title: Triage decisions for emergency department patients with chest pain: do physicians' risk attitudes make the difference?
abstract: OBJECTIVE
  To determine whether physicians' risk attitudes correlate with their triage decisions for emergency department patients with acute chest pain.
  
  
  METHODS
  Cohort.
  
  
  METHODS
  The emergency department of a university teaching hospital.
  
  
  METHODS
  Patients presenting to the emergency department with a chief complaint of acute chest pain. PHYSICIANS: All physicians who were primarily responsible for the emergency department triage of at least one patient with acute chest pain from July 1990 to July 1991.
  
  
  METHODS
  The physicians' risk attitudes were assessed by two methods: 1) a new, six-question risk-taking scale adapted from the Jackson Personality Index (JPI), and 2) the Stress from Uncertainty Scale (SUS).
  
  
  RESULTS
  The physicians who had high risk-taking scores ("risk seekers") admitted only 31% of the patients they evaluated, compared with admission rates of 44% for the medium scores and 53% for the physicians who had low risk-taking scores ("risk avoiders"), p < 0.001. After adjustment for clinical factors, the patients triaged by the risk-seeking physicians had half the odds of admission [odds ratio (OR) 0.51, 95% confidence interval (95% CI) 0.27 to 0.97], and the patients triaged by the risk-avoiding physicians had nearly twice the odds of admission (OR 1.83, 95% CI 1.10 to 3.03) of the patients triaged by the medium-risk scoring physicians. The SUS did not correlate significantly with admission rates. Of the 92 patients released home by the risk-seeking physicians, 91 (99%) were known to be alive four to six weeks afterwards and one was lost to follow-up; among the 66 patients released by the risk-avoiding physicians, 64 (97%) were known to be alive at four to six weeks, one was lost to follow-up, and one died of ischemic heart disease during a subsequent hospitalization (p = NS).
  
  
  CONCLUSIONS
  The physicians' risk attitudes as measured by a brief risk-taking scale correlated significantly with their rates of admission for emergency department patients with acute chest pain. These data do not suggest that the risk-seeking physicians achieved lower admission rates by releasing more patients who needed to be in the hospital, but an adequate evaluation of the appropriateness of triage decisions of risk-seeking and risk-avoiding physicians will require further study.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Pearson
authors.forename: L
authors.initials: L
authors.lastname: Goldman
authors.forename: E J
authors.initials: EJ
authors.lastname: Orav
authors.forename: E
authors.initials: E
authors.lastname: Guadagnoli
authors.forename: T B
authors.initials: TB
authors.lastname: Garcia
authors.forename: P A
authors.initials: PA
authors.lastname: Johnson
authors.forename: T H
authors.initials: TH
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000704:Analysis of Variance; D002637:Chest Pain / Q000628:therapy*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010820:Physicians / Q000523:psychology*; D012189:Retrospective Studies; D012309:Risk-Taking; D011795:Surveys and Questionnaires; D014218:Triage