Feasibility of patient-reported diagnostic errors following emergency department discharge: a pilot study

Abstract

ObjectivesThe National Academy of Medicine identified diagnostic error as a pressing public health concern and defined failure to effectively communicate the diagnosis to patients as a diagnostic error. Leveraging Patient’s Experience to improve Diagnosis (LEAPED) is a new program for measuring patient-reported diagnostic error. As a first step, we sought to assess the feasibility of using LEAPED after emergency department (ED) discharge.MethodsWe deployed LEAPED using a cohort design at three EDs within one academic health system. We enrolled 59 patients after ED discharge and queried them about their health status and understanding of the explanation for their health problems at 2-weeks, 1-month, and 3-months. We measured response rates and demographic/clinical predictors of patient uptake of LEAPED.ResultsOf those enrolled (n=59), 90% (n=53) responded to the 2-week post-ED discharge questionnaire (1 and 3-month ongoing). Of the six non-responders, one died and three were hospitalized at two weeks. The average age was 50 years (SD 16) and 64% were female; 53% were white and 41% were black. Over a fifth (23%) reported they were not given an explanation of their health problem on leaving the ED, and of those, a fourth (25%) did not have an understanding of what next steps to take after leaving the ED.ConclusionsPatient uptake of LEAPED was high, suggesting that patient-report may be a feasible method of evaluating the effectiveness of diagnostic communication to patients though further testing in a broader patient population is essential. Future research should determine if LEAPED yields important insights into the quality and safety of diagnostic care.

Patient and care partner assessments of diagnostic excellence in the emergency department: A cognitive interview study

“…Previous studies measuring the effectiveness of diagnostic communication with patients during emergency department visits indicate that a significant portion of participants were not given an explanation of their health problem during the visit or did not understand their diagnosis or what next steps to take after leaving the emergency department ( Gleason et al., 2021 ; Horwitz et al., 2013 ). Further, previous studies confirm that patient understanding of their symptoms and clinical prognosis was an important outcome of emergency department visits ( Vaillancourt et al., 2017 ).…”

“…Participants were sampled from June 2021 to November 2021. We used both a convenience sample from an existing longitudinal cohort study of patients with emergency department visits ( Gleason et al., 2021 ), and a purposively recruited sample of individuals lacking patient portal access from patient and family advisory councils. We interviewed participants until saturation was reached.…”

Patient Identification of Diagnostic Safety Blindspots and Participation in “Good Catches” Through Shared Visit Notes

“…We are at the very beginning stages of understanding how to engineer systems that thoughtfully use patient feedback to better support providers’ diagnostic reasoning. If diagnostic accuracy relies on some factors beyond the clinician—as delineated by the situativity model—we need systems that bring relevant information that is outside the health care provider's view to the clinical interface 61,62 . Patients themselves have innovative suggestions for how to do so 63 …”

“…If diagnostic accuracy relies on some factors beyond the clinician-as delineated by the situativity model-we need systems that bring relevant information that is outside the health care provider's view to the clinical interface. 61,62 Patients themselves have innovative suggestions for how to do so. 63 Partnership with clinician leaders, experts in user-centered design, and EHR vendors to match functionality and workflows with patient recommendations could stimulate testing of some patient-centered approaches.…”