Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 27 , ISSUE 9 ( September, 2023 ) > List of Articles

Original Article

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

Asma H Al-Arimi, Darpanarayan Hazra, Awatif K Alsarrai Al-Alawi

Keywords : Computed tomography, Decision-making, Emergency medicine, Emergency physicians, Fatigue, Shift work schedule

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

DOI: 10.5005/jp-journals-10071-24520

License: CC BY-NC 4.0

Published Online: 31-08-2023

Copyright Statement:  Copyright © 2023; The Author(s).


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 – 1048; 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.

  1. Gifford MJ, Franaszek JB, Gibson G. Emergency physicians’ and patients’ assessments: Urgency of need for medical care. Ann Emerg Med 1980;9(10):502–507. DOI: 10.1016/s0196-0644(80)80187-9.
  2. Cue F, Inglis R. Improving the operations of the emergency department. Hospitals 1978;52(13):110–113, 119. PMID: 658905.
  3. Aaronson EL, Marsh RH, Guha M, Schuur JD, Rouhani SA. Emergency department quality and safety indicators in resource-limited settings: An environmental survey. Int J Emerg Med 2015;8(1):39. DOI: 10.1186/s12245-015-0088-x.
  4. Dubash R, Bertenshaw C, Ho JH. Decision fatigue in the emergency department. Emerg Med Australas 2020;32(6):1059–1061. DOI: 10.1111/1742-6723.13670.
  5. Pignatiello GA, Martin RJ, Hickman RL Jr. Decision fatigue: A conceptual analysis. J Health Psychol 2020;25(1):123–135. DOI: 10.1177/1359105318763510.
  6. Hu SY, Hsieh MS, Lin MY, Hsu CY, Lin TC, How CK, et al. Trends of CT utilisation in an emergency department in Taiwan: A 5-year retrospective study. BMJ Open 2016;6(6):e010973. DOI: 10.1136/bmjopen-2015-010973.
  7. Gordon JA, An LC, Hayward RA, Williams BC. Initial emergency department diagnosis and return visits: Risk versus perception. Ann Emerg Med 1998;32(5):569–573. DOI: 10.1016/s0196-0644(98)70034-4.
  8. Tung M, Sharma R, Hinson JS, Nothelle S, Pannikottu J, Segal JB. Factors associated with imaging overuse in the emergency department: A systematic review. Am J Emerg Med 2018;36(2):301–309. DOI: 10.1016/j.ajem.2017.10.049.
  9. Dunne CL, Elzinga JL, Vorobeichik A, Sudershan S, Keto-Lambert D, Lang E, et al. A systematic review of interventions to reduce computed tomography usage in the emergency department. Ann Emerg Med 2022;80(6):548–560. DOI: 10.1016/j.annemergmed.2022.06.001.
  10. Thorley EV, Doshi A, Turner BRH. Doctors Improving Referrals project: A referrals toolkit for junior doctors. BMJ Open Qual 2023;12(2):e002066. DOI: 10.1136/bmjoq-2022-002066.
  11. Gorodetzer R, Alpert EA, Orr Z, Unger S, Zalut T. Lessons learned from an evaluation of referrals to the emergency department. Isr J Health Policy Res 2020;9(1):18. DOI: 10.1186/s13584-020-00377-2.
  12. Rajhans PA, Godavarthy P. COVID-19 combat fatigue among the healthcare workers: The time for retrospection and action. Indian J Crit Care Med 2021;25(1):3–5. DOI: 10.5005/jp-journals-10071-23699.
  13. Sunil R, Bhatt MT, Bhumika TV, Thomas N, Puranik A, Chaudhuri S, et al. Weathering the storm: Psychological impact of COVID-19 pandemic on clinical and nonclinical healthcare workers in India. Indian J Crit Care Med 2021;25(1):16–20. DOI: 10.5005/jp-journals-10071-23702.
  14. Zheng B, Kwok E, Taljaard M, Nemnom MJ, Stiell I. Decision fatigue in the Emergency Department: How does emergency physician decision making change over an eight-hour shift? Am J Emerg Med 2020;38(12):2506–2510. DOI: 10.1016/j.ajem.2019.12.020.
  15. Strobel S, Moosa S, Hamann K. How are patient order and shift timing associated with imaging choices in the Emergency Department? Evidence from Niagara Health Administrative Data. Ann Emerg Med 2022;80(5):392–400. DOI: 10.1016/j.annemergmed.2022.06.002.
  16. Matz K, Britt T, LaBond V. CT ordering patterns for abdominal pain by physician in triage. Am J Emerg Med 2017;35(7):974–977. DOI: 10.1016/j.ajem.2017.02.003.
  17. Charbonneau V, Kwok E, Boyle L, Stiell IG. Impact of emergency department surge and end of shift on patient workup and treatment prior to referral to internal medicine: A health records review. Emerg Med J 2018;35(5):309–315. DOI: 10.1136/emermed-2017-207149.
  18. Rischall ML, Chung AS, Tabatabai R, Doty C, Hart D. Emergency medicine resident shift work preferences: A comparison of resident scheduling preferences and recommended schedule design for shift workers. AEM Educ Train 2018;2(3):229–235. DOI: 10.1002/aet2.10104.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.