Perceived Appropriateness of Shared Decision-making in the Emergency Department: A Survey Study
Perceived Appropriateness of Shared Decision-making in the Emergency Department: A Survey Study
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DOI：
10.1111/acem.12904
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发表时间：
2016-04-01
影响因子：
4.4
通讯作者：
Richardson, Lynne D.
中科院分区：
文献类型：
--
作者：
Probst, Marc A.;Kanzaria, Hemal K.;Richardson, Lynne D.
ObjectivesThe的目的是描述执业急诊医师（EP）的看法，关于在急诊科（艾德）中使用共享决策（SDM）的适当性和法医学意义。方法我们在一个大型的全国专业会议上对EP进行了横断面调查，以评估SDM对不同类别的艾德管理（例如，诊断测试、治疗、处置）以及在常见的临床情况下（例如，低风险胸痛、晕厥、轻微头部损伤）。一个21项的调查工具，通过内容专家的审查，认知测试和试点测试迭代开发。描述性和多变量分析carried.ResultsWe接近737 EP; 709（96%）完成了调查。三分之二（67.8%）的受访者是男性; 51%在学术环境中实践，44%在社区中实践。在列出的7个管理决策类别中，SDM被报告最常适用于决定侵入性手术（71.5%）、计算机断层扫描（CT）扫描（56.7%）和ED后处置（56.3%）。在具体的临床情况中，使用溶栓剂治疗急性缺血性卒中被认为最常适用于SDM（83.4%），其次是腰椎穿刺以排除蛛网膜下腔出血（73.8%）和头部CT用于小儿轻微头部损伤（69.9%）。大多数EP（66.8%）认为，使用和记录SDM会降低他们的法医风险，而少数人（14.2%）认为，这将增加他们的risk.ConclusionsAcceptance的SDM EP之间的管理类别（诊断检测，治疗和处置），并在各种临床情况下，似乎是强大的。大多数EP认为SDM具有法医学保护作用。
ObjectivesThe 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).MethodsWe 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.ResultsWe 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.ConclusionsAcceptance 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.