Evidence map›Paper›PMID 42881454›Full record

ArticleBMC medicine2026

Front-line decision-making: a thematic analysis of interviews with hospital staff on referrals, admissions, and care for people with multiple long-term conditions.

Sara Pretorius, Sue Bellass, Rachel Cooper, Felicity Evison, Suzy Gallier, Nicola Howe, Elizabeth Sapey, Amelia Sheppard, Jana Suklan, Avan A Sayer and 2 more

Abstract read
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In one paragraph

Article in BMC medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Sara PretoriusNIHR HealthTech Research Centre in Diagnostic and Technology Evaluation, NE2 4HH, Newcastle upon Tyne, England, UK.
Sue BellassAGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, England, UK.
Rachel CooperAGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, England, UK.
Felicity EvisonPIONEER, The HDRUK Data Hub in acute care, University of Birmingham, Birmingham, England, UK.
Suzy GallierPIONEER, The HDRUK Data Hub in acute care, University of Birmingham, Birmingham, England, UK.
Nicola HoweNIHR HealthTech Research Centre in Diagnostic and Technology Evaluation, NE2 4HH, Newcastle upon Tyne, England, UK.
Elizabeth SapeyPIONEER, The HDRUK Data Hub in acute care, University of Birmingham, Birmingham, England, UK.
Amelia SheppardNIHR HealthTech Research Centre in Diagnostic and Technology Evaluation, NE2 4HH, Newcastle upon Tyne, England, UK.
Jana SuklanNIHR HealthTech Research Centre in Diagnostic and Technology Evaluation, NE2 4HH, Newcastle upon Tyne, England, UK.
Avan A SayerAGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, England, UK.
Miles D WithamAGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, England, UK. Miles.Witham@newcastle.ac.uk.
On Behalf Of The Admission Research CollaborativeNIHR HealthTech Research Centre in Diagnostic and Technology Evaluation, NE2 4HH, Newcastle upon Tyne, England, UK.

Funding

NIHR HealthTech Research Centre in Diagnostic and Technology Evaluation NIHR205290NIHR Newcastle Biomedical Research Centre NIHR203309NIHR Nottingham Biomedical Research Centre NIHR203309Strategic Priority Fund "Tackling multimorbidity at scale" programme delivered by Medical Research Council and National Institute for Health and Care Research in partnership with the Economic and Social Research Council and in collaboration with the Engineering and Physical Sciences Research Council MR/V033654/1
6 · The paper itself

Abstract

backgroundMultiple long-term conditions (MLTC) are increasingly common and present challenges for hospital healthcare professionals (HCPs) making decisions about admissions, referrals, and care management in the context of a single-organ oriented health system. This qualitative study examined how HCPs in emergency and acute hospital settings make such decisions for people living with MLTC, exploring factors that influence clinical judgement and how HCPs respond to these challenges.

methodsHCPs involved in making decisions about care for people living with MLTC presenting to hospital were recruited via National Health Service (NHS) research delivery networks and professional contacts, using purposive and snowball sampling. Semi-structured individual interviews were conducted, focusing on how HCPs make decisions regarding the care of people living with MLTC and factors influencing such decisions. Reflexive thematic analysis was undertaken. Themes relating to influences on decision-making were organised using the Social Ecological Model (SEM).

resultsWe interviewed 40 HCPs working in NHS emergency departments and acute assessment units across multiple regions, specialties and roles. Seven themes were constructed and organised into two overarching categories. The first category 'Factors Influencing Decision-Making' included the themes the complex patient, professional expertise and identity, system pressures and inflexible structures. These themes were mapped to the SEM, demonstrating influences across individual and environmental levels. The second category 'Adaptive Decision-Making Strategies' included the themes Mitigating risk and Relying on heuristics capturing how HCPs navigate the uncertainty created by these influences. The theme, Relational care, operated between categories, illustrating how relationships both shape what decisions are possible (interpersonal level of SEM) and provide a means of navigating uncertainty.

conclusionsClinical decision-making for people living with MLTC in emergency and acute settings is shaped by uncertainty arising from the interaction of factors operating across individual, interpersonal and environmental levels. To manage this uncertainty, staff employ a range of adaptive strategies. However, participants described this level of compensatory work as challenging and potentially insufficient on its own. Supporting decision-making and reducing reliance on adaptive responses may benefit from system‑level change, including improved community care, enhanced generalist expertise, opportunities for relational decision-making, better continuity and shared ownership of care, and flexible care pathways.

Indexed as

Clinical Decision-MakingDecision MakingMultiple Chronic ConditionsPatient AdmissionReferral and ConsultationEmergency Service, HospitalFemaleHumansInterviews as TopicMaleQualitative ResearchState MedicineUnited KingdomCare pathwaysClinical decision-makingHospital admissionsHospital referralsMultimorbidityMultiple long-term conditionsPatient care, patient management

Identifiers

PMID42881454

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.