Table 2 Coding of operationalizations of Clinical Decision-Making in geriatric emergency medicine

CDM as dispositional decisions

Observations of demonstrated binary CDM

“The decision to order physical restraint …” (P1280)

“… followed by a question asking if the physician completing the questionnaire would cease or continue CPR under that set of circumstances.” (P12)

Observations of demonstrated categorical CDM

Decision-making refer to which specific decision was made based on the clinical data available: “… there also were instances when the clinician decision making was contrary to the absence of an AMI.” (P1226)

CDM as cognitive processes

Cognitive: Illness scripts (networks of knowledge), Mental models, memory, judgement, human judgement/heuristic judgement/mental shortcuts, etc.

“Cognitive faculties deserve particular attention, as they are the bases of the clinical decision-making process … human abilities are limited and both gathering and retrieving information are inaccurate processes [2, 9]. Furthermore, in emergency medicine, “a priori” probabilities often are unknown, whereas missing data and ambiguities are frequent... This particular field favors intuitive and automatic tools as heuristics [1, 5].” (P2031)

“Heuristics are mental shortcuts that often produce valid judgements but can lead to errors in atypical or rare events. Because they reflect natural processes, heuristics are not easily, or even productively, replaced.” (P9204)

Knowledge and attitudes

“We designed a comprehensive written survey to assess ED provider knowledge, attitudes, and practice regarding placement of IUCs [including] team dynamics of decision making in UIC placement and management …” (P415)

Refers to confidence, attitudes and knowledge, but does not address decision-making, specifically.

Uncertainty

Diagnostic uncertainty: “… was quantified by a visual analogue scale (VAS) for ACS probability ranging from 0 to 100%.” (P29

CDM as a model

Statistical model/clinical decision rule

A decision-making analysis of certain risk stratification scores, as a statistical model.

Decision rule and motivations/perception of utility

Validation of a decision rule and investigation of the motivations for certain decisions. They were surveyed about the latter.

Describes decision-making only in terms of the decision-making support tool, but no other description.

CDM as clinical judgement

Clinical judgement: use of a structure/tool

“Upon final ED disposition, study staff administered a survey to the attending ED physician or senior resident querying the physician’s impression of the likelihood of an acute bacterial infection and the infections suspected on a 5-point Likert scale from very unlikely to very likely.” (P1803)

Clinical Judgement: Practice as usual

“Because, to the best of our knowledge, no validated scoring system exists to quantify clinical judgement, we a priori chose to use the disposition decision of the treating physician in the ED as a proxy measure for clinical judgement …” (P294)

“Clinical judgement can be defines as “an interpretation or conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response” [11]. It is complex and requires a flexible ability to recognise prominent aspects of an undefined clinical situation interpret their meaning and respond appropriately. It relates to the experience of individual clinicians.” (P5)