Upgrades to intensive care: The effects of COVID-19 on decision-making in the emergency department.
Am J Emerg Med
; 49: 100-103, 2021 11.
Article
in English
| MEDLINE | ID: covidwho-1252390
ABSTRACT
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.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Decision Making, Organizational
/
Surge Capacity
/
Pandemics
/
COVID-19
Type of study:
Experimental Studies
/
Observational study
/
Prognostic study
Limits:
Humans
Language:
English
Journal:
Am J Emerg Med
Year:
2021
Document Type:
Article
Affiliation country:
J.ajem.2021.05.078
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