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The transition to clinical expert: enhanced decision making for children aged less than 5 years attending the paediatric ED with acute respiratory conditions

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)76-81
Number of pages7
JournalEmergency Medicine Journal
Volume34
Issue number2
Early online date5 Aug 2016
DOIs
DateAccepted/In press - 8 Jul 2016
DateE-pub ahead of print - 5 Aug 2016
DatePublished (current) - 1 Feb 2017

Abstract

Background
Rates of unplanned paediatric admissions are persistently high. Many admissions are short-stay events, lasting less than 48 hours.

Objective
This qualitative research explores factors that influence clinical decision making in the paediatric ED (PED) for children under 5 attending with acute respiratory conditions, focusing on how management decisions adapt with increasing experience.

Method
Semi-structured interviews were conducted with 15 PED clinicians (doctors, emergency nurse practitioners and registered nurses) with varying levels of experience in paediatric emergency medicine (PEM), emergency medicine or paediatrics. Audio-recorded interviews were transcribed and analysed thematically.

Results
There were clear differences in decision-making approaches between experienced clinicians and junior staff. The latter were more risk adverse, relying heavily on guidelines, set admission criteria, clinical theory and second opinions. This was particularly true for doctors. ‘Informal’ learning was apparent in accounts from less-experienced doctors and nurses, whereby tacit knowledge and risk management played an increasing role in the development of clinical intuition that permitted rapid assessment and treatment of young patients.

Conclusions
The emergence of intuition entwined with approaches to risk management and the role of these skills in clinical decision making, carry implications for the development of training programmes for clinicians working in PEM. Enhanced training for such groups to permit development of the supplementary skills described in this study could have the ability to improve care delivery and even reduce paediatric admissions.

    Research areas

  • Paediatric, EMERGENCY MEDICAL-CARE, Decision Making

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via BMJ at http://emj.bmj.com/content/early/2016/08/05/emermed-2015-205211.abstract. Please refer to any applicable terms of use of the publisher.

    Final published version, 456 KB, PDF document

    Licence: CC BY

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