Presentation
Designing for Doubt: Human-Centered Decision-Making in Uncertain Systems
SessionPoster Session 1
DescriptionBackground:
Patients who leave the emergency department (ED) before their treatment is completed represent uncertain health outcomes and safety risks for health systems. This group of patients is defined as those who are seen by a provider, but leave prior to being discharged and do not sign out of the ED against medical advice. There are over two million people every year, or 2% of all ED visits, that fall into this category of patient visits. Many of these people leave the ED with diagnostic uncertainty and limited follow-up resources to address their health condition. Diagnostic uncertainty occurs when healthcare providers are unable to provide a definitive diagnosis for a patient prior to their discharge, despite having information such as a medical history, physical exam, and diagnostic test results available. This patient population may return to the ED for an unresolved health issue or go on to have a poor health outcome. Using a patient-centered lens to evaluate decision-making processes behind incomplete ED visits, interventions can be designed that increase the rates of completed patient visits, reduce return visits to the ED, and improve the health outcomes of people who leave before their treatment is completed.
Summary: A scoping review was conducted to increase the understanding of decision-making theories that apply to this ED population. The Joanna Briggs Institute checklist for scoping reviews was used to design the manuscript protocol. A review of PubMed, PsychInfo, Web of Science, JSTOR, and Google Scholar was conducted. The date range was not limited. Inclusion criteria were: scholarly theories published in the English language and also from a psychology, business, behavioral economics, or healthcare specialty. Nine theories were reviewed for relevance to the “left before treatment completed” population with a focus on diagnostic uncertainty. These included the Theory of Reasoned Action, Nudge Theory, Fuzzy-trace Theory, Rational Choice Theory, Prospect Theory, Self-determination Theory, Info-gap Decision Theory, Cognitive Continuum Theory, and Social Cognitive Theory.
Poster presentation overview:
Patient values and priorities when visiting the ED will be described along with the compounded effects of multiple diagnostic uncertainties in this setting. The decision-making theories that are most applicable when promoting the completion of patient visits will be highlighted. Healthcare organizational factors will be reviewed that likely contribute to the patient decision-making process in an ED setting, such as communities served, admission beds available, hospital census, and staffing levels. Applying key aspects of decision-making theories with a focus on uncertainty has the potential to mitigate organizational influences, promote patient engagement and empowerment in their healthcare decisions while improving their health outcomes.
Patients who leave the emergency department (ED) before their treatment is completed represent uncertain health outcomes and safety risks for health systems. This group of patients is defined as those who are seen by a provider, but leave prior to being discharged and do not sign out of the ED against medical advice. There are over two million people every year, or 2% of all ED visits, that fall into this category of patient visits. Many of these people leave the ED with diagnostic uncertainty and limited follow-up resources to address their health condition. Diagnostic uncertainty occurs when healthcare providers are unable to provide a definitive diagnosis for a patient prior to their discharge, despite having information such as a medical history, physical exam, and diagnostic test results available. This patient population may return to the ED for an unresolved health issue or go on to have a poor health outcome. Using a patient-centered lens to evaluate decision-making processes behind incomplete ED visits, interventions can be designed that increase the rates of completed patient visits, reduce return visits to the ED, and improve the health outcomes of people who leave before their treatment is completed.
Summary: A scoping review was conducted to increase the understanding of decision-making theories that apply to this ED population. The Joanna Briggs Institute checklist for scoping reviews was used to design the manuscript protocol. A review of PubMed, PsychInfo, Web of Science, JSTOR, and Google Scholar was conducted. The date range was not limited. Inclusion criteria were: scholarly theories published in the English language and also from a psychology, business, behavioral economics, or healthcare specialty. Nine theories were reviewed for relevance to the “left before treatment completed” population with a focus on diagnostic uncertainty. These included the Theory of Reasoned Action, Nudge Theory, Fuzzy-trace Theory, Rational Choice Theory, Prospect Theory, Self-determination Theory, Info-gap Decision Theory, Cognitive Continuum Theory, and Social Cognitive Theory.
Poster presentation overview:
Patient values and priorities when visiting the ED will be described along with the compounded effects of multiple diagnostic uncertainties in this setting. The decision-making theories that are most applicable when promoting the completion of patient visits will be highlighted. Healthcare organizational factors will be reviewed that likely contribute to the patient decision-making process in an ED setting, such as communities served, admission beds available, hospital census, and staffing levels. Applying key aspects of decision-making theories with a focus on uncertainty has the potential to mitigate organizational influences, promote patient engagement and empowerment in their healthcare decisions while improving their health outcomes.
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery
Patient Safety Research and Initiatives