Complex decision making in an intensive care environment: Perceived practice versus observed reality.

Area of Science:

• Healthcare delivery
• Medical education
• Clinical decision making

Background:

• Understanding decision-making in complex hospital environments is crucial for improving healthcare.
• Cognitive, social, and technological factors significantly impact clinical environments.

Purpose of the Study:

• To explore factors influencing clinician decision-making in a pediatric Cardiac Intensive Care Unit.
• To identify discrepancies between perceived and actual decision-making drivers.

Main Methods:

• Convergent mixed methods design utilizing faculty surveys, direct observations, and semi-structured interviews.
• Social network analysis was employed to visualize qualitative data, illustrating code frequency and connectivity.
• Clinical decision support systems (CDSS) were used to identify specific patient populations for observation.

Main Results:

• Individual patient characteristics were perceived as primary decision factors, but observations revealed greater weight on cognitive traits, team expertise, and value-based decisions.
• Role modeling significantly impacted the development of clinical expertise.
• System and environmental factors were perceived to influence decision-making processes.

Conclusions:

• Clinician perceptions of decision-making did not align with observed behaviors in a dynamic, complex system.
• Findings offer critical insights for clinical curricula and the design/implementation of clinical decision support systems (CDSS).
• Social network analysis provides a valuable method for exploring decision-making in complex environments.