Is emergency doctors' tolerance of clinical uncertainty on a novel measure associated with doctor well-being, healthcare resource use and patient outcomes?

Luke Budworth; Brad Wilson; Joanna Sutton-Klein; Subhashis Basu; Colin O'Keeffe; Suzanne M Mason; Andrew Ang; Sally Anne-Wilson; Kevin Reynard; Susan Croft; Anoop D Shah; Sakarias Bank; Mark Conner; Rebecca Lawton

doi:10.1136/emermed-2023-213256

Is emergency doctors' tolerance of clinical uncertainty on a novel measure associated with doctor well-being, healthcare resource use and patient outcomes?

Emerg Med J. 2024 Nov 27:emermed-2023-213256. doi: 10.1136/emermed-2023-213256. Online ahead of print.

Authors

Luke Budworth¹, Brad Wilson², Joanna Sutton-Klein³, Subhashis Basu³, Colin O'Keeffe⁴, Suzanne M Mason³, Andrew Ang⁵, Sally Anne-Wilson⁶, Kevin Reynard⁷, Susan Croft³, Anoop D Shah⁸, Sakarias Bank⁹, Mark Conner¹⁰, Rebecca Lawton^{2

11}

Affiliations

¹ Bradford Institute for Health Research, Bradford, UK l.w.budworth@leeds.ac.uk.
² Bradford Institute for Health Research, Bradford, UK.
³ The University of Sheffield School of Health and Related Research, Sheffield, UK.
⁴ ScHARR, University of Sheffield, Sheffield, UK.
⁵ Barnsley District General Hospital, Barnsley, Barnsley, UK.
⁶ Airedale General Hospital, Keighley, West Yorkshire, UK.
⁷ Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁸ University College London Institute of Health Informatics, London, UK.
⁹ University of Skövde School of Health Sciences, Skovde, Västra Götaland, Sweden.
¹⁰ University of Leeds School of Psychology, Leeds, Leeds, UK.
¹¹ University of Leeds Institute of Psychological Sciences, Leeds, Leeds, UK.

PMID: 39608855
DOI: 10.1136/emermed-2023-213256

Abstract

Introduction: Emergency doctors routinely face uncertainty-they work with limited patient information, under tight time constraints and receive minimal post-discharge feedback. While higher uncertainty tolerance (UT) among staff is linked with reduced resource use and improved well-being in various specialties, its impact in emergency settings is underexplored. We aimed to develop a UT measure and assess associations with doctor-related factors (eg, experience), patient outcomes (eg, reattendance) and resource use (eg, episode costs).

Methods: From May 2021 to February 2022, emergency doctors (specialty trainee 3 and above) from five Yorkshire (UK) departments completed an online questionnaire. This included a novel UT measure-an adapted Physicians' Reaction to Uncertainty scale collaboratively modified within our team according to Hillen et al's (2017) UT model. The questionnaire also included well-being-related measures (eg, Brief Resilience Scale) and assessed factors like doctors' seniority. Patient encounters involving prespecified 'uncertainty-inducing' problems (eg, headache) were analysed. Multilevel regression explored associations between doctor-level factors, resource use and patient outcomes.

Results: 39 doctors were matched with 384 patients. The UT measure demonstrated high reliability (Cronbach's α=0.92) and higher UT was significantly associated with better psychological well-being including greater resilience (Pearson's r=0.56; 95% CI=0.30 to 0.74) and lower burnout (eg, Cohen's d=-2.98; -4.62 to -1.33; mean UT difference for 'no' vs 'moderate/high' burnout). UT was not significantly associated with resource use (eg, episode costs: β=-0.07; -0.32 to 0.18) or patient outcomes including 30-day readmission (eg, OR=0.82; 0.28 to 2.35).

Conclusions: We developed a reliable UT measure for emergency medicine. While higher UT was linked to doctor well-being, its impact on resource use and patient outcomes remains unclear. Further measure validation and additional research including intervention trials are necessary to confirm these findings and explore the implications of UT in emergency practice.

Keywords: cost efficiency; psychology; risk management; safety; staff support.