An online tool for investigating clinical decision making

Area of Science:

• Obstetrics and Gynecology
• Clinical Decision Making
• Health Services Research

Background:

• Induction of labour is a common obstetric intervention with rising rates and unexplained hospital-level variations.
• Clinician-specific decision-making is a suspected driver of these observed variations in practice.

Purpose of the Study:

• To investigate clinical decision-making in labour induction, mitigating individual patient bias.
• To enable direct comparison of clinician behaviour and adherence to guidelines.

Main Methods:

• Utilized computer-presented imaginary clinical scenarios involving conditions like hypertensive disorders, IUGR, and postdates.
• Developed individualized 'decision rules' for each clinician based on their scenario responses.
• Applied these rules to hospital data to generate and present clinician-specific induction rates.

Main Results:

• Interviews with sixteen clinicians revealed a wide range in their induction of labour rates, from 10% to 31%.
• Demonstrated significant variability in clinician judgment regarding the timing and necessity of labour induction.

Conclusions:

• Substantial variation exists in clinician decision-making processes for labour induction.
• The developed system offers a method to study and compare clinical behaviour objectively.