“I never hear what happens, even if they die”: a survey of emergency physicians about outcome feedback

Abstract

Objective: Emergency physicians (EPs) rarely find out what happens to patients after the patients leave their care, a process we call “outcome feedback.” Some suggest this hinders the practice of emergency medicine (EM); however, evidence is lacking. We sought to evaluate EPs' perception of the current and potential role of outcome feedback in EM. Methods: We surveyed practising French- and English-speaking EPs from emergency departments within 100 km of Ottawa, Ont., in the provinces of Ontario and Quebec. The main outcomes included the prevalence, role and effect of outcome feedback. Results: Of the 297 physicians surveyed, 231 (77.8%) responded. The sample contained good representation of language groups, practice settings, sexes and age groups. All participants indicated that knowing outcomes is “essential” (62.6%) or “beneficial” (37.4%) to gaining experience in EM. Participants reported currently receiving passive outcome feedback in 10.0% of all cases, and seeking out (active) outcome feedback in 7.5% of all cases. The great majority of participants (97.3%) stated that they would like to receive more outcome feedback and believed that this would improve diagnostic accuracy (97.3%), clinical efficiency (85.5%), treatment outcomes (95.6%) and job satisfaction (95.1%). When asked to indicate “any possible negative effects that might arise from increased outcome feedback,” 62.1% indicated none. However, 17.9% hypothesized negative emotional effects and 11.5% suggested increased time requirements. Conclusion: The overwhelming majority of EPs receive very little outcome feedback. Most would like more outcome feedback and believe it would improve the practice of EM.

Outcome Feedback: An Opportunity for Quality Improvement

“…To the editor: I read with great interest Lavoie and colleagues' article regarding outcome feedback. 1 I agree with the findings that most emergency physicians would like more outcome feedback. More importantly, as Lavoie states in his editorial, 2 feedback on the outcomes of our decisions is vital to our becoming experts in our profession.…”

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

“…Lavoie et al suggested that greater feedback for staff emergency physicians could improve job satisfaction, clinical efficiency, diagnostic accuracy and treatment outcomes. 17 This belief was supported by the majority of residents and program directors in this study.…”

“…Additionally, very little has been published regarding the prevalence of passive outcome feedback within EM, but evidence suggests that it is low for both residents and staff physicians. 16,17 The study survey results reveal that there is currently no mandated follow-up of emergency department patients in residency programs; however, a majority of trainees voluntarily followed between 1-20% of patients that they had treated. Passive outcome feedback was rare, only being corroborated by residents in a single program.…”

Remember that patient you saw last week?

“…an outpatient consultation reply, or a copy of the patient's discharge summary) occurred in a median of 10% of cases, whereas feedback was actively sought by the emergency doctor in a median of 5% of cases. 8 Although this might not be directly translatable to the Australian setting, we have little reason to believe that things are much different.…”