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. 2024 Jun 20;31(7):1608-1621.
doi: 10.1093/jamia/ocae096.

The role of information systems in emergency department decision-making-a literature review

Cornelius Born  1 , Romy Schwarz  1 , Timo Phillip Böttcher  1 , Andreas Hein  2 , Helmut Krcmar  1
Affiliations

The role of information systems in emergency department decision-making-a literature review

Cornelius Born et al. J Am Med Inform Assoc. .

Abstract

Objectives: Healthcare providers employ heuristic and analytical decision-making to navigate the high-stakes environment of the emergency department (ED). Despite the increasing integration of information systems (ISs), research on their efficacy is conflicting. Drawing on related fields, we investigate how timing and mode of delivery influence IS effectiveness. Our objective is to reconcile previous contradictory findings, shedding light on optimal IS design in the ED.

Materials and methods: We conducted a systematic review following PRISMA across PubMed, Scopus, and Web of Science. We coded the ISs' timing as heuristic or analytical, their mode of delivery as active for automatic alerts and passive when requiring user-initiated information retrieval, and their effect on process, economic, and clinical outcomes.

Results: Our analysis included 83 studies. During early heuristic decision-making, most active interventions were ineffective, while passive interventions generally improved outcomes. In the analytical phase, the effects were reversed. Passive interventions that facilitate information extraction consistently improved outcomes.

Discussion: Our findings suggest that the effectiveness of active interventions negatively correlates with the amount of information received during delivery. During early heuristic decision-making, when information overload is high, physicians are unresponsive to alerts and proactively consult passive resources. In the later analytical phases, physicians show increased receptivity to alerts due to decreased diagnostic uncertainty and information quantity. Interventions that limit information lead to positive outcomes, supporting our interpretation.

Conclusion: We synthesize our findings into an integrated model that reveals the underlying reasons for conflicting findings from previous reviews and can guide practitioners in designing ISs in the ED.

Keywords: clinical decision support systems; clinical decision-making; computer-assisted decision-making; emergency medical services; information overload; information systems.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Dual model of decision-making in the ED (adapted from3)
Figure 2.
Figure 2.
Study selection process.
See this image and copyright information in PMC

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References

    1. Kovacs G, Croskerry P. Clinical decision making: an emergency medicine perspective. Acad Emerg Med. 1999;6(9):947-952. 10.1111/j.1553-2712.1999.tb01246.x - DOI - PubMed
    1. Croskerry P, Sinclair D. Emergency medicine: a practice prone to error? Can J Emerg Med. 2001;3(4):271-276. 10.1017/S1481803500005765 - DOI - PubMed
    1. Al-Azri NH. How to think like an emergency care provider: a conceptual mental model for decision making in emergency care. Int J Emerg Med. 2020;13(1):17. 10.1186/s12245-020-00274-0 - DOI - PMC - PubMed
    1. Croskerry P. Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med. 2002;9(11):1184-1204. 10.1197/aemj.9.11.1184 - DOI - PubMed
    1. Tierney WM. Improving clinical decisions and outcomes with information: a review. Int J Med Inform. 2001;62(1):1-9. 10.1016/S1386-5056(01)00127-7 - DOI - PubMed

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