Courtney W. Mangus MD (is Clinical Assistant Professor, Departments of Emergency Medicine and Pediatrics, University of Michigan.), Tyler G. James PhD (is Assistant Professor, Department of Family Medicine, University of Michigan.), Sarah J. Parker MPH (is Research Area Specialist, Department of Emergency Medicine, University of Michigan.), Elizabeth Duffy MPH (is Clinical Research Coordinator, Department of Emergency Medicine, University of Michigan.), P. Paul Chandanabhumma PhD, MPH (is Assistant Professor, Department of Family Medicine, University of Michigan.), Caitlin M. Cassady LMSW, LCSW (is PhD Candidate, Social Work and Anthropology Doctoral Program, Wayne State University.), Fernanda Bellolio MD, MS (is Emergency Medicine Physician and Health Sciences Researcher, Departments of Emergency Medicine and Health Science Research, Mayo Clinic, Rochester, Minnesota.), Kalyan S. Pasupathy PhD (is Professor, Department of Biomedical and Health Information Sciences, University of Illinois at Chicago.), Milisa Manojlovich PhD, RN (is Professor, Department of Systems, Populations and Leadership, School of Nursing, University of Michigan.), Hardeep Singh MD, MPH (is Professor, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA (US Department of Veterans Affairs) Medical Center and Baylor College of Medicine, Houston.), Prashant Mahajan MD, MBA, MPH (is Professor, Departments of Emergency Medicine and Pediatrics, University of Michigan. Please address correspondence to Courtney W. Mangus)
{"title":"Frontline Providers’ and Patients’ Perspectives on Improving Diagnostic Safety in the Emergency Department: A Qualitative Study","authors":"Courtney W. Mangus MD (is Clinical Assistant Professor, Departments of Emergency Medicine and Pediatrics, University of Michigan.), Tyler G. James PhD (is Assistant Professor, Department of Family Medicine, University of Michigan.), Sarah J. Parker MPH (is Research Area Specialist, Department of Emergency Medicine, University of Michigan.), Elizabeth Duffy MPH (is Clinical Research Coordinator, Department of Emergency Medicine, University of Michigan.), P. Paul Chandanabhumma PhD, MPH (is Assistant Professor, Department of Family Medicine, University of Michigan.), Caitlin M. Cassady LMSW, LCSW (is PhD Candidate, Social Work and Anthropology Doctoral Program, Wayne State University.), Fernanda Bellolio MD, MS (is Emergency Medicine Physician and Health Sciences Researcher, Departments of Emergency Medicine and Health Science Research, Mayo Clinic, Rochester, Minnesota.), Kalyan S. Pasupathy PhD (is Professor, Department of Biomedical and Health Information Sciences, University of Illinois at Chicago.), Milisa Manojlovich PhD, RN (is Professor, Department of Systems, Populations and Leadership, School of Nursing, University of Michigan.), Hardeep Singh MD, MPH (is Professor, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA (US Department of Veterans Affairs) Medical Center and Baylor College of Medicine, Houston.), Prashant Mahajan MD, MBA, MPH (is Professor, Departments of Emergency Medicine and Pediatrics, University of Michigan. Please address correspondence to Courtney W. Mangus)","doi":"10.1016/j.jcjq.2024.03.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Few studies have described the insights of frontline health care providers and patients on how the diagnostic process can be improved in the emergency department (ED), a setting at high risk for diagnostic errors. The authors aimed to identify the perspectives of providers and patients on the diagnostic process and identify potential interventions to improve diagnostic safety.</p></div><div><h3>Methods</h3><p>Semistructured interviews were conducted with 10 ED physicians, 15 ED nurses, and 9 patients/caregivers at two separate health systems. Interview questions were guided by the ED–Adapted National Academies of Sciences, Engineering, and Medicine Diagnostic Process Framework and explored participant perspectives on the ED diagnostic process, identified vulnerabilities, and solicited interventions to improve diagnostic safety. The authors performed qualitative thematic analysis on transcribed interviews.</p></div><div><h3>Results</h3><p>The research team categorized vulnerabilities in the diagnostic process and intervention opportunities based on the ED–Adapted Framework into five domains: (1) team dynamics and communication (for example, suboptimal communication between referring physicians and the ED team); (2) information gathering related to patient presentation (for example, obtaining the history from the patients or their caregivers; (3) ED organization, system, and processes (for example, staff schedules and handoffs); (4) patient education and self-management (for example, patient education at discharge from the ED); and (5) electronic health record and patient portal use (for example, automatic release of test results into the patient portal). The authors identified 33 potential interventions, of which 17 were provider focused and 16 were patient focused.</p></div><div><h3>Conclusion</h3><p>Frontline providers and patients identified several vulnerabilities and potential interventions to improve ED diagnostic safety. Refining, implementing, and evaluating the efficacy of these interventions are required.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 7","pages":"Pages 480-491"},"PeriodicalIF":2.3000,"publicationDate":"2024-07-01","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/S1553725024000722","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Few studies have described the insights of frontline health care providers and patients on how the diagnostic process can be improved in the emergency department (ED), a setting at high risk for diagnostic errors. The authors aimed to identify the perspectives of providers and patients on the diagnostic process and identify potential interventions to improve diagnostic safety.
Methods
Semistructured interviews were conducted with 10 ED physicians, 15 ED nurses, and 9 patients/caregivers at two separate health systems. Interview questions were guided by the ED–Adapted National Academies of Sciences, Engineering, and Medicine Diagnostic Process Framework and explored participant perspectives on the ED diagnostic process, identified vulnerabilities, and solicited interventions to improve diagnostic safety. The authors performed qualitative thematic analysis on transcribed interviews.
Results
The research team categorized vulnerabilities in the diagnostic process and intervention opportunities based on the ED–Adapted Framework into five domains: (1) team dynamics and communication (for example, suboptimal communication between referring physicians and the ED team); (2) information gathering related to patient presentation (for example, obtaining the history from the patients or their caregivers; (3) ED organization, system, and processes (for example, staff schedules and handoffs); (4) patient education and self-management (for example, patient education at discharge from the ED); and (5) electronic health record and patient portal use (for example, automatic release of test results into the patient portal). The authors identified 33 potential interventions, of which 17 were provider focused and 16 were patient focused.
Conclusion
Frontline providers and patients identified several vulnerabilities and potential interventions to improve ED diagnostic safety. Refining, implementing, and evaluating the efficacy of these interventions are required.
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