergency physicians recruited in 3 French hospitals. Physicians were equipped with a microcamera to record their clinical activity from their "own-point-of-view perspective." Semistructured interviews, based on viewing the video, were held with each physician after an actual clinical encounter with a patient. They were then analyzed thematically, using constant comparison and matrices, to identify the central themes.ResultsFifteen expert emergency physicians were interviewed. Almost all of them reported using their knowledge of other health care professionals to assess the seriousness of the patient's overall condition (sometimes even before his or her arrival in the ED) to optimize the patient's treatment and to anticipate future care.ConclusionEmergency physicians interact with many other health care workers during the different stages of the patient's management. The many ways in which experts use their knowledge of other health care professionals to make decisions puts traditional conceptions of expert knowledge into perspective and opens avenues for future research.Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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