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Updated: Mar 1, 2026

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
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Decision-making under pressure: medical errors in uncertain and dynamic environments.

Alicia M Zavala1, Gary E Day1, David Plummer2

  • 1School of Medicine, Griffith University, Gold Coast Campus, 58 Parklands Drive, Southport, Qld 4215, Australia. Email.

Australian Health Review : a Publication of the Australian Hospital Association
|June 6, 2017
PubMed
Summary

Clinical decision-making under pressure is influenced by multiple factors, including systems, workload, and teamwork. Understanding these pressures is key to improving patient safety in emergency situations.

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Area of Science:

  • Healthcare Management
  • Clinical Psychology
  • Medical Error Analysis

Background:

  • Emergency departments (EDs) face high complexity and uncertainty, leading to unpredictable workflows.
  • Existing literature highlights the challenges of clinical decision-making in dynamic and emergency settings.

Purpose of the Study:

  • To provide a narrative overview of literature on clinical decision-making under pressure.
  • To understand the origins of medical errors in high-pressure situations and their impact on patient outcomes.

Main Methods:

  • A six-phase thematic analysis framework was used to review 95 papers published between 1980 and 2015.
  • Literature searches were conducted using a Summons Search Service platform.

Main Results:

  • Six key themes emerged: organizational systems, workload, time pressure, teamwork, individual human factors, and case complexity.
  • Clinical outcomes in emergency settings are influenced by interconnected factors affecting care quality and timeliness.

Conclusions:

  • Further research is needed to enhance knowledge on safe patient management in high-pressure clinical environments.
  • Optimizing clinical decision-making in uncertain situations requires a whole-of-system perspective, not just individual accountability.