Failed Frequent Flyers

2020 ◽  
pp. 111-118
Author(s):  
Pat Croskerry
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Sufficient Information ◽  
Principal Characteristic ◽  
Cognitive Pattern ◽  
Cognitive Miser

Two cases are reviewed in Case 16; both demonstrate problems with “frequent flyers” in the emergency department (ED). The principal characteristic of these patients is that despite their symptoms and complaints being minor, they frequently present to the ED. Inevitably, ED staff tend to view their visits disparagingly. However, like the boy who cried wolf, they will occasionally have serious underlying conditions that need to be addressed. A prominent cognitive pattern is described: the cognitive miser function. It is the tendency to uncritically accept things at face value. Although this may be adequate for many routine decisions, the failure to unpack sufficient information will sometimes result in suboptimal decision making.

Assessment of advance care planning documentation for residents of residential aged care facilities presenting to the emergency department

2020 ◽  
Vol 44 (6) ◽  
pp. 847
Author(s):  
Tzy Harn Chua ◽  
Jessica Ru-Jia Foong ◽  
Ryan Renxin Tan ◽  
Princess Natsai Rukasha ◽  
Carolyn Hullick
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Aged Care ◽  
Residential Aged Care ◽  
Sufficient Information ◽  
Care Planning ◽  
Advance Care

ObjectiveThis study assessed the availability and quality of advance care planning (ACP) documentation among older residential aged care facility (RACF) residents who presented to the emergency department (ED). MethodsA prospective review of the medical records of RACF residents aged ≥75 years who presented to the ED from May to June 2018 was conducted. Availability of ACP was determined based on the presence of an ACP document inclusive of an advance care directive (ACD) in the medical record. The quality of ACP documentation was determined based on the presence of nine key components. ResultsIn all, 48.8% of patients presented to the ED with either ACP or an ACD. However, only a mean total of 3.8 (out of 9) ACP components were documented in these documents. ConclusionsJust under half (48.8%) of RACF residents presented to the ED with ACP documentation. There was limited coverage of core ACP components needed to guide clinical decision making. What is known about the topic?RACF residents are in the last years of their life and commonly lack capacity to make decisions regarding health care. Residents are at high risk of dying when acutely unwell in hospital. ACP documentation, when readily available, helps provide appropriate end-of-life care and improves both patient and family satisfaction. What does this paper add?Less than half the residents reporting to the ED from an RACF had ACP documentation available for clinicians. For those who presented to the ED with ACP documentation, most lacked sufficient information needed to provide care in full accordance with the patient’s preferences. What are the implications for practitioners?There is a need to encourage, initiate, actively engage and develop systems for ACP conversations, documentation and availability when acutely unwell for people living in RACFs to provide sufficient information to guide clinical decision making. Without quality ACP, the provision of patient-centred health care may be compromised.

scholarly journals A survey of methods for evaluating mini-publics

2021 ◽  
Author(s):  
Takeuchi Ayano
Keyword(s):  
Decision Making ◽  
Academic Research ◽  
Future Research ◽  
The Political ◽  
Decision Making Process ◽  
Sufficient Information ◽  
Practical Case ◽  
Political Decision ◽  
Wide Range ◽  
Political Decision Making

AbstractPublic participation has become increasingly necessary to connect a wide range of knowledge and various values to agenda setting, decision-making and policymaking. In this context, deliberative democratic concepts, especially “mini-publics,” are gaining attention. Generally, mini-publics are conducted with randomly selected lay citizens who provide sufficient information to deliberate on issues and form final recommendations. Evaluations are conducted by practitioner researchers and independent researchers, but the results are not standardized. In this study, a systematic review of existing research regarding practices and outcomes of mini-publics was conducted. To analyze 29 papers, the evaluation methodologies were divided into 4 categories of a matrix between the evaluator and evaluated data. The evaluated cases mainly focused on the following two points: (1) how to maintain deliberation quality, and (2) the feasibility of mini-publics. To create a new path to the political decision-making process through mini-publics, it must be demonstrated that mini-publics can contribute to the decision-making process and good-quality deliberations are of concern to policy-makers and experts. Mini-publics are feasible if they can contribute to the political decision-making process and practitioners can evaluate and understand the advantages of mini-publics for each case. For future research, it is important to combine practical case studies and academic research, because few studies have been evaluated by independent researchers.

