We all make choices: A decision analysis framework for disposition decision in the ED

Capan M, Pigeon J, Marco D, Powell J, Groner K

Am J Emerg Med 2018 Mar;36(3):450-454

PMID: 29174450


BACKGROUND: Emergency Department (ED) providers’ disposition decision impacts patient care and safety. The objective of this brief report is to gain a better understanding of ED providers’ disposition decision and risk tolerance of associated outcomes.

METHODS: We synthesized qualitative and quantitative methods including decision mapping, survey research, statistical analysis, and word clouds. Between July 2017 and August 2017, a 10-item survey was developed and conducted at the study hospital. Descriptive and statistical analyses were used to assess the relationship between the participant characteristics (age, gender, years of experience in the ED, and level of expertise) and risk tolerance of outcomes (72-h return and negative outcome) associated with disposition decision. Word clouds facilitated prioritization of qualitative responses regarding information impacting and supporting the disposition decision.

RESULTS: Total of 46 participants completed the survey. The mean age was 39.5 (standard deviation (SD) 10years), and mean years of experience was 9.6years (SD 8.7years). Decision map highlighted the connections between patient-, provider-, and system-related factors. Survey results showed that negative outcome resulted in less risk tolerance compared to 72-h return. Chi-square tests did not provide sufficient evidence to indicate that the responses are independent of participants characteristics – except age and the risk of 72-h return (p=0.046).

CONCLUSION: Discharge decision making in the ED is complex as it involves interconnected patient, provider, and system factors. Synthesizing qualitative and quantitative methods promise enhanced understanding of how providers arrive to disposition decision, as well as safety and quality of care in the ED.

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