Upgrades to intensive care: The effects of COVID-19 on decision-making in the emergency department
| Autor: | Derek Isenberg, Nicole V. Lucas, Jennifer Rosenbaum, Richard Martin, Kraftin E. Schreyer |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19) Critical Care media_common.quotation_subject Critical Illness Misdiagnosis Article law.invention Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine Cognition law Intensive care Acute care Medicine Humans Medical diagnosis Pandemics Decision Making Organizational media_common Retrospective Studies business.industry Surge Capacity COVID-19 030208 emergency & critical care medicine General Medicine Emergency department Intensive care unit Cognitive bias Intensive Care Units Confirmation bias Emergency medicine business Emergency Service Hospital |
| Zdroj: | The American Journal of Emergency Medicine |
| ISSN: | 1532-8171 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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