Journal of General Internal Medicine

, Volume 10, Issue 10, pp 557–564 | Cite as

Triage decisions for emergency department patients with chest pain

Do physicians’ risk attitudes make the difference?
  • Steven D. Pearson
  • Lee Goldman
  • E. John Orav
  • Edward Guadagnoli
  • Tomas B. Garcia
  • Paula A. Johnson
  • Thomas H. Lee
Original Articles

Abstract

OBJECTIVE: To determine whether physicians’ risk attitudes correlate with their triage decisions for emergency department patients with acute chest pain.

DESIGN: Cohort.

SETTING: The emergency department of a university teaching hospital.

PATIENTS: Patients presenting to the emergency department with a chief complaint of acute chest pain.

PHYSICIANS: All physicians who were primarily responsible for the emergency department triage of at least one patient with acute chest pain from July 1990 to July 1991.

METHODS: The physicians’ risk attitudes were assessed by two methods: 1) a new, six-question risk-taking scale adapted from the Jackson Personality Index (JPI), and 2) the Stress from Uncertainty Scale (SUS).

RESULTS: The physicians who had high risk-taking scores (“risk seekers”) admitted only 31% of the patients they evaluated, compared with admission rates of 44% for the medium scorers and 53% for the physicians who had low risk-taking scores (“risk avoiders”), p<0.001. After adjustment for clinical factors, the patients triaged by the risk-seeking physicians had half the odds of admission [odds ratio (OR) 0.51, 95% confidence interval (95% CI) 0.27 to 0.97], and the patients triaged by the risk-avoiding physicians had nearly twice the odds of admission (OR 1.83, 95% CI 1.10 to 3.03) of the patients triaged by the medium-risk scoring physicians. The SUS did not correlate significantly with admission rates. Of the 92 patients released home by the risk-seeking physicians, 91 (99%) were known to be alive four to six weeks afterwards and one was lost to follow-up; among the 66 patients released by the risk-avoiding physicians, 64 (97%) were known to be alive at four to six weeks, one was lost to follow-up, and one died of ischemic heart disease during a subsequent hospitalization (p=NS).

CONCLUSIONS: The physicians’ risk attitudes as measured by a brief risk-taking scale correlated significantly with then-rates of admission for emergency department patients with acute chest pain. These data do not suggest that the risk-seeking physicians achieved lower admission rates by releasing more patients who needed to be in the hospital, but an adequate evaluation of the appropriateness of triage decisions of risk-seeking and risk-avoiding physicians will require further study.

Key words

physician attitudes risk triage decision making emergency department 

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Copyright information

© Hanley & Befus, inc. 1995

Authors and Affiliations

  • Steven D. Pearson
  • Lee Goldman
    • 1
  • E. John Orav
  • Edward Guadagnoli
  • Tomas B. Garcia
  • Paula A. Johnson
  • Thomas H. Lee
  1. 1.Section for Clinical EpidemiologyBrigham and Women’s HospitalBoston

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