Decision making in asthma exaverbation: a clinical judgement analysis

Jenkins, John; Shields, Mike; Patterson, Chris; Kee, Frank
August 2007
Archives of Disease in Childhood;Aug2007, Vol. 92 Issue 8, p672
Academic Journal
Background: Clinical decisions which impact directly on patient safety and quality of care are made during acute asthma attacks by individual doctors based on their knowledge and experience. Decisions include administration of systemic corticosteroids (CS) and oral antibiotics, and admission to hospital. Clinical judgement analysis provides a methodology for comparing decisions between practitioners with different training and experience, and improving decision making. Methods: Stepwise linear regression was used to select clinical cues based on visual analogue scale assessments of the propensity of 62 clinicians to prescribe a short course of oral CS (decision 1), a course of antibiotics (decision 2), and/or admit to hospital (decision 3) for 60 "paper" patients. Results: When compared by specialty, paediatricians' models for decision 1 were more likely to include level of alertness as a cue (54% vs 16%); for decision 2 they were more likely to include presence of crepitations (49% vs 16%) and less likely to include inhaled CS (8% vs 40%), respiratory rate (0% vs 24%) and air entry (70% vs 100%). When compared to other grades, the models derived for decision 3 by consultants/general practitioners were more likely to include wheeze severity as a cue (39% vs 6%). Conclusions: Clinicians differed in their use of individual cues and the number included in their models. Patient safety and quality of care will benefit from clarification of decision-making strategies as general learning points during medical training, in the development of guidelines and care pathways, and by clinicians developing self-awareness of their own preferences.


Related Articles

  • COPD strategy has potential to halve hospital admissions. Parr, Chris // Independent Nurse;8/22/2011, p9 

    The article discusses the British government's Outcomes Strategy for COPD and Asthma that the British Lung Foundation (BLF) has claimed could halve the number of hospital admissions for patients with chronic obstructive pulmonary disease (COPD) or asthma.

  • Little Battles. Malcolm, Robert // JAMA: Journal of the American Medical Association;1/5/90, Vol. 263 Issue 1, p90 

    Recounts the experiences of an admissions section doctor. Interviews conducted with patients; Medical conditions of the patients and the kind of care required; Ways of reviewing patients' charts; Doctors' anxieties regarding malpractice accusations and lawsuits; Outpatient rehabilitation for...

  • Predictors of hospital admission due to asthma in children and adolescents enrolled in an asthma control program. Brandão, Heli Vieira; Cruz, Constança Sampaio; Guimarães, Armênio; Camargos, Paulo Augusto Moreira; Cruz, Álvaro Augusto // Jornal Brasileiro de Pneumologia;nov2010, Vol. 36 Issue 6, p700 

    Objective: To determine the clinical characteristics and the predictors of hospital admission due to asthma among children and adolescents with asthma under treatment at a referral center. Methods: A retrospective cohort study comprising 151 children and adolescents with asthma, referred from...

  • Weekend admission to hospital has a higher risk of death in the elective setting than in the emergency setting: a retrospective database study of national health service hospitals in England.  // BMC Health Services Research;2012, Vol. 12 Issue 1, p87 

    The article offers information on a research that analyzes the mortality rate of patients admitted to the acute hospitals over the weekends as compared to those admitted on weekdays in Great Britain. It is mentioned that logistic regression model was used to analyze the discharge of patients...

  • Health Matters. Whitaker, Phil // New Statesman;5/13/2016, Vol. 145 Issue 5314, p57 

    A personal narrative is presented of the author's experience as a doctor trying to gain consent from a mentally disabled patient for admission into a hospital for treatment.

  • The importance of place of residence in patient satisfaction. Levinton, Carey; Veillard, Jeremy; Slutsky, Arthur; Brown, Adalsteinn // International Journal for Quality in Health Care;Oct2011, Vol. 23 Issue 5, p495 

    Objective To determine the effect of patients' place of residence on their evaluations of care, and to explore related policy implications. Study Design We used a conditional regression analysis of stratum matched case controls to examine whether place of residence of patients living in the...

  • The effect of activity-based financing on hospital length of stay for elderly patients suffering from heart diseases in Norway. Yin, Jun; Lurås, Hilde; Hagen, Terje P.; Dahl, Fredrik A. // BMC Health Services Research;2013, Vol. 13 Issue 1, p1 

    Background: Whether activity-based financing of hospitals creates incentives to treat more patients and to reduce the length of each hospital stay is an empirical question that needs investigation. This paper examines how the level of the activity-based component in the financing system of...

  • Physicians must take charge. Frank, Jerry R. // Family Practice Management;Jul/Aug2003, Vol. 10 Issue 7, p14 

    Comments on the published article 'Seven Ways to help Your Hospital Stay in Business' in the U.S. Role of family physician in medical care; Consequences from the delay in care and discharge of patients; Need to establish a care maps or guidelines to assist physicians.

  • Keeping hospitals afloat. Shearer, Chris // Family Practice Management;Jul/Aug2003, Vol. 10 Issue 7, p14 

    Comments on the published article 'Seven Ways to Help Your Hospital Stay in Business' in the U.S. Disagreement about the incentive for physicians to prolong hospital stays; Comparison between cost and patient care in terms of importance; Necessity of patient-centered approach to physician...


Read the Article

Other Topics