Opportunistic decision making and complexity in emergency care

Amy Franklin, Ying Liu, Zhe Li, Vickie Nguyen, Todd R. Johnson, David Robinson, Nnaemeka Okafor, Brent King, Vimla L. Patel, Jiajie Zhang

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


In critical care environments such as the emergency department (ED), many activities and decisions are not planned. In this study, we developed a new methodology for systematically studying what are these unplanned activities and decisions. This methodology expands the traditional naturalistic decision making (NDM) frameworks by explicitly identifying the role of environmental factors in decision making. We focused on decisions made by ED physicians as they transitioned between tasks. Through ethnographic data collection, we developed a taxonomy of decision types. The empirical data provide important insight to the complexity of the ED environment by highlighting adaptive behavior in this intricate milieu. Our results show that half of decisions in the ED we studied are not planned, rather decisions are opportunistic decision (34%) or influenced by interruptions or distractions (21%). What impacts these unplanned decisions have on the quality, safety, and efficiency in the ED environment are important research topics for future investigation.

Original languageEnglish (US)
Pages (from-to)469-476
Number of pages8
JournalJournal of Biomedical Informatics
Issue number3
StatePublished - Jun 2011


  • Across-task decisions
  • Complexity
  • Emergency department
  • Methodology
  • Opportunistic decision making
  • Opportunistic planning
  • Taxonomy of decision types

ASJC Scopus subject areas

  • Computer Science Applications
  • Health Informatics


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