Browsing by Author "Czosnowski, Lauren"

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    Decision fatigue in hospital medicine: A scoping review
    (The Society for Hospital Medicine, 2024-04) Jones, Sarah; Perry, Kelsey; Stumpff, Julia C.; Kruer, Rachel; Czosnowski, Lauren; Kara, Areeba
    BACKGROUND: Decision fatigue describes the erosion of decision-making capacity as a consequence of the repeated acts of decision making. The phenomenon has been detected in ambulatory settings with higher rates of inappropriate antimicrobial and opiate prescribing and lower rates of cancer screening associated with appointments that occur later in the day. As hospital medicine is acknowledged to be a cognitively intense specialty, we decided to explore decision fatigue in hospital medicine. METHODS: As a relatively unexplored concept, we undertook a scoping review to understand what is known about decision fatigue in hospital medicine. All studies including healthcare workers in acute care settings and exploring the concepts of decision fatigue, cognitive burden and/or fatigue were included. Conceptually related studies of sleep deprivation, shift work, Circadian disruption, and excessive workloads with actual or theoretical paths of causality related to patient outcomes were also included. RESULTS: Our preliminary search revealed fifteen studies that met our inclusion criteria. No study specifically included hospitalists. Most studies described the concept among nurses, residents, and/or emergency department physicians. The outcomes studied were diverse and included self reported perceptions (e.g. perceived impact on patient care) and validated scales to measure fatigue and psychomotor performance. Fewer studies investigated clinical decisions such as the use of consultations, imaging and disposition decisions through the emergency department. Mitigating circumstances such as age, experience, responsibilities outside the hospital (e.g. having children) were infrequently described. CONCLUSIONS: While hospital medicine's fast pace, multitasking, fragmentation between clinicians and interruptions make it susceptible to decision fatigue, the concept remains under-explored in hospital medicine. The lack of consistent terminology complicates the evaluation of a phenomenon which ultimately is the culmination of individual, patient, work system and work environment factors. There is a need to detect and defuse the impact of decision fatigue in hospital medicine.
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    Decision Fatigue in Hospital Settings: A Scoping Review
    (Wiley, 2024-11-11) Perry , Kelsey; Jones , Sarah; Stumpff, Julia C.; Kruer, Rachel; Czosnowski, Lauren; Kashiwagi, Deanne; Kara, Areeba
    BACKGROUND: ‘Decision Fatigue’ (DF) describes the impaired ability to make decisions because of repeated acts of decision-making. We conducted a scoping review to describe DF in inpatient settings. METHODS: To be included, studies should have explored a clinical decision, included a mechanism to account for the order of decision making, published in English in or after the year 2000. Six data bases were searched. Retrieved citations were screened and retained studies were reviewed against inclusion criteria. References of included studies were manually searched, and forward citation searches were conducted to capture relevant sources. RESULTS: The search retrieved 12,781 citations of which 41 were retained following screening. Following review, sixteen studies met inclusion criteria. Half were conference abstracts and no studies examined hospitalists. Emergency medicine and intensive care settings were the most frequently studied clinical environments (n=13, 81%). All studies were observational. The most frequently examined decisions were about resource utilization (n=8, 50%), however only half of these examined downstream clinical outcomes. Decision quality against prespecified standards was examined in four (25%) studies. Work environment and patient attributes were often described but not consistently accounted for in analyses. Clinician attributes were described in four (25%) investigations. Findings were inconsistent: both supporting and refuting DF’s role in the outcome studied. CONCLUSIONS: The role of clinician, patient and work environment attributes in mediating DF is understudied. Similarly, the contexts surrounding the decision under study require further explication and when assessing resource use and decision quality, adjudication should be made against prespecified standards.