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The Impact of Environmental Factors on Physician Decision Making in Emergency Department

Author: Ying Liu, MD

Primary Advisor: Amy Franklin, PhD (co-author)

Committee Members: Vickie D. Nguyen, MA (co-author); Zhe Li, BA (co-author); Brent King, MD (co-author); David Robinson, MD (co-author); Nnaemeka Okafor, MD (co-author); Vilma L. Patel, PhD (co-author); Jiajie Zhang, PhD (co-author)

Masters thesis, The University of Texas School of Health Information Sciences at Houston.


The Emergency Department (ED) is a complex environment that is time critical, stressful, uncertain, and sometime chaotic. This study investigated how environmental factors affect ED physician decision making during task transitions – when one task is finished and the next task is selected. Shadowing, an ethnographic technique, was used to collect data from 6 attending physicians in a Level-One Trauma Center for a total of 48 hours. We identified four top-level factors that affect decision making during task transitions: human, physical, time, and system factors. Our data allowed us to link these factors to four decision types under the taxonomy developed by Franklin et al. (1) planned, opportunistic, multi-tasking, and break. Our results show that the system factor only affected planned decision making .The human, time and physical factors affected multiple decision types. The implications of these results were discussed in the context of critical care complexity and medical error.