Clinical decision making in the surgical assessment unit version 1.0

• Research type

  Research Study

• Full title

  An exploration of personal, social and organisational factors affecting diagnostic decision making and clinical management in acute surgical admissions.

• IRAS ID

  169060

• Contact name

  Alexandra Cope

• Contact email

  a.c.cope@leeds.ac.uk

• Sponsor organisation

  University of Leeds

• Duration of Study in the UK

  2 years, 0 months, 1 days

• Research summary

  Patients requiring emergency surgical admission are among the sickest patients in the NHS. Often elderly, frail and with significant co-morbidity, the risk of death or serious complication is high. A diversity of different surgical pathologies can present with acute abdominal pain, some of which can be managed conservatively, whilst other pathologies can make the patient life-threateningly unwell very quickly. These patients present throughout the 24 hour 'on-call' and are initially seen by junior members of the surgical team. Important decisions about admission or discharge as well as decisions around initial management, the need to escalate for senior review and for further tests need to be made quickly. These clinical decisions made quickly in the acute setting can have profound implications on time to definitive diagnosis, complications and patient outcomes.
  It is known that different doctors will make different decisions in similar circumstances but yet little is known about what shapes these clinical decisions in the acute setting. Therefore this study aims to:
  - Explore the personal, social and organisational factors that shape decision making in acute surgical admissions
  - Understand the barriers to timely assessment, access to scanning and escalation of care
  - Develop an evidence based educational intervention for use with clinical staff involved in the care of acute surgical admissions

  We will undertake a multiple case study at across four NHS hospital Trusts to understand the processes through which clinical decisions are made and enacted in Surgical Assessment Units. Observation and video recordings of healthcare workers will be combined with interviews with clinical staff and patients. The study will involve patients who have been referred to the Surgical Assessment Unit either via A&E or through their General Practitioner, regardless of whether they are subsequently admitted or discharged or whether they need an operation. The study involves no interventions to the patient's care.

• REC name

  West Midlands - Coventry & Warwickshire Research Ethics Committee

• REC reference

  15/WM/0103

• Date of REC Opinion

  23 Apr 2015

• REC opinion

  Further Information Favourable Opinion