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We all make choices: A decision analysis framework for disposition decision in the ED
Muge Capan1, Jessica Pigeon2, Debra Marco3
1Christiana Care Health System, Value Institute, 4755 Ogletown-Stanton Road, Newark, DE 19718, United States.
The American Journal of Emergency Medicine
|November 28, 2017
Summary
Emergency Department (ED) providers weigh patient, provider, and system factors in disposition decisions. Negative outcomes are tolerated less than 72-hour returns, with age influencing return risk.
Area of Science:
- Emergency Medicine
- Healthcare Decision Making
- Patient Safety
Background:
- Emergency Department (ED) provider disposition decisions significantly influence patient care and safety.
- Understanding ED provider decision-making processes and risk tolerance is crucial for improving care quality.
Purpose of the Study:
- To investigate the factors influencing Emergency Department (ED) providers' disposition decisions.
- To assess ED providers' risk tolerance for adverse outcomes associated with disposition decisions.
Main Methods:
- A mixed-methods approach combining decision mapping, survey research, statistical analysis, and word clouds.
- A 10-item survey administered to 46 ED providers between July and August 2017.
- Analysis of participant characteristics (age, gender, experience, expertise) and their relationship with risk tolerance for 72-hour returns and negative outcomes.
Main Results:
- Decision mapping revealed interconnected patient-, provider-, and system-related factors influencing disposition.
- ED providers demonstrated lower risk tolerance for negative outcomes compared to 72-hour returns.
- A statistically significant association was found between provider age and the risk of 72-hour return (p=0.046).
Conclusions:
- ED discharge decision-making is a complex process influenced by multiple interconnected factors.
- The synthesis of qualitative and quantitative methods enhances understanding of ED disposition decisions.
- Improved understanding of these decisions can lead to enhanced safety and quality of care in the ED.
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