Major Challenges and Barriers in Clinical Decision-making as Perceived by Emergency Medical Services Personnel: A Qualitative Content Analysis

Abstract

Background: Having to work in unpredictable and critical conditions, emergency care services (EMS) personnel experience complicated situations at the scene of accidents which, inevitably, influence their clinical decisions. There is a lack of research into the challenges which these professionals encounter. Accordingly, the present study aims to explore the major challenges and barriers which affect clinical decision-making from the perspective of EMS personnel. Methods: The present study is a qualitative work with a content analysis approach. Selected via purposeful sampling, the subjects were 25 members of the EMC personnel in Iran who met the inclusion criteria. The study lasted from December 2019 to July 2020. Sampling was maintained to the point of data saturation. Data were collected using semi-structured, in-depth, individual interviews. The collected data were analyzed via qualitative content analysis. Results: 4 main categories—professional capabilities, occupational and environmental factors, inefficient organizational management, and ethical issues—and 23 subcategories were extracted from the findings of the study. Conclusion: The results of the present study show that personal and occupational factors, organizational management, and ethical issues are the most significant sources of challenge which affect the clinical decision-making and, consequently, the performance of EMC personnel at the scene of accidents. Thus, it is essential that pre-hospital emergency care managers improve the quality of EMC personnel’s clinical decision-making skills and the reliability of care provided by them by creating the right professional and organizational settings, free of occupational distress.

The Need for Purposeful Teaching, Learning and Assessment of Crisis Resource Management Principles and Practices in the Undergraduate Pre-Hospital Emergency Care Curriculum: A Narrative Literature Review

“…Nonetheless, some reports for the use of CRM in various fields of medical practice, such as emergency medicine (4,14), obstetrics (15), anaesthesiology (16) and nursing (17) were identified. Furthermore, our findings reveal that CRM focusses on addressing non-technical skills necessary for effective teamwork and that those identified to be relevant for effective teamwork in pre-hospital emergency care setting include situation awareness (SA), decision-making, verbal communication and teamwork, as well as leadership and followership skills (18)(19)(20). Identified themes were discussed under the following sub-headings: the importance of SA skills for pre-hospital emergency care providers; importance of clinical decision-making skills for pre-hospital emergency care providers; communication skills and the pre-hospital emergency care provider; teamwork skills and the pre-hospital emergency care provider; and leadership/followership skills and the prehospital emergency care provider.…”

Pre-hospital Emergency Service Challenges in the Face of the COVID-19 Pandemic in Iran

“…This fear did not allow them to thoroughly examine the patient. 25 The inability to adapt psychologically to the stress, created during the COVID-19 period, caused the staff to develop anger and irritability, as well as confusion and wondering in their decision makings. Lack of motivation to continue working and feeling frustrated and reaching the end of the line were among the sentences that were heard the most of the participants in the interviews.…”

Priority setting in the Brazilian emergency medical service: a multi-criteria decision analysis (MCDA)

“…The recent findings in the literature on decision-making in EMS focus on the following points? (1) managing ethical aspects of advance directives in emergency care services; (2) decision support for patient admission; (3) presentation of a structure that provides healthcare professionals with a just-in-time basis; and (4) exploration of the main challenges and barriers that affect clinical decision-making [ 49 – 52 ]. In summary, these studies determine paramedics’ decision-making styles, and also question how decision-making is carried out in this context [ 53 – 57 ].…”