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

Marc A. Probst, Hemal K. Kanzaria, Dominick L. Frosch, Erik P. Hess, Gary Winkel, Ka Ming Ngai, Lynne D. Richardson

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20 Scopus citations

Abstract

Objectives: The objective was to describe perceptions of practicing emergency physicians (EPs) regarding the appropriateness and medicolegal implications of using shared decision-making (SDM) in the emergency department (ED). Methods: We conducted a cross-sectional survey of EPs at a large, national professional meeting to assess perceived appropriateness of SDM for different categories of ED management (e.g., diagnostic testing, treatment, disposition) and in common clinical scenarios (e.g., low-risk chest pain, syncope, minor head injury). A 21-item survey instrument was iteratively developed through review by content experts, cognitive testing, and pilot testing. Descriptive and multivariate analyses were conducted. Results: We approached 737 EPs; 709 (96%) completed the survey. Two-thirds (67.8%) of respondents were male; 51% practiced in an academic setting and 44% in the community. Of the seven management decision categories presented, SDM was reported to be most frequently appropriate for deciding on invasive procedures (71.5%), computed tomography (CT) scanning (56.7%), and post-ED disposition (56.3%). Among the specific clinical scenarios, use of thrombolytics for acute ischemic stroke was felt to be most frequently appropriate for SDM (83.4%), followed by lumbar puncture to rule out subarachnoid hemorrhage (73.8%) and CT head for pediatric minor head injury (69.9%). Most EPs (66.8%) felt that using and documenting SDM would decrease their medicolegal risk while a minority (14.2%) felt that it would increase their risk. Conclusions: Acceptance of SDM among EPs appears to be strong across management categories (diagnostic testing, treatment, and disposition) and in a variety of clinical scenarios. SDM is perceived by most EPs to be medicolegally protective.

Original languageEnglish (US)
JournalAcademic Emergency Medicine
DOIs
StateAccepted/In press - 2016

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ASJC Scopus subject areas

  • Emergency Medicine

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Probst, M. A., Kanzaria, H. K., Frosch, D. L., Hess, E. P., Winkel, G., Ngai, K. M., & Richardson, L. D. (Accepted/In press). Perceived Appropriateness of Shared Decision-making in the Emergency Department: A Survey Study. Academic Emergency Medicine. https://doi.org/10.1111/acem.12904