inproTeamED - clinical reasoning in the emergency department as an individual and interprofessional process: a qualitative analysis

BACKGROUND AND OBJECTIVE: Patients in the emergency department (ED) are assessed and treated by the ED-Team consisting of nurses and physicians. The clinical assessment (CA) of emergency patients and the clinical reasoning (CR) of both professions play a decisive role in determining the quality of emergency care. This pilot study explores CR in daily routine practice of the ED on a cognitive-individual level, relying on the Dual-process Theory and on a social-interprofessional level, arguing interprofessional collaboration (IPC) as a part of CR. At least, organizational-structural factors influencing CR are analyzed as a third level. METHODS: This is a qualitative study of 13 semi-structured individual interviews with nurses and physicians from three EDs in Germany, analysed using content analysis and methodological fundation. RESULTS: In the individual-cognitive CR, both physicians and nurses groups identified similar key factors for CA and used Systems 1 and 2 of the Dual-process Theory in their CR. On the social-interprofessional level, IPC was generally described positively, naming characteristics of good IPC and communication barriers were reported as rare. As possible organizational-structural factors influencing CR working experience as a prerequisite, size and region of the ED, age structure of the team and digitization were found. CONCLUSION: This pilot study provides insights into the CR of nurses and physicians in the ED and analyzes CR on an individual-cognitive, a social-interprofessional and an organizational-structural level, allowing to conclusions regarding the prerequisites for successful ED-teams.