Frontline Providers’ and Patients’ Perspectives on Improving Diagnostic Safety in the Emergency Department: A Qualitative Study

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES
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)
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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.

一线医护人员和患者对改善急诊科诊断安全的看法:定性研究
背景很少有研究描述一线医疗服务提供者和患者对如何改进急诊科(ED)诊断流程的见解,而急诊科是诊断错误的高发场所。作者旨在确定医疗服务提供者和患者对诊断过程的看法,并确定潜在的干预措施,以提高诊断安全性。访谈问题以 ED 适应美国国家科学、工程和医学院诊断流程框架为指导,探讨了参与者对 ED 诊断流程的看法,发现了漏洞,并寻求干预措施以提高诊断安全性。作者对转录的访谈进行了定性专题分析。结果研究小组根据 ED 适应框架将诊断过程中的薄弱环节和干预机会分为五个领域:(1) 团队动力和沟通(例如,转诊医生和急诊室团队之间的沟通欠佳);(2) 与患者表现相关的信息收集(例如,从患者或其看护人处获取病史;(3) 急诊室组织、系统和流程(例如,员工日程安排和交接);(4) 患者教育和自我管理(例如,急诊室出院时的患者教育);以及 (5) 电子病历和患者门户网站的使用(例如,自动将检查结果发布到患者门户网站)。作者确定了 33 项潜在干预措施,其中 17 项以医疗服务提供者为重点,16 项以患者为重点。需要对这些干预措施进行改进、实施和效果评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.80
自引率
4.30%
发文量
116
审稿时长
49 days
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