'Heads you win, tails I lose': a critical incident study of GPs' decisions about emergency admission referrals

Abstract

Referral decisions require the evaluation of several conflicting consequences for many stakeholders in time-pressured and peer-reviewed situations. These factors encourage the use of heuristics, i.e. GPs' judgements will be influenced more by the social context of the choice than information about the patient's condition. Emergency referral guidelines provide more information to evaluate from another stakeholder; introducing guidelines is likely to increase GPs' use of heuristics and the making of less optimal decisions.

Factors influencing professional decision making on unplanned hospital admission: a qualitative study

“…6,7 This study supports these findings, and adds a multiprofessional perspective by identifying a variety of potentially conflicting interests and rationalities across different health and social care sectors. These areas of tension may impact professional decision making and contribute to unplanned hospital admissions.…”

“…6 Decisions about referral for emergency admission may involve conflicts of interests for GPs, who have to strike a balance between concerns for the patient's health, consequences for other stakeholders and their own professional reputations. 7 However, variation in referral rates remains poorly understood and largely unexplained. 8 The aim of this study is to explore factors impacting on professional decision making around unplanned hospital admission across the primary, emergency, and social care sectors, in order to enhance the understanding of variations in rates of admission.…”

Identity transition following traumatic brain injury: A dynamic process of contraction, expansion and tentative balance

“…The critical incident technique (CIT) [35] was used to facilitate an understanding of the sequence of events surrounding critical decision points. Developed by Flanagan [36], the CIT is a method of identifying actual events or behaviours that are thought to lead to a particular outcome [37,38].…”

Professional perceptions of joint working in primary care and social care services for older people in Scotland

“…Second, older people are high users of health services and recent research highlights that frequent users of health services are also more likely to use social services (Keene, Swift, Bailey, & Janacek, 2001). A further reason why joint working is particularly germane for older people is because health professionals often take into consideration social as well as clinical needs when deciding to which services they refer patients (Dempsey & Bekker, 2002). In light of these developments it is not surprising that joint working between health and social care services has rapidly become a policy panacea for meeting older people's needs (Audit Commission, 2002;Department of Health, 2000Scottish Executive, 2001).…”