The Disposition Decision: A Qualitative Study of Swedish Emergency Physicians' Objectives Through a Value-Focused Thinking Analysis.

OBJECTIVES

Disposition decisions in emergency departments involve multiple, often conflicting objectives. This study aimed to develop avalue assessment framework, expressed as a hierarchy of objectives, based on emergency physicians' values.

METHODS

We used value-focused thinking to analyze the disposition decision through semi-structured interviews with thirteen emergency physicians in Sweden. A hierarchy of objectives was developed through content analysis and refined through iterative group interviews with the participants.

RESULTS

Three fundamental objectives were identified: maximizing patient health, maximizing alignment with patient preferences, and maximizing healthcare equity. Maximizing patient healthencompassed minimizing morbidity and mortality risk while maximizing wellbeing. Maximizing healthcare equity required balancing individual patient needs against those of other patients in the ED, hospital, and broader healthcare system.

CONCLUSIONS

This study conceptualizes the disposition decision as a value-based decision about subsequent care after an ED visit. The hierarchy of objectives provides a transparent framework for analyzing value conflicts, supporting stakeholder communication, and facilitating the development and evaluation of disposition alternatives.