Theories of clinical judgment and decision-making: A review of the theoretical literature

Source: OAI


  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Emergency doctors must make decisions for many patients in a limited time. Various emergency cases are not compatible with routine conditions as described in textbooks, so doctors use clinical decision making (CDM) processes to act in the best possible way. In the present work, these processes and some of the related factors were assessed. Decisions made by doctors were studied via patient medical records, doctors' notes and interviews with decision-making doctors from the Emergency Department of Rasul-Akram Hospital, Tehran, Iran. All doctors were unaware of this research, and they had previously studied CDM processes as part of their training curriculum. A total of 10 day and 10 night shifts (240 h) between 1 March 2010 and 30 May 2010 were considered for the study. Rule-based, event-driven, knowledge-based and skill-based decisions, respectively, were the most frequent processes used by doctors in 726 first visits. It was also found that 7% of decisions were not made on a known CDM basis, that all of them were for non-urgent and 'standard' patients, and that most patients who were non-urgent were referred to first-year postgraduates. Skill-based decisions were not applied in very urgent cases; 107 out of 726 decisions on first visits had shifted to knowledge-based process by the time of final treatment decisions. For final treatment decisions, rule-based and knowledge-based processes were more frequently used than other CDM processes. The rule-based process is the most common CDM process used by emergency doctors, perhaps because of the minimisation of human error in this process. CDM choice may be influenced by triage level, treatment room and doctors' educational levels. Revealing and studying these factors may help shift decisions to the best possible decision making levels, defining a model in future research.
    Emergency Medicine Journal 04/2011; 29(5):394-8. · 1.65 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The project investigated the experiences of ambulance paramedics in applying the principles and protocols of prehospital multiple casualty triage at the scene of motor vehicle accidents. Key objectives included investigation of the situational cues and other contextual factors influencing triage practice and the development of recommendations for the future education of ambulance paramedics. A triangulated approach was used incorporating demographic data, the use of focus groups and in-depth interviews. A thematic analysis was undertaken following the well established practices of human science research. Results and The research describes an extended and broadened triage process returning to a more authentic definition of triage as the practice of sorting of casualties to determine priority. The findings highlight the need to consider triage as an extended and complex process that incorporates evidence based physiological cues to assist decision making and the management of the process of triage from call out to conclusion including assessment of contextual and situational variables.
    Emergency Medicine Journal 05/2008; 25(4):230-4. · 1.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: There has been a rapid increase in members of the Australian population using opioids in recent years. The flow-on effect has been an increase in demand for treatments, particularly opioid replacement therapy (ORT), but the availability of treatments has not increased. This has frequently resulted in delays before treatment can be commenced. Outcomes could improve if health-care professionals had clearer guidelines on how to prioritize access to ORT. This review investigates the triage of consumers in ORT within Australia. Information on triage in ORT was not available, and an understanding of how consumer needs are managed when they present for ORT triage was not identified. In the absence of research to guide this practice, the body of evidence regarding ORT treatment access is weighted on government policies. Triage, as applied in general health and mental health-care service delivery, was reviewed to consider the components of triage and how these might pertain to triage in ORT. Failure to facilitate the needs of consumers accessing ORT can result in further harm to consumers and increased social and financial costs for society. Research is required to investigate how this issue is currently being managed and to lead the way for needed improvements in service delivery.
    International journal of mental health nursing 05/2011; 20(6):418-27. · 1.29 Impact Factor

Full-text (2 Sources)

Available from
May 29, 2014