The effect of physician risk tolerance and the presence of an observation unit on decision making for ED patients with chest pain.
Publication/Presentation Date
9-1-2010
Abstract
OBJECTIVES: We sought to determine whether risk tolerance as measured by scales (malpractice fear scale [MFS], risk-taking scale [RTS], and stress from uncertainty scale [SUS]) is associated with decisions to admit or use computed tomography (CT) coronary angiogram and decisions to order cardiac markers in emergency department (ED) patients with chest pain. We also studied if the opening of an ED-based observation unit affected the relationship between risk scales and admission decisions.
METHODS: Data from a prospective study of ED patients 30 years or older with chest pain were used. Risk scales were administered to ED attending physicians who initially evaluated them. Physicians were divided into quartiles for each separate risk scale. Fisher's exact test and logistic regression were used for statistical analysis.
RESULTS: A total of 2872 patients were evaluated by 31 physicians. The most risk-averse quartile of RTS was associated with higher admission rates (78% vs 68%) and greater use of cardiac markers (83% vs 78%) vs the least risk-averse quartile. This was not true for MFS or SUS. Similar associations were observed in low-risk patients (Thrombolysis in Myocardial Infarction risk score of 0 or 1). The observation unit was not associated with a higher admission rate and did not modify the relationship between risk scales and admission rates.
CONCLUSION: The RTS was associated with the decision to admit or use computed tomography coronary angiogram, as well as the use of cardiac markers, whereas the MFS and SUS were not. The observation unit did not affect admission rates and nor did it affect how physician's risk tolerance affects admission decisions.
Volume
28
Issue
7
First Page
771
Last Page
779
ISSN
1532-8171
Published In/Presented At
Pines, J. M., Isserman, J. A., Szyld, D., Dean, A. J., McCusker, C. M., & Hollander, J. E. (2010). The effect of physician risk tolerance and the presence of an observation unit on decision making for ED patients with chest pain. The American journal of emergency medicine, 28(7), 771–779. https://doi.org/10.1016/j.ajem.2009.03.019
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
20837253
Department(s)
Administration and Leadership
Document Type
Article