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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| Format: | Article |
| Language: | English |
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BMC
2024-12-01
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| Series: | BMC Medical Informatics and Decision Making |
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| Online Access: | https://doi.org/10.1186/s12911-024-02805-8 |
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| author | Peter Taber Charlene Weir Susan L. Zickmund Elizabeth Rutter Jorie Butler Barbara E. Jones |
| author_facet | Peter Taber Charlene Weir Susan L. Zickmund Elizabeth Rutter Jorie Butler Barbara E. Jones |
| author_sort | Peter Taber |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-275a43ef297849f2ba4729faef93f87d |
| institution | OA Journals |
| issn | 1472-6947 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj-art-275a43ef297849f2ba4729faef93f87d2025-08-20T02:31:41ZengBMCBMC Medical Informatics and Decision Making1472-69472024-12-0124111210.1186/s12911-024-02805-8The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision supportPeter Taber0Charlene Weir1Susan L. Zickmund2Elizabeth Rutter3Jorie Butler4Barbara E. Jones5Department of Biomedical Informatics, University of UtahInformation, Decision Enhancement and Analytics Center of Innovation, Salt Lake City Veterans AffairsInformation, Decision Enhancement and Analytics Center of Innovation, Salt Lake City Veterans AffairsDepartment of Emergency Medicine, University of UtahDepartment of Biomedical Informatics, University of UtahInformation, Decision Enhancement and Analytics Center of Innovation, Salt Lake City Veterans AffairsAbstract 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.https://doi.org/10.1186/s12911-024-02805-8DiagnosisUncertaintySocial processesInformation managementQualitativeSyndrome |
| spellingShingle | Peter Taber Charlene Weir Susan L. Zickmund Elizabeth Rutter Jorie Butler Barbara E. Jones The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support BMC Medical Informatics and Decision Making Diagnosis Uncertainty Social processes Information management Qualitative Syndrome |
| title | The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support |
| title_full | The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support |
| title_fullStr | The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support |
| title_full_unstemmed | The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support |
| title_short | The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support |
| title_sort | social experience of uncertainty a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support |
| topic | Diagnosis Uncertainty Social processes Information management Qualitative Syndrome |
| url | https://doi.org/10.1186/s12911-024-02805-8 |
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