Next-generation audit and feedback for inpatient quality improvement using electronic health record data: a cluster randomised controlled trial

Patel, Sajan; Rajkomar, Alvin; Harrison, James D.; Prasad, Priya; Valencia, Victoria; Ranji, Sumant R; Mourad, Michelle

doi:10.1136/bmjqs-2017-007393

Cited by 22 publications

(42 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is evidence that already exists for the benefits of an embedded audit and feedback system that facilitates reflective practice for staff. 16…”

Section: Discussionmentioning

confidence: 99%

The diagnostic certainty levels of junior clinicians: A retrospective cohort study

Chen

Nagendran

Kilic

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose of the Study To characterise the documentation of working diagnoses and their associated level of certainty by clinicians assessing patients referred to the medical team from the emergency department. Design This was a single centre retrospective cohort study of non-consultant grade clinicians at the Royal London Hospital, Barts Health NHS Trust between 01/03/19 to 31/03/19. De-identified electronic health record data was collected to include the type of diagnosis documented (clinical, laboratory result or symptom/sign defined) and the certainty adjective used for single diagnoses. Presence or absence of diagnostic uncertainty was collected for multiple diagnoses. Results 865 medical assessments were recorded during the study period. 850 were available for further analysis. 420 presented a single diagnosis while 430 presented multiple diagnoses. Of the 420 single diagnoses, 67 (16%) were documented as either a symptom or physical sign, and 16 (4%) were laboratory-result defined diagnoses. No uncertainty was expressed in 309 (74%) of the diagnoses. Of 430 multiple diagnoses, uncertainty was expressed in 346 (80%) compared to 84 (20%) in which no uncertainty was expressed. Conclusion The documentation of working diagnoses is highly variable amongst non-consultant grade clinicians assessing patients admitted via the emergency department. In nearly three quarters of assessments with single diagnoses, no element of uncertainty was implied or quantified. More uncertainty was expressed in multiple diagnoses than single diagnoses however documentation style was heterogenous. These data have implications for prospective studies examining the quantification of diagnostic certainty and its association with important process or outcome measures.

show abstract

“…There is evidence that already exists for the benefits of an embedded audit and feedback system that facilitates reflective practice for staff. 16…”

Section: Discussionmentioning

confidence: 99%

The diagnostic certainty levels of junior clinicians: A retrospective cohort study

Chen

Nagendran

Kilic

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Future studies could couple this information into an audit and feedback system that facilitates reflective practice. 29 The mere act of quantifying a certainty rating might form a cognitive brake and thus an important debiasing strategy that mitigates against avoidable medical error occurring from under-or overconfidence. [30][31][32][33] For researchers, there is very weak existing evidence to suggest a relationship between certainty self-ratings and outcomes such as mortality, readmission and length of stay.…”

Section: Implications For Clinicians and Researchersmentioning

confidence: 99%

Real time self-rating of decision certainty by clinicians: a systematic review

2019

View full text Add to dashboard Cite

Background We sought to establish to what extent decision certainty has been measured in real time and whether high or low levels of certainty correlate with clinical outcomes. Methods Our pre-specified study protocol is published on PROSPERO, CRD42019128112. We identified prospective studies from Medline, Embase and PsycINFO up to February 2019 that measured real time self-rating of the certainty of a medical decision by a clinician. Findings Nine studies were included and all were generally at high risk of bias. Only one study assessed long-term clinical outcomes: patients rated with high diagnostic uncertainty for heart failure had longer length of stay, increased mortality and higher readmission rates at 1 year than those rated with diagnostic certainty. One other study demonstrated the danger of extreme diagnostic confidence-7% of cases (24/341) labelled as having either 0% or 100% diagnostic likelihood of heart failure were made in error. Conclusions The literature on real time self-rated certainty of clinician decisions is sparse and only relates to diagnostic decisions. Further prospective research with a view to generating hypotheses for testable interventions that can better calibrate clinician certainty with accuracy of decision making could be valuable in reducing diagnostic error and improving outcomes.

show abstract

“… 15 17 18 While dashboards have so far been primarily used in the outpatient setting, 6 some hospitalist groups have deployed them in the inpatient setting with improvement in performance metrics. 19–21 …”

Section: Introductionmentioning

confidence: 99%

Creating a culture of quality: our experience with providing feedback to frontline hospitalists

et al. 2021

View full text Add to dashboard Cite

BackgroundOne way to provide performance feedback to hospitalists is through the use of dashboards, which deliver data based on agreed-upon standards. Despite the growing trend on feedback performance on quality metrics, there remain limited data on the means, frequency and content of feedback that should be provided to frontline hospitalists.ObjectiveThe objective of our research is to report our experience with a comprehensive feedback system for frontline hospitalists, as well as report the change in our quality metrics after implementation.Design, setting and participantsThis quality improvement project was conducted at a tertiary academic medical centre among our hospitalist group consisting of 46 full-time faculty members.Intervention or exposureA monthly performance feedback report was distributed to provide ongoing feedback to our hospitalist faculty, including an individual dashboard and a peer comparison report, complemented by coaching to incorporate process improvement tactics into providers’ daily workflow.Main outcomes and measuresThe main outcome of our study is the change in quality metrics after implementation of the monthly performance feedback reportResultsThe dashboard and rank order list were sent to all faculty members every month. An improvement was seen in the following quality metrics: length of stay index, 30-day readmission rate, catheter-associated urinary tract infections, central line-associated bloodstream infections, provider component of Healthcare Consumer Assessment of Healthcare Providers and Systems scores, attendance at care coordination rounds and percentage of discharge orders placed by 10:00.ConclusionsImplementation of a monthly performance feedback report for hospitalists, complemented by peer comparison and guidance on tactics to achieve these metrics, created a culture of quality and improvement in the quality of care delivered.

show abstract

Next-generation audit and feedback for inpatient quality improvement using electronic health record data: a cluster randomised controlled trial

Abstract: The trial was registered with ClinicalTrials.gov (NCT02593253).

Cited by 22 publications

References 19 publications

The diagnostic certainty levels of junior clinicians: A retrospective cohort study

The diagnostic certainty levels of junior clinicians: A retrospective cohort study

Real time self-rating of decision certainty by clinicians: a systematic review

Creating a culture of quality: our experience with providing feedback to frontline hospitalists

Contact Info

Product

Resources

About