Decreasing clinically significant adverse events using feedback to emergency physicians of telephone follow-up outcomes

Chern, Chorng–Shyan; How, Chorng–Kuang; Wang, Lee-Min; Lee, Chen‐Hsen; Graff, Louis

doi:10.1016/j.annemergmed.2004.08.012

Cited by 37 publications

(45 citation statements)

References 31 publications

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“…Therefore, absence of any one component in the process is not thought to be a ‘pure’ judgement error. The objective review process to determine CSAEs and also their causes, as shown in figure 1B, uses a systematic method to ascertain whether there was clinical evidence to indicate insufficiencies in the BMP9 13 14 or a definite error. Any insufficiency in this process was considered to be an error of ‘not done’ (a neglect of the basic requirement) and not a ‘judgement error’.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, in this study we investigated the EPs' reasons for discharge of patients with clinically significant adverse events (CSAEs). CSAEs included major operative conditions, major medical conditions, significant deterioration of clinical conditions and prolonged hospital stay (>3 days) 4 9. We based our observations on EPs' subjective reasoning for discharging patients and senior EPs' objective evaluations.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of clinically significant adverse events in patients discharged from a tertiary-care emergency department in Taiwan

et al. 2012

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ObjectiveTo investigate the reasons for the occurrence of clinically significant adverse events (CSAEs) in emergency department-discharged patients through emergency physicians' (EPs) subjective reasoning and senior EPs' objective evaluation.DesignThis was a combined prospective follow-up and retrospective review of cases of consecutive adult non-traumatic patients who presented to a tertiary-care emergency department in Taiwan between 1 September 2005 and 31 July 2006. Data were extracted from ‘on-duty EPs' subjective reasoning for discharging patients with CSAEs (study group) and without CSAEs (control group)’ and ‘objective evaluation of CSAEs by senior EPs, using clinical evidences such as recording history, physical examinations, laboratory/radiological examinations and observation of inadequacies in the basic management process (such as recording history, physical examinations, laboratory/radiological examinations and observation) as the guide’. Subjective reasons for discharging patients’ improvement of symptoms, and the certainty of safety of the discharge were compared in the two groups using χ2 statistics or t test.ResultsOf the 20 512 discharged cases, there were 1370 return visits (6.7%, 95% CI 6.3% to 7%) and 165 CSAEs due to physicians' factors (0.82%, 95% CI 0.75% to 0.95%). In comparisons between the study group and the control group, only some components of discharge reasoning showed a significant difference (p<0.001). Inadequacies in the basic management process were the main cause of CSAEs (164/165).ConclusionThe authors recommended that EP follow-up of the basic management processes (including history record, physical examination, laboratory and radiological examinations, clinical symptoms/signs and treatment) using clinical evidence as a guideline should be made mandatory.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of clinically significant adverse events in patients discharged from a tertiary-care emergency department in Taiwan

et al. 2012

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“…Using a review of admissions and repeated telephone calls to patients who did not improve, the authors monitored the rate of clinically significant adverse events (CSAEs), which were defined as return visits with serious management error (misdiagnosis or erroneous treatment plan) resulting in death, or admission for longer than 3 days." 21 During this outcome feedback intervention, Chern and coworkers 21 observed a drop in the rate of CSAEs in high-risk cases from 4.1% in the control period to 1.5% during the intervention period (a reduction of 2.6%, 95% confidence interval 0.3%-4.8%), and relative reduction of the overall CSAE rate of more than 50%, from 0.9% to 0.4% (reduction of 0.5%, 95% confidence interval 0.1%-0.9%). 21 However, a number of limitations of this study merit consideration.…”

Section: Cjem • Jcmumentioning

confidence: 99%

“…21 During this outcome feedback intervention, Chern and coworkers 21 observed a drop in the rate of CSAEs in high-risk cases from 4.1% in the control period to 1.5% during the intervention period (a reduction of 2.6%, 95% confidence interval 0.3%-4.8%), and relative reduction of the overall CSAE rate of more than 50%, from 0.9% to 0.4% (reduction of 0.5%, 95% confidence interval 0.1%-0.9%). 21 However, a number of limitations of this study merit consideration. First, the outcome information provided to the residents was combined with other feedback including a discussion of "the pitfalls in diagnosis or management, [and] appropriate performance that might avoid adverse event recurrence and the possible error."…”

