Primary care physiotherapists ability to make correct management decisions – is there room for improvement? A mixed method study

Abstract Background With increasing interest in direct access to physiotherapy, it is important to consider the physiotherapists (PTs) ability to make correct management decisions, because identification of differential diagnostic pathologies and timely referral for specialist care is vital for patient safety. The aims of the study were to investigate PTs ability to make correct management decisions in patients presenting with musculoskeletal conditions and to identify explanatory factors associated with this ability. Furthermore, we wanted to explore the PTs views on the identified factors. Methods The study was a mixed methods study with an explanatory sequential design consisting of a questionnaire survey and semi-structured interviews. The questionnaire comprised 12 clinical vignettes describing patient scenarios for musculoskeletal conditions, non-critical medical conditions and critical medical conditions. Based on this, the PTs indicated whether the patient should be managed by the PT or were in need of medical referral. Associations between correct decisions and explanatory variables was analyzed by mixed- effects logistic regression. Interviews were performed with nine PTs to explore their reactions to the results. A directed content analysis was performed. Results A total of 195 PTs participated in the questionnaire survey and 9 PTs were interviewed. Overall, PTs were more likely to make correct management decisions in the musculoskeletal conditions category, whereas wrong decisions were more often chosen for underlying medical conditions categories. Positive associations between correct management decision in the critical medical category were found for experience: odds ratio (OR) 2.73 (1.33;5.57) and passed quality audit OR 2.90 (1.50;5.58). In the interviews, PTs expressed concerns about the differential diagnostic abilities. They all noted, that experience is immensely important in the clinical reasoning process because the ability to recognise diagnostic patterns evolves over time. Furthermore, the quality audit seems to address and systematize the clinical reasoning process and workflow within the clinics. Conclusion The lack of ability to make correct management decision in critical medical categories and the uncertainties expressed by PT’s should raise concern, as direct access to physiotherapy is already well-established and the results indicate that patient safety could be at risk. The findings that experience and passed quality audit was associated with correct management decisions highlights the need for ongoing awareness and education into differential diagnostics.

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Decision-Making Ability of Physical Therapists: Physical Therapy Intervention or Medical Referral

Physical Therapy ◽

10.2522/ptj.20050393 ◽

2006 ◽

Vol 86 (12) ◽

pp. 1619-1629 ◽

Cited By ~ 136

Author(s):

Diane U Jette ◽

Kerry Ardleigh ◽

Kellie Chandler ◽

Lesley McShea

Keyword(s):

Physical Therapy ◽

Confidence Interval ◽

Physical Therapists ◽

Physical Therapist ◽

Direct Access ◽

Medical Conditions ◽

Musculoskeletal Conditions ◽

Logistic Regressions ◽

American Physical ◽

Medical Referral

Abstract Background and PurposeOpponents of direct access to physical therapy argue that physical therapists may overlook serious medical conditions. More information is needed to determine the ability of physical therapists to practice safely in direct-access environments. The purpose of this study was to describe the ability of physical therapists to make decisions about the management of patients in a direct-access environment. Subjects. Of a random sample of 1,000 members of the Private Practice Section of the American Physical Therapy Association, 394 participated. Methods. A survey included 12 hypothetical case scenarios. For each case, participants determined whether they would provide intervention without referral, provide intervention and refer, or refer before intervention. The percentage of correct decisions for each group of scenarios was calculated for each participant, and participants were classified as having made correct decisions for 100% of cases or less for each group. Three sets of logistic regressions were completed to determine the characteristics of the participants in relation to the decision category. Results. The average percentages of correct decisions were 87%, 88%, and 79% for musculoskeletal, noncritical medical, and critical medical conditions, respectively. Of all participants, approximately 50% made correct decisions for all cases within each group. The odds of making 100% correct decisions if a physical therapist had an orthopedic specialization were 2.23 (95% confidence interval=1.35–3.71) for musculoskeletal conditions and 1.89 (95% confidence interval=1.14–3.15) for critical medical conditions. Discussion and Conclusion. Physical therapists with an orthopedic specialization were almost twice as likely to make correct decisions for critical medical and musculoskeletal conditions.

