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.