Budworth, L. orcid.org/0000-0002-2905-6011, Wilson, B., Sutton-Klein, J. et al. (11 more authors) (2025) Is emergency doctors’ tolerance of clinical uncertainty on a novel measure associated with doctor well-being, healthcare resource use and patient outcomes? Emergency Medicine Journal, 42 (1). pp. 41-48. ISSN 1472-0205
Abstract
Introduction
Emergency doctors routinely face uncertainty—they work with limited patient information, under tight time constraints and receive minimal post-discharge feedback. While higher uncertainty tolerance (UT) among staff is linked with reduced resource use and improved well-being in various specialties, its impact in emergency settings is underexplored. We aimed to develop a UT measure and assess associations with doctor-related factors (eg, experience), patient outcomes (eg, reattendance) and resource use (eg, episode costs).
Methods
From May 2021 to February 2022, emergency doctors (specialty trainee 3 and above) from five Yorkshire (UK) departments completed an online questionnaire. This included a novel UT measure—an adapted Physicians’ Reaction to Uncertainty scale collaboratively modified within our team according to Hillen et al’s (2017) UT model. The questionnaire also included well-being-related measures (eg, Brief Resilience Scale) and assessed factors like doctors’ seniority. Patient encounters involving prespecified ‘uncertainty-inducing’ problems (eg, headache) were analysed. Multilevel regression explored associations between doctor-level factors, resource use and patient outcomes.
Results
39 doctors were matched with 384 patients. The UT measure demonstrated high reliability (Cronbach’s α=0.92) and higher UT was significantly associated with better psychological well-being including greater resilience (Pearson’s r=0.56; 95% CI=0.30 to 0.74) and lower burnout (eg, Cohen’s d=−2.98; −4.62 to −1.33; mean UT difference for ‘no’ vs ‘moderate/high’ burnout). UT was not significantly associated with resource use (eg, episode costs: β=−0.07; −0.32 to 0.18) or patient outcomes including 30-day readmission (eg, OR=0.82; 0.28 to 2.35).
Conclusions
We developed a reliable UT measure for emergency medicine. While higher UT was linked to doctor well-being, its impact on resource use and patient outcomes remains unclear. Further measure validation and additional research including intervention trials are necessary to confirm these findings and explore the implications of UT in emergency practice.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. |
Keywords: | cost efficiency; psychology; risk management; safety; staff support |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 10 Jan 2025 12:32 |
Last Modified: | 10 Jan 2025 12:32 |
Status: | Published |
Publisher: | BMJ |
Refereed: | Yes |
Identification Number: | 10.1136/emermed-2023-213256 |
Related URLs: | |
Sustainable Development Goals: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:221520 |