An article in this week’s Wall Street Journal focused on the development and use of shared decision-making (SDM) tools in the emergency department (ED). Decision tools can help engage patients in making decisions about their care, including decisions about which tests and treatments to pursue. In the ED, relevant decisions are (1) decisions involving two similarly reasonable options (“preference-sensitive health care decisions”) and (2) decisions that patients or their families can take some time to consider. The examples mentioned in the WSJ article are
- children with uncomplicated acute appendicitis: IV antibiotics versus surgery
- adults with chest pain and normal initial test results: watchful waiting (not doing any tests) versus extensive testing (you can try out this tool here)
- mild traumatic injury: watchful waiting versus head CT scan
Other scenarios for which SDM tools have been studied include
- testing for bacterial infections among children with fever-without-an-obvious-source
- choice of anesthesia and sedation for the repair of small lacerations in children
- choice of hydration methods (IV or oral) for children with dehydration from a vomiting/diarrhea illness.
- management of acute musculoskeletal pain in adults
Selection of SDM is the focus for the 2016 Academic Emergency Medicine consensus conference, “Shared Decision-making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda”. I pose here one of the many questions to be addressed at that conference: What are the priority ED presenting conditions for which ED-based SDM should be most urgently developed?