812 Decision Making in Emergency Laparotomy – Do Trainees and Consultants Take Decisions Differently? Preliminary Results of an International Quality Enhancement Initiative (DILEMMA Study)

Abstract

Abstract Aim The aim of our study is to assess how professionals take decisions when evaluating suitability of patients for emergency laparotomy and compare judgement profiles between trainees and consultants. Method We created and validated a dataset of 90 short case vignettes based on real patients admitted with surgical pathology correctable only via an emergency laparotomy. We removed any information concerning real life outcomes. We submitted the vignettes to consultants and trainees in surgery, anaesthesia, and intensive care, asking them if they would or not offer an emergency laparotomy. The data was analysed using Judgement Analysis methodology (binomial logistic regression) to identify factors playing a role in the decision-making process. We then compared judgement profiles, accuracy scores (the lower the value the higher the likelihood of operating on patients that survived at 30 days), and inconsistency between trainees and consultants and between trainees of different grades. Results Twelve centres provided data (4 from Italy, 7 from the UK, 1 from Greece). 47 consultants, 9 SAS doctors, 28 higher trainees, 13 core trainees or equivalent took part in the study. Average concordance between decision makers and real life was 78.9%. Median accuracy was 16.5 (IQR 11-30.5). Median inconsistency score was 13% (IQR 7%-20%). Accuracy and inconsistency were better for consultants and worse for trainees. Judgment Analysis demonstrated differences between grades, specialities, and institutions. Conclusions Different clinicians, when faced with the same information, make different decisions. Accuracy and consistency differed between trainees and consultants.