How do emergency physicians make discharge decisions?

Area of Science:

• Emergency Medicine
• Patient Safety
• Clinical Decision-Making

Background:

• Patient disposition (admission vs. discharge) is a critical decision for emergency department (ED) physicians.
• High-acuity patients present unique challenges for disposition decisions.

Purpose of the Study:

• To investigate how ED physicians perceive their discharge decisions for high-acuity patients.
• To assess the impact of these decisions on adverse events.

Main Methods:

• A real-time survey of ED physicians discharging high-acuity patients.
• Open-ended questions explored decision rationale (clinical judgment vs. evidence).
• 30-day outcomes were tracked and reviewed for adverse events by blinded physicians.

Main Results:

• Physicians reported using clinical judgment in 87.6% of decisions, evidence in 12.4%.
• 18.8% of cases had flagged outcomes, with 2.7% identified as adverse events.
• All identified adverse events were deemed preventable; no association found between decision rationale and adverse events.

Conclusions:

• Experienced ED physicians frequently rely on clinical acumen over evidence-based guidelines for high-acuity discharges.
• Neither approach showed a significant association with adverse events.
• Future research should explore decision support and feedback interventions to enhance discharge safety.