Abstract
Background
Clinicians' occupational fatigue can lead to suboptimal decisions that do not align
with evidence-based guidelines or patient needs.
Objectives
Examining the effects of occupational fatigue on (1) clinical decision making and
(2) the use of clinical decision support (CDS) in a pediatric emergency department
(ED).
Methods
We interviewed 30 pediatric ED clinicians from a single site. Clinicians included
physicians and advanced practice practitioners. The interviews were semi-structured
and guided by the dual-processing model. Data were qualitatively analyzed.
Results
Four main themes emerged from our analysis: (1) fatigue is a dynamic state and has
multiple reasons; (2) fatigue affects decision-making in ED care; (3) fatigue affects
the use of CDS; (4) fatigue affects a clinician's productivity and outcomes. We developed
a conceptual framework that highlights the effects of fatigue on outcomes in the ED
setting.
Conclusion
In EDs, fatigue is inevitable because of high clinical acuity and the rapid pace of
decision-making. Our study highlighted an important need in EDs to support narrative
decision-making. Narrative decision-making requires clinicians to make analytical
decisions, as opposed to relying on intuition in providing care. Organizational redesign
and informatics-based interventions initiatives could be useful to mitigate the effects
of fatigue. Rigorous evaluation approaches that account for clinicians' fatigue would
improve the usability and usefulness of organizational interventions (e.g., CDS) that
improve quality and safety.
Keywords
dual processing - requirements analysis and design - implementation and deployment
- burnout - sociotechnical aspects of information technology
