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

Abstract

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.

Empowering Clinician Education With Patient‐outcome Feedback

“…The questions that clinicians need answered from POF are: 15,16 1. Did the patient follow the expected clinical course?…”

“…WHICH PATIENT-OUTCOME CASES MOST HELP EPS? 9,15,31,32 Because diagnostic (misdiagnoses and missed diagnoses) and treatment errors account for 6% to 17% of hospital adverse events, most EPs want feedback to learn whether their diagnoses and treatments were correct, especially in the patients at the highest risk, 33 but even with electronic records, it is impractical for EPs to follow up all their patients. To maximize the educational benefit, EPs need to prioritize which charts to review.…”

Remember that patient you saw last week?

“…6 The term 'outcome feedback' was more formally defined by Lavoie and colleagues as 'the natural process of finding out what happens to one's patients after their evaluation and treatment in the (ED)'. 7 The authors highlight the relatively sparse research in this field, suggesting further work is required to determine: • The severity of Croskerry's 'Feedback Sanction' • Whether increasing outcome feedback yields anticipated educational benefits • Whether increasing outcome feedback might improve ED care. Within the world of medicine, this problem of rarely seeing your patient again is infrequently encountered in other specialties.…”

Outcome Feedback within Emergency Medicine Training Programs: An Opportunity to Apply the Theory of Deliberate Practice?

“…1 A recent systematic review defined outcome feedback as "the natural process of finding out what happens to one's patients after their evaluation and treatment in the emergency department." 2 This review attempted to elucidate current knowledge regarding outcome feedback, as well as its impact, incidence, and modifiers. While seven reports were identified, all were deemed to be of inadequate quality to make definitive recommendations on anything beyond future directions for research.…”

“…While seven reports were identified, all were deemed to be of inadequate quality to make definitive recommendations on anything beyond future directions for research. 2 At the current time, there are no clearly established guidelines by the Accreditation Council for Graduate Medical Education (ACGME) or the Royal College of Physicians and Surgeons of Canada that delineate what, if any, outcome feedback systems should be in place in EM residencies. While no guidelines have been published, reflective practice and patient follow-up are endorsed by the ACGME, American Board of Emergency Medicine (ABEM) and others.…”