title: Emergency Physicians' Perceptions and Decision-making Processes Regarding Patients Presenting with Palpitations.
abstract: BACKGROUND
  Palpitations are a common emergency department (ED) complaint, yet relatively little research exists on this topic from an emergency care perspective.
  
  
  OBJECTIVE
  We sought to describe the perceptions and clinical decision-making processes of emergency physicians (EP) surrounding patients with palpitations.
  
  
  METHODS
  We conducted 21 semistructured interviews with a convenience sample of EPs. We recruited participants from academic and community practice settings from four regions of the United States. The transcribed interviews were analyzed using a combination of structural coding and grounded theory approaches with ATLAS.ti, a qualitative data analysis software program (version 7; Atlas.ti Scientific Software Development GmbH, Berlin, Germany).
  
  
  RESULTS
  EPs perceive palpitations to be a common but generally benign chief complaint. EPs' clinical approach to palpitations, with regards to testing, treatment, and ED management, can be classified as relating to one or more of the following themes: (1) risk stratification, (2) diagnostic categorization, (3) algorithmic management, and (4) case-specific gestalt. With regard to disposition decisions, four main themes emerged: (1) presence of a serious diagnosis, (2) perceived need for further cardiac testing/monitoring, (3) presence of key associated symptoms, (4) request of other physician or patient desire. The interrater reliability exercise yielded a Fleiss' kappa measure of 0.69, indicating substantial agreement between coders.
  
  
  CONCLUSIONS
  EPs perceive palpitations to be a common but generally benign chief complaint. EPs rely on one or more of four main clinical approaches to manage these patients. These findings could help guide future efforts at developing risk-stratification tools and clinical algorithms for patients with palpitations.
authors.affiliation: Department of Emergency Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Probst
authors.affiliation: Department of Emergency Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, California; U.S. Department of Veterans Affairs, VA West Los Angeles Medical Center, Los Angeles, California.
authors.forename: Hemal K
authors.initials: HK
authors.lastname: Kanzaria
authors.affiliation: Department of Emergency Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Jerome R
authors.initials: JR
authors.lastname: Hoffman
authors.affiliation: Department of Emergency Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: William R
authors.initials: WR
authors.lastname: Mower
authors.affiliation: Department of Emergency Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Roya S
authors.initials: RS
authors.lastname: Moheimani
authors.affiliation: Department of Emergency Medicine, Center for Policy Research-Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Sun
authors.affiliation: RAND Corporation, Santa Monica, California.
authors.forename: Denise D
authors.initials: DD
authors.lastname: Quigley
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D004635:Emergency Medicine; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D018570:Risk Assessment; D014481:United States
keywords: clinical decision-making; emergency medicine; interviews; palpitations