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Tytuł:
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Upgrades to intensive care: The effects of COVID-19 on decision-making in the emergency department.
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Autorzy:
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Lucas NV; Department of Emergency Medicine, Temple University Hospital, 1316 W. Ontario Street, 10(th) floor Jones Hall, Philadelphia, PA 19140, United States.
Rosenbaum J; Department of Emergency Medicine, Temple University Hospital, 1316 W. Ontario Street, 10(th) floor Jones Hall, Philadelphia, PA 19140, United States.
Isenberg DL; Department of Emergency Medicine, Temple University Hospital, 1316 W. Ontario Street, 10(th) floor Jones Hall, Philadelphia, PA 19140, United States.
Martin R; Department of Emergency Medicine, Temple University Hospital, 1316 W. Ontario Street, 10(th) floor Jones Hall, Philadelphia, PA 19140, United States.
Schreyer KE; Department of Emergency Medicine, Temple University Hospital, 1316 W. Ontario Street, 10(th) floor Jones Hall, Philadelphia, PA 19140, United States. Electronic address: .
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Źródło:
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The American journal of emergency medicine [Am J Emerg Med] 2021 Nov; Vol. 49, pp. 100-103. Date of Electronic Publication: 2021 Jun 03.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: 1983- : Philadelphia, PA : W B Saunders
Original Publication: [Philadelphia, PA. : Centrum Philadelphia, c1983]-
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MeSH Terms:
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COVID-19*
Decision Making, Organizational*
Pandemics*
Surge Capacity/*organization & administration
Cognition ; Critical Care ; Critical Illness ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Retrospective Studies ; Tertiary Care Centers
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References:
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Ann Emerg Med. 2003 Jan;41(1):110-20. (PMID: 12514691)
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Acad Med. 2011 Mar;86(3):307-13. (PMID: 21248608)
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Contributed Indexing:
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Keywords: Cognitive bias; Emergency medicine; Misdiagnosis
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Entry Date(s):
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Date Created: 20210607 Date Completed: 20211123 Latest Revision: 20221221
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Update Code:
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20240104
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PubMed Central ID:
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PMC8172306
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DOI:
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10.1016/j.ajem.2021.05.078
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PMID:
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34098327
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Introduction: The initial surge of critically ill patients in the COVID-19 pandemic severely disrupted processes at acute care hospitals. This study examines the frequency and causes for patients upgraded to intensive care unit (ICU) level care following admission from the emergency department (ED) to non-critical care units.
Methods: The number of ICU upgrades per month was determined, including the percentage of upgrades noted to have non-concordant diagnoses. Charts with non-concordant diagnoses were examined in detail as to the ED medical decision-making, clinical circumstances surrounding the upgrade, and presence of a diagnosis of COVID-19. For each case, a cognitive bias was assigned.
Results: The percentage of upgraded cases with non-concordant diagnoses increased from a baseline range of 14-20% to 41.3%. The majority of upgrades were due to premature closure (72.2%), anchoring (61.1%), and confirmation bias (55.6%).
Conclusion: Consistent with the behavioral literature, this suggests that stressful ambient conditions affect cognitive reasoning processes.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
