在重症监护环境中复杂的决策:感知实践与观察到的现实对比
Sarah A Teele1,2, Patrice Tremoulet3, Peter C Laussen1
1Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Journal of evaluation in clinical practice
|September 28, 2023
概括
在复杂的医院环境中,临床医师的决策受认知特征和团队动态的影响,而不仅仅是患者因素. 了解这些影响可以改善医疗保健和临床教育.
科学领域:
- 提供医疗保健服务.
- 医学教育 医学教育
- 临床决策 临床决策
背景情况:
- 了解复杂的医院环境中的决策对于改善医疗保健至关重要.
- 认知,社会和技术因素对临床环境产生重大影响.
研究的目的:
- 探索影响临床医师在儿科心脏重症监护病房决策的因素.
- 识别被认为和实际的决策驱动因素之间的差异.
主要方法:
- 融合混合方法设计利用教师调查,直接观察和半结构面试.
- 用社交网络分析可视化定性数据,说明代码频率和连接性.
- 临床决策支持系统 (CDSS) 用于确定特定的患者群体进行观察.
主要成果:
- 个人患者的特征被认为是主要的决策因素,但观察显示,认知特征,团队专业知识和基于价值的决策更重要.
- 角色建模对临床专业知识的发展产生了重大影响.
- 系统和环境因素被认为会影响决策过程.
结论:
- 临床医生对决策的看法与动态,复杂系统中观察到的行为不一致.
- 结果为临床课程和临床决策支持系统 (CDSS) 的设计/实施提供了关键的见解.
- 社交网络分析为探索复杂环境中的决策提供了一种有价值的方法.
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