How the Availability of Observation Status Affects Emergency Physician Decisionmaking

Abstract

Emergency 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.

Decisionmaking in Emergency Medicine: Experienced-Based and Contextually Anchored Rather Than Evidence Based and Universal

“…We appreciate the opportunity to respond to Dr. Pelaccia's letter, 1 which sought to draw some important conclusions for the field of emergency medicine decisionmaking from our recent article. 2 On the whole, we generally agree with Dr. Pelaccia and thank him for bringing further attention to the importance of our work. Our findings certainly underscore that emergency physicians vary in their approach to decisionmaking as a result not only of their years in practice but also of their personal level of risk aversion, which, one might argue, is shaped in them well before they become physicians.…”

“…This "individualization" of decisionmaking mechanisms seems to be reinforced by the influence of personal factors such as risk aversion. 2 From a contextual standpoint, the results discussed by Wright et al tend to confirm research that postulates that context has a major influence on decisionmaking. 3,4 The heuristics used by emergency physicians included in the study to manage patients with abdominal pain would thus likely be very different in other, less acute contexts of medical practice.…”

“…To the Editor: In 2006, Sandhu et al 1 called for researchers to undertake more studies to understand how emergency physicians make their decisions. The study by Wright et al 2 sheds new light on this field of research in terms of the weight of experience and the role of context in decisionmaking.…”

In reply:

“…We appreciate the opportunity to respond to Dr. Pelaccia's letter, 1 which sought to draw some important conclusions for the field of emergency medicine decisionmaking from our recent article. 2 On the whole, we generally agree with Dr. Pelaccia and thank him for bringing further attention to the importance of our work. Our findings certainly underscore that emergency physicians vary in their approach to decisionmaking as a result not only of their years in practice but also of their personal level of risk aversion, which, one might argue, is shaped in them well before they become physicians.…”

Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits

“…It is unclear whether visits to such unfamiliar hospitals were for higheracuity conditions or whether visiting a hospital unfamiliar with the clinical history of a patient with cancer affects the decision by an ED to hospitalize. 26 More work should be done to understand how to increase awareness and use of the cancer UCC, disseminate this delivery innovation to other practice settings, and understand its impact on unplanned hospitalizations.…”