Milisa Manojlovich PhD, RN, FAAN (is Professor, Department of Systems, Populations and Leadership, University of Michigan School of Nursing.), Amanda P. Bettencourt PhD, APRN, CCRN-K, ACCNS-P (is Assistant Professor, Department of Family and Community Health, University of Pennsylvania School of Nursing.), Courtney W. Mangus MD (is Clinical Assistant Professor, Department of Emergency Medicine, University of Michigan.), Sarah J. Parker MPH (is Research Area Specialist, Department of Emergency Medicine, University of Michigan.), Sarah E. Skurla MPH (is Project Manager, Center for Clinical Management Research, US Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan.), Heather M. Walters MS (is Senior Research Project Manager, VA Ann Arbor Healthcare System.), Prashant Mahajan MD, MPH, MBA (is Professor, Department of Emergency Medicine, University of Michigan. Please address correspondence to. Milisa Manojlovich)
{"title":"Refining a Framework to Enhance Communication in the Emergency Department During the Diagnostic Process: An eDelphi Approach","authors":"Milisa Manojlovich PhD, RN, FAAN (is Professor, Department of Systems, Populations and Leadership, University of Michigan School of Nursing.), Amanda P. Bettencourt PhD, APRN, CCRN-K, ACCNS-P (is Assistant Professor, Department of Family and Community Health, University of Pennsylvania School of Nursing.), Courtney W. Mangus MD (is Clinical Assistant Professor, Department of Emergency Medicine, University of Michigan.), Sarah J. Parker MPH (is Research Area Specialist, Department of Emergency Medicine, University of Michigan.), Sarah E. Skurla MPH (is Project Manager, Center for Clinical Management Research, US Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan.), Heather M. Walters MS (is Senior Research Project Manager, VA Ann Arbor Healthcare System.), Prashant Mahajan MD, MPH, MBA (is Professor, Department of Emergency Medicine, University of Michigan. Please address correspondence to. Milisa Manojlovich)","doi":"10.1016/j.jcjq.2024.01.013","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Emergency departments (EDs) are susceptible to diagnostic error. Suboptimal communication between the patient and the interdisciplinary care team increases risk to diagnostic safety. The role of communication remains underrepresented in existing diagnostic decision-making conceptual models.</p></div><div><h3>Methods</h3><p>The authors used eDelphi methodology, whereby data are collected electronically, to achieve consensus among an expert panel of 18 clinicians, patients, family members, and other participants on a refined ED–based diagnostic decision-making framework that integrates several potential opportunities for communication to enhance diagnostic quality. This study examined the entire diagnostic process in the ED, from prehospital to discharge or transfer to inpatient care, and identified where communication breakdowns could occur. After four iterative rounds of the eDelphi process, including a final validation round by all participants, the project's a priori consensus threshold of 80% agreement was reached.</p></div><div><h3>Results</h3><p>The authors developed a final framework that positions communication more prominently in the diagnostic process in the ED and enhances the original National Academies of Sciences, Engineering, and Medicine (NASEM) and ED–adapted NASEM frameworks. Specific points in the ED journey were identified where more attention to communication might be helpful. Two specific types of communication—information exchange and shared understanding—were identified as high priority for optimal outcomes. Ideas for communication-focused interventions to prevent diagnostic error in the ED fell into three categories: patient-facing, clinician-facing, and system-facing interventions.</p></div><div><h3>Conclusion</h3><p>This project's refinement of the NASEM framework adapted to the ED can be used to develop communications-focused interventions to reduce diagnostic error in this highly complex and error-prone setting.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725024000424","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
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Abstract
Background
Emergency departments (EDs) are susceptible to diagnostic error. Suboptimal communication between the patient and the interdisciplinary care team increases risk to diagnostic safety. The role of communication remains underrepresented in existing diagnostic decision-making conceptual models.
Methods
The authors used eDelphi methodology, whereby data are collected electronically, to achieve consensus among an expert panel of 18 clinicians, patients, family members, and other participants on a refined ED–based diagnostic decision-making framework that integrates several potential opportunities for communication to enhance diagnostic quality. This study examined the entire diagnostic process in the ED, from prehospital to discharge or transfer to inpatient care, and identified where communication breakdowns could occur. After four iterative rounds of the eDelphi process, including a final validation round by all participants, the project's a priori consensus threshold of 80% agreement was reached.
Results
The authors developed a final framework that positions communication more prominently in the diagnostic process in the ED and enhances the original National Academies of Sciences, Engineering, and Medicine (NASEM) and ED–adapted NASEM frameworks. Specific points in the ED journey were identified where more attention to communication might be helpful. Two specific types of communication—information exchange and shared understanding—were identified as high priority for optimal outcomes. Ideas for communication-focused interventions to prevent diagnostic error in the ED fell into three categories: patient-facing, clinician-facing, and system-facing interventions.
Conclusion
This project's refinement of the NASEM framework adapted to the ED can be used to develop communications-focused interventions to reduce diagnostic error in this highly complex and error-prone setting.
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