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Competency In Critical Care Nursing With Approach Methods Journal Sharing of Critical Care (JSCC) In Nursing Profession Students

STRADA JURNAL ILMIAH KESEHATAN ◽

10.30994/sjik.v9i2.361 ◽

2020 ◽

Vol 9 (2) ◽

pp. 686-693

Author(s):

Heru Suwardianto ◽

Vitaria Wahyu Astuti

Keyword(s):

Critical Care ◽

Patient Safety ◽

Exposure Assessment ◽

Clinical Reasoning ◽

Nursing Care ◽

Positive Impact ◽

Exam Score ◽

Reasoning Process ◽

Airway Assessment ◽

Primary Assessment

The results showed that most respondents had good critical nursing competency scores including primary assessment: airway assessment (53.8%); breathing assessment (56.4%); Circulation assessment (61.5%); Disability assessment (56.4%); and Exposure assessment (59%), professionalism (56.4%), critical nursing care competencies (79.5%), Clinical reasoning process (71.8%), Patient safety (61.5%) and critical care exam score (46.2%). The result of statistical test with Pearson test obtained that the primary assessment: airway assessment (ρ = 0.038); circulation assessment (ρ = 0.029); Exposure assessment (ρ = 0.023), competence of critical nursing care (ρ = 0.049), clinical reasoning process (ρ = 0.028) and patient safety (ρ = 0.001) have a significant relationship to the critical care exam score. The implementation of learning methods for journal sharing of critical care has a positive impact on competencies and results in good student competencies.

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Lessons in clinical reasoning – pitfalls, myths, and pearls: the contribution of faulty data gathering and synthesis to diagnostic error

Diagnosis ◽

10.1515/dx-2019-0108 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Martin A. Schaller-Paule ◽

Helmuth Steinmetz ◽

Friederike S. Vollmer ◽

Melissa Plesac ◽

Felix Wicke ◽

...

Keyword(s):

Patient Safety ◽

Clinical Reasoning ◽

Data Gathering ◽

Diagnostic Errors ◽

Diagnostic Error ◽

Care Physician ◽

Diagnostic Process ◽

Myasthenic Crisis ◽

Hospital Organization ◽

Substantial Impact

Abstract Objectives Errors in clinical reasoning are a major factor for delayed or flawed diagnoses and put patient safety at risk. The diagnostic process is highly dependent on dynamic team factors, local hospital organization structure and culture, and cognitive factors. In everyday decision-making, physicians engage that challenge partly by relying on heuristics – subconscious mental short-cuts that are based on intuition and experience. Without structural corrective mechanisms, clinical judgement under time pressure creates space for harms resulting from systems and cognitive errors. Based on a case-example, we outline different pitfalls and provide strategies aimed at reducing diagnostic errors in health care. Case presentation A 67-year-old male patient was referred to the neurology department by his primary-care physician with the diagnosis of exacerbation of known myasthenia gravis. He reported shortness of breath and generalized weakness, but no other symptoms. Diagnosis of respiratory distress due to a myasthenic crisis was made and immunosuppressive therapy and pyridostigmine were given and plasmapheresis was performed without clinical improvement. Two weeks into the hospital stay, the patient’s dyspnea worsened. A CT scan revealed extensive segmental and subsegmental pulmonary emboli. Conclusions Faulty data gathering and flawed data synthesis are major drivers of diagnostic errors. While there is limited evidence for individual debiasing strategies, improving team factors and structural conditions can have substantial impact on the extent of diagnostic errors. Healthcare organizations should provide the structural supports to address errors and promote a constructive culture of patient safety.

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EFFICIENCY OF MANAGEMENT DECISIONS IN LOCAL GOVERNMENT BODIES

Electronic scientific publication Public Administration and National Security ◽

10.25313/2617-572x-2021-4-7420 ◽

2017 ◽

Author(s):

Tetiana Sych ◽

◽

Keyword(s):

Decision Making ◽

Local Government ◽

Public Administration ◽

Professional Training ◽

Human Factor ◽

Nobel Laureate ◽

Management Decision ◽

Management Decisions ◽

State Management ◽

Public Administration Reform

The article considers the factors influencing the efficiency of management decisions made by local government bodies in the modern conditions of public administration reform and the development of local self-government in Ukraine. The author outlines the features of this problem, the main features of state-management decisions, the essence of the concepts "effect", "efficiency of management decisions", the main approaches to the study of the problem of decision-making are highlighted. The main attention is paid to the direction of research, which takes into account the human factor. The main ideas of the representative of this direction - the Nobel laureate D. Kahneman, presented in the book "Noise", are considered. This work raises the issue of system errors among those who make decisions. The views of the domestic scientist O. Maltsev on the designated problem and the provisions of D. Kahneman's book are presented. The results of the analysis by scientists of the influence of the human factor and psychological characteristics of management decision-making on the efficiency of decisions are reflected. The conclusions of scientists regarding the need to take into account the qualities of a decision- making person and his professional training are summarized. The main characteristics of the personality that influence decision-making are given from the domestic scientific literature on public administration problems. In accordance with these ideas, the requirements for the positions of civil servants, local self-government bodies, as well as the modern practice of training specialists and managers in this field are considered. It is concluded that the primary importance for making effective decisions by local government bodies is the use by specialists and managers of modern technologies for developing and making management decisions, the development of their personal qualities for making management decisions in the process of training and obtaining specialized management education in universities.

