Article Text

PDF
Decision making in asthma exacerbation: a clinical judgement analysis
  1. John Jenkins2,
  2. Mike Shields1,
  3. Chris Patterson1,
  4. Frank Kee1
  1. 1Queen’s University Belfast, Belfast, UK
  2. 2Queen’s University Belfast, Paediatric Department, Antrim Hospital, Antrim BT41 2RL, UK
  1. Correspondence to:
    Dr John Jenkins
    Queen’s University Belfast, Paediatric Department, Antrim Hospital, Antrim BT41 2RL, UK; j.jenkins{at}qub.ac.uk

Abstract

Background: Clinical decisions which impact directly on patient safety and quality of care are made during acute asthma attacks by individual doctors based on their knowledge and experience. Decisions include administration of systemic corticosteroids (CS) and oral antibiotics, and admission to hospital. Clinical judgement analysis provides a methodology for comparing decisions between practitioners with different training and experience, and improving decision making.

Methods: Stepwise linear regression was used to select clinical cues based on visual analogue scale assessments of the propensity of 62 clinicians to prescribe a short course of oral CS (decision 1), a course of antibiotics (decision 2), and/or admit to hospital (decision 3) for 60 “paper” patients.

Results: When compared by specialty, paediatricians’ models for decision 1 were more likely to include level of alertness as a cue (54% vs 16%); for decision 2 they were more likely to include presence of crepitations (49% vs 16%) and less likely to include inhaled CS (8% vs 40%), respiratory rate (0% vs 24%) and air entry (70% vs 100%). When compared to other grades, the models derived for decision 3 by consultants/general practitioners were more likely to include wheeze severity as a cue (39% vs 6%).

Conclusions: Clinicians differed in their use of individual cues and the number included in their models. Patient safety and quality of care will benefit from clarification of decision-making strategies as general learning points during medical training, in the development of guidelines and care pathways, and by clinicians developing self-awareness of their own preferences.

  • A&E, accident and emergency
  • CS, corticosteroids
  • GPs, general practitioners
  • VAS, visual analogue scale
  • clinical judgement analysis
  • decision making
  • asthma
  • systemic corticosteroids
  • hospital admission

Statistics from Altmetric.com

Footnotes

  • Published Online First 11 April 2007

  • Funding: None.

  • Competing interests: None.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Précis
    BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health