Understanding and enhancing tolerance of uncertainty in emergency departments

Intolerance of uncertainty is associated with burnout rates and risk-averse
approaches to patient management among doctors. Doctors working in the
emergency department (ED) are exposed to high levels of uncertainty, often
making admission or discharge decisions with only symptom-based diagnoses.
However, the majority of efforts to enhance uncertainty tolerance has focused
on general practitioners or medical school students. This PhD therefore aimed
to develop understanding of uncertainty tolerance in the ED, and the factors
contributing to uncertainty being appraised, and responded to, positively or
negatively.
The studies in this thesis were theoretically underpinned by an integrative
model of uncertainty tolerance developed by Hillen and colleagues (2017).
Hillen and colleagues (2017) propose that where uncertainty is consciously
perceived, the subsequent appraisals or responses can range from positive to
negative. Research in this thesis aimed to elucidate the factors influencing the
valence of responses in an ED context and patient safety outcomes associated
with uncertainty tolerance.
A systematic, scoping review (study 1) synthesises existing evidence
identifying sources of uncertainty, responses to uncertainty, factors influencing
such responses and outcomes of uncertainty tolerance in the ED. This review
was also conducted to understand where existing efforts to enhance uncertainty
tolerance have focused. To establish public preference on the responses to
uncertainty identified in the scoping review, a survey study was conducted
(study 2). To explore the factors associated with uncertainty tolerance in an
NHS context, ED doctors were interviewed, drawing on experience of uncertain
admission and discharge decisions (study 3). Finally, a modified e-Delphi
survey was conducted with experts to identify important functions for UT
interventions based on findings from the previous chapters (study 4). Findings
from this thesis provide novel suggestions for stakeholders seeking to enhance
the uncertainty tolerance of ED doctors while developing, and critiquing,
uncertainty tolerance theory in a clinical context.