scholarly journals Exploring Factors Affecting the Emergency Specialists’ Decision-Making in Case of Emergencies in Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Abbasali Ebrahimian ◽  
Seyed-Hossein Hashemi-Amrei ◽  
Mohammadreza Monesan
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Qualitative Content Analysis ◽  
Decision Makers ◽  
Decision Making Process ◽  
Factors Affecting ◽  
Emergency Situations ◽  
The Core ◽  
Semistructured Interviews ◽  
Emergency Decision

Introduction. Appropriate decision-making is essential in emergency situations; however, little information is available on how emergency decision-makers decide on the emergency status of the patients shifted to the emergency department of the hospital. This study aimed at explaining the factors that influence the emergency specialists’ decision-making in case of emergency conditions in patients. Methods. This study was carried out with a qualitative content analysis approach. The participants were selected based on purposive sampling by the emergency specialists. The data were collected through semistructured interviews and were analyzed using the method proposed by Graneheim and Lundman. Results. The core theme of the study was “efforts to perceive the acute health threats of the patient.” This theme was derived from the main classes, including “the identification of the acute threats based on the patient’s condition” and “the identification of the acute threats based on peripheral conditions.” Conclusions. The conditions governing the decision-making process about patients in the emergency department differ from the conditions in other health-care departments at hospitals. Emergency specialists may have several approaches to decide about the patients’ emergency conditions. Therefore, notably, the emergency specialists’ working conditions and the others’ expectations from these specialists should be considered.

Decision-Making Processes of Patients Who Use the Emergency Department for Primary Care Needs

2013 ◽  
Vol 24 (3) ◽  
pp. 1288-1305 ◽  
Author(s):  
Eric K. Shaw ◽  
Jenna Howard ◽  
Elizabeth C. Clark ◽  
Rebecca S. Etz ◽  
Rajiv Arya ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Emergency Department ◽  
Care Needs ◽  
Decision Making Processes

scholarly journals Defining criteria to choose appropriate destination hospital for trauma patients: Piacenza Local Health Authority’s Piacenza trauma algorithm protocol

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Fabio Mozzarelli ◽  
Stefano Nani ◽  
Enrica Rossi ◽  
Mario Pizzamiglio
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Observational Study ◽  
Electronic Device ◽  
Local Health ◽  
Trauma Patients ◽  
Medical Facility ◽  
Provincial Hospital ◽  
Trauma Algorithm ◽  
Data Context

Ambulance crew’s choosing of appropriate destination hospital for trauma patients can affect survival and morbidity outcomes. Aim of the present study is to devise a decision-making algorithm in order to allow the best choice of destination hospital for trauma patients and to apply it on an electronic device able to facilitate the decision made by ambulance staff. The method used was analysis of literature data, context and workload with a retrospective observational study. A comparison between the destination hospitals actually chosen and those that could have been chosen with the <em>Piacenza trauma algorithm</em> has been applied. The data shows a 9.5% (P&gt;0.10) more advantageous change in appropriateness in the choice of medical facility and a 1.4% increase in admissions to the Emergency Department of the provincial hospital. The creation and use of a medical protocol and its consequent installation on an electronic device (tablet) that can be shared over a computer platform could help medical staff make appropriate pre-hospital choices as regards the destination hospital for trauma patients.

scholarly journals Perceived Appropriateness of Shared Decision-making in the Emergency Department: A Survey Study

2016 ◽  
Vol 23 (4) ◽  
pp. 375-381 ◽  
Author(s):  
Marc A. Probst ◽  
Hemal K. Kanzaria ◽  
Dominick L. Frosch ◽  
Erik P. Hess ◽  
Gary Winkel ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Shared Decision Making ◽  
Survey Study ◽  
Shared Decision
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