124 - Decision-Making Under Pressure: How Pediatric Critical Care Physicians Make Decisions about Decompensating Patients

Publication Number: 124.4348

Laura Schroeder, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Ellen F. Goldman, George Washington University, RESTON, VA, United States

Background: Appropriate recognition and management of acutely decompensating hospitalized pediatric patients is crucial as late recognition significantly worsens clinical outcomes, but decision-making during these complicated clinical situations is poorly understood. Learning more about how Pediatric Critical Care Medicine (PCCM) physicians approach this complex task could provide valuable insight for future clinical interventions and related education.

Objective: This study aimed to better understand how PCCM physicians make decisions when asked to evaluate potentially deteriorating pediatric patients.

Design/Methods: An initial conceptual framework based on the naturalistic decision-making literature guided this qualitative study. Ten pediatric intensivists meeting specific selection criteria were recruited to participate in individual semi-structured interviews. An inductive coding process was used to analyze the interview transcripts, codes were clustered and themes were identified. Numerous trustworthiness procedures were used.

Results: Six themes emerged: (1) Repeated patient experiences and autonomy inform decision making. (2) Decision making requires self-assessment and self-management skills. (3) Time pressure to make decisions depends on an initial clinical assessment. (4) Role selection is a key decision. (5) Multiple evaluations occur during decision making. (6) Resources impact the final decision.

Conclusion(s): This study adds to the literature by describing the decision-making process of PCCM physicians assessing potentially decompensating pediatric patients. While some aspects of their decision-making are consistent with known models such as Recognition Primed Decision Making, important new concepts are revealed in this study including the importance of role selection and self-management and self-assessment skills. This study has important implications for the understanding of clinical decision-making, future research, and education.

Conceptual Model of Decision Making by PCCM Physicians Evaluating Potentially Deteriorating Patients
Conceptual Model Figure.pdf