Identification of the essential and critical factors of decision-making for COVID-19 patient management: a mixed-method study

Abstract

Background: Understanding the contributing factors for decision-making based on the disease stage is highly crucial to improving patient care. Aim: This study aimed to identify the critical and essential factors to enhance clinical decision-making for COVID-19 patients. Methods: This mixed-method research was conducted in two phases. In the first phase, a systematic literature review was performed using defined search strategies across four databases, including PubMed, Scopus, Web of Science, and IEEE. A total of 136 studies were obtained. Next, a questionnaire-based survey was conducted to validate the findings from the review and to categorize the factors into essential and critical factors. The content validity ratio was used to categorize the factors accordingly. The identified factors were classified into six main categories based on the stages of care and the corresponding decision-making. Results: The expert panel consisted of 10 clinicians from various fields. The potential factors were categorized into six categories. A total of 293 factors were found in the literature review. The findings of the consensus survey revealed 10 factors related to the decisions on the length of stay, eight factors for ward referral decisions, one factor for decisions on home referrals, six factors for deterioration diagnosis decisions, two factors for discharge decisions, and 10 factors for decisions on intensive care unit referrals. In addition, the study identified respiratory rate, oxygen saturation at administration, arterial oxygen pressure, sequential organ failure assessment score, and glomerular filtration rate as significant decision-making factors for COVID-19 patient management. Conclusion: For medical emergencies (e.g., COVID-19 management), fewer but more significant factors may increase the efficiency of decision-making, thereby improving the quality of patient management. On this basis, this study identified the essential and critical factors for decision-making at different stages of COVID-19 patient management. Relevance for Patients: This study identified the most important factors in diagnosing the deterioration of COVID-19 patients to improve the treatment outcome of COVID-19 patients.