Section: Cjem • Jcmumentioning

confidence: 99%

“…The impact of outcome feedback Table 2 summarizes the articles that address the impact of outcome feedback in EM. The first study by Chern and colleagues 21 was a controlled intervention study that found a significant reduction in adverse events in response to telephone outcome feedback. This was a before-and-after study of the effect of outcome feedback obtained by telephone calls to patients on the rate of adverse patient outcomes in a Taiwanese hospital.…”

Section: Cjem • Jcmumentioning

confidence: 99%

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Does outcome feedback make you a better emergency physician? A systematic review and research framework proposal

Lavoie

Schachter

Stewart

et al. 2009

CJEM

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Objective: The organization of emergency medical care limits the ability of emergency physicians to know the outcomes of most of their patients after the patients leave the emergency department. This lack of outcome feedback may hinder the practice of emergency medicine (EM) by preventing "calibration" of the decision tools of practitioners. We sought to determine what is currently known about outcome feedback in EM, including its incidence, impact and modifiers. Data source: We searched the following databases: PreMED-LINE, MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO, DARE, Health Technology Assessment Database and AMED. We performed manual searches on abstract databases, reference lists, various health information and research websites, and nonindexed journals. Study selection: Selection entailed a 2-step screening process to exclude articles not pertaining to outcome feedback in EM. Data extraction: Our search yielded 1128 bibliographic records, from which screening identified 7 relevant reports: 5 surveys, 1 system level evaluation and 1 intervention trial. Data synthesis: All studies were found to have "inadequate" or "unable to assess" reporting and study quality. Systems for outcome feedback to EM residents have been increasingly available since 1984, though they are perceived to be inadequate. Commonly used mechanisms for outcome feedback include automatic routing of discharge summaries, case conferences for admitted patients and telephone calls to patients or families for discharged patients. With respect to attending emergency physicians, no conclusions or clinical recommendations can be made given the level of available evidence. Conclusion:The potential importance of outcome feedback remains, at this time, underevaluated. We propose a research framework, and hypothesize that increasing outcome feedback would increase emergency physician diagnostic accuracy, therapeutic outcomes, clinical efficiency and job satisfaction. Future research in this area should include surveys and focus groups, as well as simulated or real-world intervention trials.

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Empowering Clinician Education With Patient‐outcome Feedback

Iserson

2020

AEM Education and Training

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Emergency physicians (EPs) often lack the information they need about their patients' outcomes so that they can both optimally adjust and refine their diagnostic and treatment processes and recognize their clinical errors. Patient-outcome feedback (POF) provides that information by informing clinicians about a patient's clinical course after that clinician's evaluation and treatment. This feedback may encompass the period after the EP has transferred a patient's care to another EP or after the patient has left the ED or hospital. EPs obtain POF through various active and passive methods, depending on their institutional and medical record systems. Active methods require that clinicians or others spend time and effort acquiring the information; passive methods deliver it automatically. POF is an excellent performance-based measurement that helps clinicians to stimulate their learning and to build their own validated mental library of outcomes with which to make clinical decisions, i.e., heuristics and System 1 thinking. POF offers especially useful feedback about patients who have been admitted, were referred to specialists, had major interventions, had potentially significant tests pending on discharge, or were handed off to another EP. The current health care system makes it difficult for EPs to discover their patients' outcomes, squandering significant educational opportunities. Three stimuli to improve this situation would be to require EPs to receive passive POF as part of hospital accreditation, for reviewing POF to be classified as a Category 1 Continuing Medical Education activity, and to reimburse clinicians for learning activities related to POF. Research indicates that our health care institutions and systems would be well served to provide clinicians with ongoing automatic information about their patients' outcomes.

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Decreasing clinically significant adverse events using feedback to emergency physicians of telephone follow-up outcomes

Cited by 37 publications

References 31 publications

Evaluation of clinically significant adverse events in patients discharged from a tertiary-care emergency department in Taiwan

Evaluation of clinically significant adverse events in patients discharged from a tertiary-care emergency department in Taiwan

Does outcome feedback make you a better emergency physician? A systematic review and research framework proposal

Empowering Clinician Education With Patient‐outcome Feedback

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