• Brad Wright, Graham P Martin, Azeemuddin Ahmed, Jay Banerjee, Suzanne Mason, and Damian Roland.
• Department of Health Management and Policy, University of Iowa, Iowa City, IA. Electronic address: brad-wright@uiowa.edu.
• Ann Emerg Med. 2018 Oct 1; 72 (4): 401-409.

Study ObjectiveThis study seeks to understand how emergency physicians decide to use observation services, and how placing a patient under observation influences physicians' subsequent decisionmaking.MethodsWe conducted detailed semistructured interviews with 24 emergency physicians, including 10 from a hospital in the US Midwest, and 14 from 2 hospitals in central and northern England. Data were extracted from the interview transcripts with open coding and analyzed with axial coding.ResultsWe found that physicians used a mix of intuitive and analytic thinking in initial decisions to admit, observe, or discharge patients, depending on the physician's individual level of risk aversion. Placing patients under observation made some physicians more systematic, whereas others cautioned against overreliance on observation services in the face of uncertainty.ConclusionEmergency physicians routinely make decisions in a highly resource-constrained environment. Observation services can relax these constraints by providing physicians with additional time, but absent clear protocols and metacognitive reflection on physician practice patterns, this may hinder, rather than facilitate, decisionmaking.Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

20 keywords...

hide…