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BACKGROUND/RATIONALE:
This short-term project will identify opportunities to enhance decision support systems, such as by automatically flagging patients with a high mortality risk, in order to encourage timely disposition to the hospital. Some variability in risk-adjusted mortality across sites might be explained by variability in Emergency Department (ED) disposition practices. Disposition decisions are conducted under time pressure, uncertainty, have potentially high consequences for failure, and are based on highly distributed information embedded in mounds of irrelevant data.
OBJECTIVE(S):
There are 3 main objectives:
1.Assess variation in disposition decisions by emergency department physicians
2.Compare disposition strategies with vs. without the use of ED Tracking Board software
3.Identify barriers and facilitators to the use of automated detection of high mortality risk indicators
METHODS:
Data collection: Direct (in situ) ethnographic observations will be conducted in emergency departments at two sites for 5 days each by 3 trained observers. Data collection will sequentially capture both 1) observable activities and verbalizations, and 2) self-report data about how artifacts (tools) support or hinder performance.
Data analysis: A qualitative case-based analysis will be employed. For each case, decisions will be coded for: site, educational level of physician, disposition strategy, information included in the disposition decision, and barriers and facilitators to use of automated enhancements.
FINDINGS/RESULTS:
Data collection is underway. No results at this time.
IMPACT:
Improving the ED Tracking Board software, a national informatics application, might reduce lengths of stay in the emergency department and potentially reduce patient mortality by better supporting accurate and timely disposition decisions for high-risk patients.
PUBLICATIONS:
None at this time.
DRA:
none
DRE:
none
Keywords:
none
MeSH Terms:
none
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