What cognitive psychology tells us about ED physician decision-making and how to improve it

In this issue of Academic Emergency Medicine, Patterson et al. report a link between two measures of emergency department (ED) crowding –ED census and physician load – to hospital admission decisions. Disposition appeared to change based on both the degree of ED crowding and how many total patients the physician making the admission decision was carrying at the time. This translated to important swings: an average admission rate of 35% with an empty waiting room and zero patient load which increased to 40% with 12 patients waiting or physician was carrying 16 ED patients. They concluded that disposition decisions were significantly impacted by workflow concerns of both the provider and the department.

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