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. 2023 Sep;27(9):620-624.
doi: 10.5005/jp-journals-10071-24520.

Impact of Fatigue on Emergency Physicians' Decision-making for Computed Tomographic Scan Requests and Inpatient Referrals: An Observational Study from a Tertiary Care Medical Center of the Sultanate of Oman

Asma H Al-Arimi  1 , Darpanarayan Hazra  2 , Awatif K Alsarrai Al-Alawi  2
Affiliations

Impact of Fatigue on Emergency Physicians' Decision-making for Computed Tomographic Scan Requests and Inpatient Referrals: An Observational Study from a Tertiary Care Medical Center of the Sultanate of Oman

Asma H Al-Arimi et al. Indian J Crit Care Med. 2023 Sep.

Abstract

Objective: Multiple factors contribute to decision fatigue experienced by emergency physicians (EPs). This study examines the association between decision fatigue and the frequency of computed tomographic (CT) scan requests and inpatient referrals among EPs.

Methods: This retrospective database analysis was done for 3 months. Scans and inpatient referral requests were coded and analyzed to assess the impact of physician fatigue on decision-making. Subsequently, the outcomes were evaluated.

Results: The majority of patients (n = 481; 51.1%) had a CT brain request. Among these requests, the morning shift (8:00 a.m.-3:00 p.m.) accounted for the highest number (n = 400; 42.5%), followed by the evening shift (3:00-11:00 p.m.) (n = 345; 36.7%). Approximately one-third of the patients (n = 301; 31.9%) had positive CT scan findings. Statistical analysis comparing the first and the second halves of each shift did not reveal significant variations in the percentage of negative CT results (p-value: 0.093). Inpatient referral was necessary for over half of the patients (n = 1,048; 52.7%), and the majority of these referrals (n = 778; 74.2%) were deemed necessary for treatment under various surgical or medical specialties. There was a statistically significant difference in the proportion of negative inpatient referrals between the first and the second halves of the afternoon shift (p-value < 0.001).

Conclusions: Fatigue among EPs was observed, leading to more frequent consultations without inpatient admission during the latter half of the afternoon shift. However, the study found no significant impact of decision fatigue on CT scan decision-making.

How to cite this article: Al-Arimi AH, Hazra D, Al-Alawi AKA. Impact of Fatigue on Emergency Physicians' Decision-making for Computed Tomographic Scan Requests and Inpatient Referrals: An Observational Study from a Tertiary Care Medical Center of the Sultanate of Oman. Indian J Crit Care Med 2023;27(9):620-624.

Keywords: Computed tomography; Decision-making; Emergency medicine; Emergency physicians; Fatigue; Shift work schedule.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1
Fig. 1
The strengthening the reporting of observational studies in epidemiology diagram
Fig. 2
Fig. 2
Illustration of the number of CT scans requested in each shift interval
Fig. 3
Fig. 3
Illustration of the number of inpatient referrals requested in each shift interval
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References

    1. Gifford MJ, Franaszek JB, Gibson G. Emergency physicians’ and patients’ assessments: Urgency of need for medical care. Ann Emerg Med. 1980;9(10):502–507. doi: 10.1016/s0196-0644(80)80187-9. - DOI - PubMed
    1. Cue F, Inglis R. Improving the operations of the emergency department. Hospitals. 1978;52(13):110–113, 119. 658905 - PubMed
    1. Aaronson EL, Marsh RH, Guha M, Schuur JD, Rouhani SA. Emergency department quality and safety indicators in resource-limited settings: An environmental survey. Int J Emerg Med. 2015;8(1):39. doi: 10.1186/s12245-015-0088-x. - DOI - PMC - PubMed
    1. Dubash R, Bertenshaw C, Ho JH. Decision fatigue in the emergency department. Emerg Med Australas. 2020;32(6):1059–1061. doi: 10.1111/1742-6723.13670. - DOI - PubMed
    1. Pignatiello GA, Martin RJ, Hickman RL. Decision fatigue: A conceptual analysis. J Health Psychol. 2020;25(1):123–135. doi: 10.1177/1359105318763510. - DOI - PMC - PubMed

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