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Decision Fatigue in Emergency Medicine: An Exploration of Its Validity

Emergency physicians face a relentless stream of complex, high-stakes decisions in a fast-paced and dynamic environment. The concept of decision fatigue, a phenomenon characterized by a decline in the quality of decision-making after a long sequence of choices, has garnered increasing attention within healthcare. Several investigations show that the number and complexity of decisions made during prolonged shifts correlate with increased self-reported fatigue; however, the effect on clinical decision quality is uncertain. Conversely, a subset of studies found no clear relationship between decision fatigue and errors in clinical judgment. Importantly, some researchers argue that decision fatigue may be mitigated by factors such as experience, training, and support systems. This narrative review highlights the existing literature on decision fatigue among emergency physicians and explores whether this concept holds as a valid concern or remains a myth in the context of their practice.

Impact of Fatigue on Emergency Physicians' Decision-making for Computed Tomographic Scan Requests and Inpatient Referrals: An Observational Study from a Tertiary Care Medical Center of the Sultanate of Oman

Objective

Multiple factors contribute to decision fatigue experienced by emergency physicians (EPs). This study examines the association between decision fatigue and the frequency of computed tomographic (CT) scan requests and inpatient referrals among EPs.

Methods

This retrospective database analysis was done for 3 months. Scans and inpatient referral requests were coded and analyzed to assess the impact of physician fatigue on decision-making. Subsequently, the outcomes were evaluated.

Results

The majority of patients (n = 481; 51.1%) had a CT brain request. Among these requests, the morning shift (8:00 a.m.-3:00 p.m.) accounted for the highest number (n = 400; 42.5%), followed by the evening shift (3:00-11:00 p.m.) (n = 345; 36.7%). Approximately one-third of the patients (n = 301; 31.9%) had positive CT scan findings. Statistical analysis comparing the first and the second halves of each shift did not reveal significant variations in the percentage of negative CT results (p-value: 0.093). Inpatient referral was necessary for over half of the patients (n = 1,048; 52.7%), and the majority of these referrals (n = 778; 74.2%) were deemed necessary for treatment under various surgical or medical specialties. There was a statistically significant difference in the proportion of negative inpatient referrals between the first and the second halves of the afternoon shift (p-value < 0.001).

Conclusions

Fatigue among EPs was observed, leading to more frequent consultations without inpatient admission during the latter half of the afternoon shift. However, the study found no significant impact of decision fatigue on CT scan decision-making.

How to cite this article

Al-Arimi AH, Hazra D, Al-Alawi AKA. Impact of Fatigue on Emergency Physicians' Decision-making for Computed Tomographic Scan Requests and Inpatient Referrals: An Observational Study from a Tertiary Care Medical Center of the Sultanate of Oman. Indian J Crit Care Med 2023;27(9):620-624.