Shared decision-making is key to delivering patient-centred care. Discussing care options with their clinicians can help patients to make better decisions about their own care.
In the busy, and often chaotic, environment of a hospital's emergency room, it may be difficult to have such discussions. In a blog post for Health Affairs, two clinicians emphasise that these patient-doctor discussions should also take place even in the fast-paced emergency department. In the ED, patients are scared, sick, and tired — and often not thinking beyond the acute issue of the moment.
Clinicians are busy and constantly interrupted by situations that may be more urgent than the one at hand. These circumstances contribute to a chaotic environment that is not an ideal setting for patients and clinicians to carefully consider different healthcare options.
is tremendous potential for driving value-based care in the emergency setting
through shared decision-making, wrote Edward Melnick, MD, assistant professor
of emergency medicine at the Yale School of Medicine and Erik Hess, associate
professor of emergency medicine and research chair for the Department of Emergency Medicine at the Mayo Clinic. “As we continue to build incentives for
value-based care into our healthcare system, we should not leave the ED
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In the emergency department setting, "decision-aids" can be employed to encourage shared decision-making between the patient and the care team. According to the blog post, the value of decision-aids in promoting shared decision-making was made clear during a randomised control trial at six EDs across the United States.
The pilot programme used a decision aid, "Chest Pain Choice,” developed by Prof. Hess and his research team. Chest pain, a common reason for patient visits to the ER, often leads to unnecessary admissions. The research team wanted to see what would happen if clinicians took the time to inform patients of their options.
The results: Increased patient engagement and a reduction in unnecessary hospital admissions for cardiac testing. Hess and Melnick saw it as a “multi-billion dollar opportunity” to reduce waste in the healthcare system. The findings were so promising that the research team began working on the development of decision aids to discuss CAT scans for adults and children with minor head trauma.
"The use of shared decision-making in practice has shown that better informed patients who understand their healthcare options tend to make better decisions about their own care, choosing care options that work for them and selecting care plans that they are more likely to follow," Hess and Melnick noted. "Ultimately, this combination of informed choices and increased adherence has been shown to both improve the quality of care and lower costs."
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