The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support

The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support

Abstract Background This study sought to understand the process of clinical decision-making for suspected pneumonia by emergency departments (ED) providers in Veterans Affairs (VA) Medical Centers. The long-term goal of this work is to create clinical decision support tools to reduce unwarranted var...

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Bibliographic Details
Main Authors: Peter Taber, Charlene Weir, Susan L. Zickmund, Elizabeth Rutter, Jorie Butler, Barbara E. Jones
Format: Article
Language:English
Published: BMC 2024-12-01
Series:BMC Medical Informatics and Decision Making
Subjects:
Diagnosis
Uncertainty
Social processes
Information management
Qualitative
Syndrome
Online Access:https://doi.org/10.1186/s12911-024-02805-8
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Summary:Abstract Background This study sought to understand the process of clinical decision-making for suspected pneumonia by emergency departments (ED) providers in Veterans Affairs (VA) Medical Centers. The long-term goal of this work is to create clinical decision support tools to reduce unwarranted variation in diagnosis and treatment of suspected pneumonia. Methods Semi-structured qualitative interviews were conducted with 16 ED clinicians from 9 VA facilities demonstrating variation in antibiotic and hospitalization decisions. Interviews of ED providers focused on understanding decision making for provider-selected pneumonia cases and providers’ organizational contexts. Results Thematic analysis identified four salient themes: i) ED decision-making for suspected pneumonia is a social process; ii) the “diagnosis drives treatment” paradigm is poorly suited to pneumonia decision-making in the ED; iii) The unpredictability of the ED requires deliberate and effortful information management by providers in CAP decision-making; and iv) the emotional stakes and high uncertainty of pneumonia care drive conservative decision making. Conclusions Ensuring CDS reflects the realities of clinical work as a socially organized process with high uncertainty may ultimately improve communication between ED and admitting providers, continuity of care and patient outcomes.
ISSN:1472-6947

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