Impairment and severity: how ED physicians decide to override an impaired patient's refusal.

Full Abstract

We attempted to identify the contributions of impairment and illness severity in the decision to treat a patient who refuses treatment using case vignettes. We constructed 4 emergency department (ED)-based case vignettes of adults with varied impairment and illness severity who each refused care. Clinician used a 100-mm visual analog scale (VAS) to assess patient impairment, illness severity, and their willingness to override a patient's refusal (WOPR) of treatment. We used correlation and logistic regression to assess the contributions of impairment and illness severity on WOPR. Thirty-seven ED physicians participated. Increasing impairment (r = 0.80) and illness severity (r = 0.81) correlated with WOPR, and an increase of 10 mm of impairment on the VAS (odds ratio, 2.1; 95% confidence interval, 1.5-3.0) and an increase of 10 mm of severity (odds ratio, 1.5; 95% confidence interval, 1.2-2.0) independently predicted a WOPR. Both degrees of impairment and illness severity impact an ED physician's WOPR.

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Author information

Author/s: Withers, Elizabeth (E); Sklar, David P (DP); Crandall, Cameron S (CS);

Affiliation: Department of Emergency Medicine, MSC10 5560, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.

Journal and publication information

Publication Type: Journal Article

Journal: The American journal of emergency medicine (Am J Emerg Med), published in United States. (Language: eng)

Reference: 2008-Sep; vol 26 (issue 7) : pp 803-7

Dates: Created 2008/09/08; Completed 2008/09/24;

PMID: 18774048, status: MEDLINE (last retrieval date: 11/6/2008)

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