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A decision theory overview and case-based discussion

02 August 2021
Volume 13 · Issue 8


Paramedics make decisions as part of their everyday role but often, the theory behind clinical decision-making is not discussed in depth. This article explores the theories of decision-making as they apply to a clinical case. With the increasing use of technology in healthcare, the introduction of human reliability analysis is becoming more pertinent.

Practitioners use decision theory in everyday practice. However, little consideration is given to the processes used to arrive at a diagnosis. This article will briefly explore the theory behind decision-making in paramedic practice. A hypothetical but realistic case, set in a hospital, will be used to show how the theory is applied in practice.

The example given in this article uses a hospital inpatient to discuss the difficulties in diagnosing those with undifferentiated pathology, but the themes relate directly to prehospital care. The rationale for choosing an inpatient is for a greater depth of understanding and to showcase the roles in which a paramedic may find themselves working with a need to understand decision theory in greater detail.

An elderly person is an inpatient on an acute medical ward following an unplanned admission with systemic infection against a background of medication non-compliance. The patient had been treated on the ward for more than a week before there was an acute change in their presentation, and ward staff noted a stepwise decrement in the patient's consciousness levels. The patient's Glasgow Coma Score had steadily declined over the course of the day, with a single hypoglycaemic episode earlier in the day having been successfully treated. A review of the notes elicits a new diagnosis of acute kidney injury (AKI) on day 5 of admission.

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