How hospitalists experience and manage clinical uncertainty: A qualitative study

Hospitalists work in complex clinical environments with rising patient acuity and competing demands. Uncertainty is an inescapable part of this work, yet little is known about how hospitalists experience and manage clinical uncertainty.

To explore how hospitalists experience and manage uncertainty in clinical practice.

We conducted a single-center qualitative study using reflexive thematic analysis within a constructivist paradigm. We interviewed hospitalist attending physicians during and/or after their work week and analyzed data inductively, drawing on literature about uncertainty in other clinical contexts. To strengthen rigor and trustworthiness, we held return-of-findings feedback sessions with participants.

We interviewed 12 hospitalists between April 2023 and September 2024. Across diverse clinical situations, participants framed uncertainty through the lens of hospital discharge, using it as an anchor for decision-making. Managing uncertainty required cognitive and emotional resources and was influenced by participants' "bandwidth," or perceived capacity to manage competing professional and personal demands. Perceived bandwidth shaped participants' responses to uncertainty. Adequate bandwidth encouraged uncertainty engagement, while limited bandwidth prompted deferral or offloading. Participants described how they attempted to ease the burden of uncertainty for their oncoming colleagues by adjusting their documentation and care plans during handoffs.

Hospitalists experience uncertainty as a routine part of clinical practice and manage it pragmatically to advance patients toward discharge. Their approaches are shaped by their perceived bandwidth. The influences of uncertainty should be considered when assessing workload, organizing clinical service, and planning handoffs.