Table 4 Facilitators of immediate notification of the attending physician and barriers to seeking attending input
Domain (n)Major categories (n)Representative comments
Barriers to seeking attending physican’s advice (7)Conflict with decision making autonomy (2)“it was a pain to kind of run by things with [the attending] … because it would kind of influence things too much and then you wouldn’t get a chance to make up your own mind and figure it out.” [R#21]
Fund of knowledge expectations (2)“I would turn to [the attending] for advice unless it’s something, I would if it was difficult or pressing, but I mean if it’s a question just something that I didn’t know the answer to …” [R#27]
Existence of defined hierarchy (2)“… between [the MICU resident or the MROC] or the other residents, I usually talk to them before I would make a decision to go up the chain” [R#38]
Fear of repercussion (1)‘I mean [the attending] said I could call him in the middle of the night if I needed anything but I am not going to do that … I am not going to wake him up …” [R#35]
Facilitators to seeking the attending physician’s advice (6)Need for escalation of care (4)“it wasn’t anything that critical it needed to be addressed that night, if I had been I would have been totally comfortable calling my attending because she made it a point to know that that was fine in calling” [R#39]
Options in decision making (1)“I feel like I can call the attendings if I have questions above my head or especially if there are a couple of options of what to do on the question I always run it by the attending to make sure, even if its with a text page” [R#37]
Clinical experience (1)“but if it were more like a clinical judgment thing and I hadn’t had that situation then I would ask [the attending] …”[R#22]