Sources of non-compliance with clinical practice guidelines in trauma ...
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Sources of non-compliance with clinical practice guidelines in trauma ...
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RESEARCH
Open Access
Sources of non-compliance with clinical practice guidelines in trauma triage: a decision science study Deepika Mohan1,2*, Matthew R Rosengart1,2, Coreen Farris3, Baruch Fischhoff4, Derek C Angus1 and Amber E Barnato5
Abstract Background: United States trauma system guidelines specify when to triage patients to specialty centers. Nonetheless, many eligible patients are not transferred as per guidelines. One possible reason is emergency physician decision-making. The objective of the study was to characterize sensory and decisional determinants of emergency physician trauma triage decision-making. Methods: We conducted a decision science study using a signal detection theory-informed approach to analyze physician responses to a web-based survey of 30 clinical vignettes of trauma cases. We recruited a national convenience sample of emergency medicine physicians who worked at hospitals without level I/II trauma center certification. Using trauma triage guidelines as our reference standard, we estimated physicians’ perceptual sensitivity (ability to discriminate between patients who did and did not meet guidelines for transfer) and decisional threshold (tolerance for false positive or false negative decisions). Results: We recruited 280 physicians: 210 logged in to the website (response rate 74%) and 168 (80%) completed the survey. The regression coefficient on American College of Surgeons – Committee on Trauma (ACS-COT) guidelines for transfer (perceptual sensitivity) was 0.77 (p logitð0:95Þ þ Decisional Threshold ð4Þ