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Adoption of management decisions based on programming methods as a subgroup of methods for optimizing performance indicators

Journal of Management Studies ◽

10.12737/article_5d68d583605411.06206955 ◽

2019 ◽

Vol 4 (9) ◽

pp. 34-44

Author(s):

А. Тебекин ◽

A. Tebekin

Keyword(s):

Decision Making ◽

Performance Indicators ◽

Management Decision ◽

Management Decisions ◽

General Classification ◽

Managerial Decisions ◽

Management Decision Making ◽

First Time

The author's classification of management decision-making methods, including twenty-five classes of methods, is presented for the first time. As part of the general classification of management decision-making methods, the role and place of a group of methods for making managerial decisions based on the optimization of performance indicators was demonstrated. In the group of methods for making managerial decisions based on the optimization of performance indicators, a subgroup of programming methods (linear, nonlinear and dynamic) is considered in detail. The features of use and application are shown when making managerial decisions of a subgroup of programming methods.

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MODELING AS A SCIENTIFIC TOOL FOR SUBSTANTIATION OF MANAGEMENT DECISIONS IN OPERATIONAL ACTIVITIES OF TRANSPORT ENTERPRISES

The National Transport University Bulletin ◽

10.33744/2308-6645-2021-2-49-162-172 ◽

2021 ◽

Vol 49 (2) ◽

pp. 162-172

Author(s):

Snizhko L ◽

◽

Buzun T ◽

Razvodovska V ◽

◽

...

Keyword(s):

Decision Making ◽

System Analysis ◽

Management Decision ◽

Decision Making Process ◽

Management Decisions ◽

Legal Form ◽

Operational Decisions ◽

Operational Activities ◽

Problem Formalization ◽

Scientific Tool

On the basis of analysis of existing approaches to the process of decision making, in this article the procedure of taking optimal operational decisions is proposed, which describes in detail all of its aspects and features related to the specifics of the operational activities of transport enterprises. In this procedure the basic steps are those directly related to the modeling: formulation of the problem (formalization of the original problem), construction of the model, its solution, credibility and adequacy check, restoration (or adjustment) of the model. The object of the research is decision-making process in the operational management of transport enterprises. The purpose of the research is to develop a procedure for the process of making optimal operational decisions based on existing approaches to the decision-making process, using modeling as a scientific tool to substantiate them. The research method is methods of system analysis and modeling. It has been discovered that the need to reduce the subjectivity of the process of making important decisions in the operational activities of transport enterprises and increase its scientific validity is especially relevant today, in the face of threats and uncertainty about the external environment of the organization. All methods of rational decision-making are based on models, which, in turn, are scientific tools. Modeling creates a serious informational and methodological basis for structural analysis of decisions needed to improve the management process for operational managers and hence - to increase the level of management in general, because it makes them more systematic, and the tools used during this help them be more rational. The results of the article can be implemented during making complex and important management decisions in the operational activities of both transport enterprises and other business entities of various activities, regardless of the organizational and legal form and ownership. KEY WORDS: MODELING METHOD, MODELING, MODEL, TRANSPORT ENTERPRISE, OPERATIONAL ACTIVITY, OPERATIONS MANAGER, MANAGEMENT DECISION.

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Heuristic procedures for solving mixed-integer harvest scheduling–transportation planning models

Canadian Journal of Forest Research ◽

10.1139/x95-176 ◽

1995 ◽

Vol 25 (10) ◽

pp. 1618-1626 ◽

Cited By ~ 32

Author(s):

Andrés Weintraub ◽

Adrian Magendzo ◽

Ariel Magendzo ◽

Daniel Malchuk ◽

Greg Jones ◽

...

Keyword(s):

Land Management ◽

Transportation Planning ◽

Road Construction ◽

Mixed Integer ◽

Management Decision ◽

Heuristic Procedure ◽

Harvest Scheduling ◽

Management Decisions ◽

Planning Models ◽

Heuristic Procedures

Modeling both road construction and land management activities as 0–1 variables greatly enhances the spatial aspect of linear programming models dealing with harvest scheduling and transportation planning. In previous work we developed a heuristic procedure that modeled only road construction as 0–1 variables. We have expanded this past procedure to also consider land management decisions as 0–1 variables. This paper outlines the heuristic procedure developed for modeling both road building and land management decisions as integer variables in light of adjacency constraints. The heuristic procedure allows economic or physical objectives to be maximized or minimized. A wide variety of side constraints can be accommodated and these constraints can include both road construction and land management decision variables. These heuristic procedures have performed well on models tested thus far.

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