Patient-Identified Needs Related to Seeking a Diagnosis in the Emergency Department

Gerolamo, Angela M.; Jutel, Annemarie; Kovalsky, Danielle; Gentsch, Alexzandra T.; Doty, Amanda; Rising, Kristin L.

doi:10.1016/j.annemergmed.2018.02.021

Cited by 14 publications

(11 citation statements)

References 20 publications

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“…Understanding the diagnosis and cause of symptoms proved an important outcome for patients seeking help at the ED. A study focussing on patient needs at the ED already revealed that many patients seek emergency care to get a diagnosis 31. However, on closer examination, patients appear to not only desire an explanation for their symptoms, but also treatment and guidance for symptoms and clear communication about testing, treatment and diagnosis, which is in line with our findings.…”

Section: Discussionsupporting

confidence: 87%

Patient’s perspective on improving the quality of acute medical care: determining patient reported outcomes

Kremers¹,

Zaalberg

Ende

et al. 2019

BMJ Open Qual

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RationaleThere is an increasing societal demand for quality assurance and transparency of medical care. The American National Academy of Medicine has determined patient centredness as a quality domain for improvement of healthcare. While many of the current quality indicators are disease specific, most emergency department (ED) patients present with undifferentiated complaints. Therefore, there is a need for generic outcome measures. Our objective was to determine relevant patient reported outcomes (PROs) for quality measurement of acute care.MethodsWe conducted semistructured interviews in patients ≥18 years presenting at the ED for internal medicine. Patients with a cognitive impairment or language barrier were excluded. Interviews were analysed using qualitative content analysis.ResultsThirty patients were interviewed. Patients reported outcomes as relevant in five domains: relief of symptoms, understanding the diagnosis, presence and understanding of the diagnostic and/or therapeutic plan, reassurance and patient experiences. Experiences were often mentioned as relevant to the perceived quality of care and appeared to influence the domain reassurance.ConclusionWe determined five domains of relevant PROs in acute care. These domains will be used for developing generic patient reported measures for acute care. The patients’ perspective will be incorporated in these measures with the ultimate aim of organising truly patient-centred care at the ED.

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Section: Discussionsupporting

confidence: 87%

Patient’s perspective on improving the quality of acute medical care: determining patient reported outcomes

Kremers¹,

Zaalberg

Ende

et al. 2019

BMJ Open Qual

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“…Our recent work suggests that many patients discharged from the ED with a SBD have struggles related to their lack of a definitive diagnosis, with further work needed to explore the challenges unique to this patient population. 3,4,[16][17][18] Until now, there has not been a well-defined automated process for identifying these patients based upon their category of diagnosis (ie, "symptom-based") instead of a specific diagnosis name (eg, "myocardial infarction"). Our software was able to identify SBDs with a high sensitivity and specificity on the encounter level.…”

Section: Discussionmentioning

confidence: 99%

Identifying Emergency Department Symptom-Based Diagnoses with the Unified Medical Language System

Slovis

McCarthy

Nord

et al. 2019

WestJEM

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“…Our prior work suggests that patients’ decisions regarding when and where to seek care are influenced by potentially modifiable factors, such as emotional state, health system trust, and satisfaction. Patients report that they seek care in the ED because they are afraid and uncertain about various aspects of their symptoms and that they return to the ED because of ongoing uncertainty related to their symptoms . Uncertainty is defined as “the inability to determine the meaning of illness‐related events.” Mishel developed the Uncertainty in Illness Scale to measure the level of uncertainty in hospitalized patients with chronic conditions.…”

Section: Introductionmentioning

confidence: 99%

Patient Uncertainty as a Predictor of 30‐day Return Emergency Department Visits: An Observational Study

Rising

LaNoue

Gerolamo³

et al. 2018

Academic Emergency Medicine

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Objective: The objective was to examine the relationship between patient uncertainty at the time of emergency department (ED) discharge as measured by the "Uncertainty Scale" (U-Scale) and 30-day return ED visits. We hypothesized that a higher score on the U-Scale predicts a higher likelihood of a 30-day return ED visit.Methods: This was a cross-sectional single-site pilot study performed with adult patients discharged from an urban academic ED to assess the relationship of U-Scale total and subscale scores with 30-day return ED visits. We collected demographic and U-Scale scores at the time of ED discharge and subsequent 30-day ED utilization data by follow-up telephone call. Results:No association was found between the total U-Scale score and subsequent ED utilization. Patients with higher uncertainty on the Treatment Quality subscale of the U-Scale had higher odds of a 30-day return ED visit (adjusted odds ratio [AOR] = 1.16), while patients with lower uncertainty on the Decision to Seek Care subscale had higher odds of a 30-day return ED visit (AOR = 0.68).

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Patient-Identified Needs Related to Seeking a Diagnosis in the Emergency Department

Cited by 14 publications

References 20 publications

Patient’s perspective on improving the quality of acute medical care: determining patient reported outcomes

Patient’s perspective on improving the quality of acute medical care: determining patient reported outcomes

Identifying Emergency Department Symptom-Based Diagnoses with the Unified Medical Language System

Patient Uncertainty as a Predictor of 30‐day Return Emergency Department Visits: An Observational Study

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