J Biomed Inform - Opportunistic decision making and complexity in emergency care.

Tópicos

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{ surgeri(1148) surgic(1085) robot(1054) }
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{ record(1888) medic(1808) patient(1693) }
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{ research(1218) medic(880) student(794) }
{ model(2656) set(1616) predict(1553) }
{ age(1611) year(1155) adult(843) }
{ signal(2180) analysi(812) frequenc(800) }
{ cost(1906) reduc(1198) effect(832) }
{ group(2977) signific(1463) compar(1072) }
{ sampl(1606) size(1419) use(1276) }
{ data(3008) multipl(1320) sourc(1022) }
{ first(2504) two(1366) second(1323) }
{ intervent(3218) particip(2042) group(1664) }
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{ time(1939) patient(1703) rate(768) }
{ patient(1821) servic(1111) care(1106) }
{ can(981) present(881) function(850) }
{ health(1844) social(1437) communiti(874) }
{ structur(1116) can(940) graph(676) }
{ cancer(2502) breast(956) screen(824) }
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{ drug(1928) target(777) effect(648) }
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{ estim(2440) model(1874) function(577) }
{ process(1125) use(805) approach(778) }
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{ method(2212) result(1239) propos(1039) }
{ detect(2391) sensit(1101) algorithm(908) }

Resumo

In critical care environments such as the emergency department (ED), many activities and decisions are not planned. In this study, we developed a new methodology for systematically studying what are these unplanned activities and decisions. This methodology expands the traditional naturalistic decision making (NDM) frameworks by explicitly identifying the role of environmental factors in decision making. We focused on decisions made by ED physicians as they transitioned between tasks. Through ethnographic data collection, we developed a taxonomy of decision types. The empirical data provide important insight to the complexity of the ED environment by highlighting adaptive behavior in this intricate milieu. Our results show that half of decisions in the ED we studied are not planned, rather decisions are opportunistic decision (34%) or influenced by interruptions or distractions (21%). What impacts these unplanned decisions have on the quality, safety, and efficiency in the ED environment are important research topics for future investigation.

Resumo Limpo

critic care environ emerg depart ed mani activ decis plan studi develop new methodolog systemat studi unplan activ decis methodolog expand tradit naturalist decis make ndm framework explicit identifi role environment factor decis make focus decis made ed physician transit task ethnograph data collect develop taxonomi decis type empir data provid import insight complex ed environ highlight adapt behavior intric milieu result show half decis ed studi plan rather decis opportunist decis influenc interrupt distract impact unplan decis qualiti safeti effici ed environ import research topic futur investig

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