Increasing Compliance With the Residency Review Committee Requirements for Follow-up in Academic Emergency Departments

Gaeta, Theodore J.; Osborn, Harold H

doi:10.1016/s0196-0644(99)70337-9

Cited by 7 publications

(13 citation statements)

References 3 publications

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“…Three of these studies 17,19,20 surveyed EM residency program directors, over several years. The results indicate that outcome feedback systems for EM residents have been increasingly available since 1984.…”

Section: Resultsmentioning

confidence: 99%

“…For admitted patients, automatic mailing of discharge summaries and case conferences (or quality assurance activities) were reported to be the most commonly available mechanisms for EM residents, 16,19,20 as well as the most popular for attending emergency physicians. 18 Only 1 study looked at mechanisms of outcome feedback for discharged patients.…”

Section: Resultsmentioning

confidence: 99%

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

Lavoie

Schachter

Stewart

et al. 2009

CJEM

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Lavoie

Schachter

Stewart

et al. 2009

CJEM

View full text Add to dashboard Cite

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“…12 Despite this requirement, many residency programs across the United States consistently failed to achieve this standard. [13][14][15] The practice of patient follow-up has been more recently endorsed in a 2012 publication jointly written by the ACGME and ABEM that defines the suggested progression of competencies within an EM training program. 3 The extent to which outcome feedback and follow-up is currently taking place in Canadian EM training programs has not been previously studied.…”

Section: Discussionmentioning

confidence: 99%

“…In the most recent evidence from the United States, a group of researchers surveyed all American program directors in 1984,1988,1992, and 1996 to determine the levels of compliance with the RRC-EM requirements. 13 In 1996, 74% (75/101) of programs had a follow-up system in place for admitted patients, and 51% (52/101) for patients discharged home. 13 The extent of patient follow-up that has been occurring more recently is not known.…”

Section: Discussionmentioning

confidence: 99%

“…13 In 1996, 74% (75/101) of programs had a follow-up system in place for admitted patients, and 51% (52/101) for patients discharged home. 13 The extent of patient follow-up that has been occurring more recently is not known. There is currently no literature that describes the proportion of residents who perform voluntary follow-up or what proportion of patients is followed.…”

Section: Discussionmentioning

confidence: 99%

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

Dalseg

Calder

Lee

et al. 2015

CJEM

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Objectives: Outcome feedback is the process of learning patient outcomes after their care within the emergency department. We conducted a national survey of Canadian Royal College emergency medicine (EM) residents and program directors to determine the extent to which active outcome feedback and follow-up occurred. We also compared the perceived educational value of outcome feedback between residents and program directors. Methods: We distributed surveys to all Royal Collegeaccredited adult and pediatric EM training programs using a modified Dillman method. We analyzed the data using student's t-test for continuous variables and Fisher's exact test for categorical variables. Results: We received 210 completed surveys from 260 eligible residents (80.8%) and 21 of 24 program directors (87.5%) (overall 81.3%). Mandatory active outcome feedback was not present in any EM training program for admitted or discharged patients (0/21). Follow-up was performed electively by 89.4% of residents for patients admitted to the hospital, and by 44.2% of residents for patients discharged home. A majority of residents (76.9%) believed that patient follow-up should be mandatory compared to 42.9% of program directors (p = 0.002). The perceived educational value of outcome feedback was 5.8/7 for residents and 5.1/7 for program directors (difference 0.7; p = 0.002) based on a seven-point Likert scale (1 = not important; 7 = very important). Conclusion: While Canadian EM training programs do not mandate follow-up, it is performed electively by the majority of residents surveyed. Residents place a significantly greater educational value on outcome feedback than their program directors, and believe that follow-up should be a mandatory component of EM residencies. RÉSUMÉOBJECTIFS: On entend par rétroaction sur les résultats le processus d'apprentissage des résultats obtenus chez les patients après la prestation de soins au service des urgences (SU). Les auteurs ont mené une enquête nationale parmi les résidents et les directeurs de programme en médecine d'urgence (MU) du Collège royal des médecins et chirurgiens du Canada afin de déterminer dans quelle mesure il y avait une rétroaction active sur les résultats et sur le suivi des patients. A cela s'ajoute une comparaison de la valeur éducative de la rétroaction sur les résultats, perçue tant par les résidents que par les directeurs de programme. MÉTHODE: Des outils d'enquête ont été envoyés, selon une version modifiée de la méthode de Dillman, dans tous les programmes de formation en MU pour adultes et pour enfants, reconnus par le Collège royal. Il y a eu analyse des données selon le test t de Student pour évaluer les variables continues et le test exact de Fisher pour évaluer les variables nominales. RESULTS: Deux cent dix résidents sur une possibilité de 260 (80,8 %) et 21 directeurs de programme sur 24 (87,5 %) (taux général: 81,3 %) ont répondu aux questionnaires. Dans aucun des programmes de formation en MU (0/21), il n'y avait de rétroaction active obligatoire sur les résult...

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Empowering Clinician Education With Patient‐outcome Feedback

Iserson

2020

AEM Education and Training

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Emergency physicians (EPs) often lack the information they need about their patients' outcomes so that they can both optimally adjust and refine their diagnostic and treatment processes and recognize their clinical errors. Patient-outcome feedback (POF) provides that information by informing clinicians about a patient's clinical course after that clinician's evaluation and treatment. This feedback may encompass the period after the EP has transferred a patient's care to another EP or after the patient has left the ED or hospital. EPs obtain POF through various active and passive methods, depending on their institutional and medical record systems. Active methods require that clinicians or others spend time and effort acquiring the information; passive methods deliver it automatically. POF is an excellent performance-based measurement that helps clinicians to stimulate their learning and to build their own validated mental library of outcomes with which to make clinical decisions, i.e., heuristics and System 1 thinking. POF offers especially useful feedback about patients who have been admitted, were referred to specialists, had major interventions, had potentially significant tests pending on discharge, or were handed off to another EP. The current health care system makes it difficult for EPs to discover their patients' outcomes, squandering significant educational opportunities. Three stimuli to improve this situation would be to require EPs to receive passive POF as part of hospital accreditation, for reviewing POF to be classified as a Category 1 Continuing Medical Education activity, and to reimburse clinicians for learning activities related to POF. Research indicates that our health care institutions and systems would be well served to provide clinicians with ongoing automatic information about their patients' outcomes.

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Increasing Compliance With the Residency Review Committee Requirements for Follow-up in Academic Emergency Departments

Cited by 7 publications

References 3 publications

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

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

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

Empowering Clinician Education With Patient‐outcome Feedback

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