The use of outcome feedback by emergency medicine physicians: Results of a physician survey

doi:10.5847/wjem.j.1920-8642.2019.01.002

Abstract

Abstract:

BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of emergency department (ED) outcome feedback called the return visit report (RVR) and present the results of a survey assessing physicians’ perceptions of this novel form of feedback.
METHODS: An Opinio web-based survey was conducted in 81 emergency physicians (EPs) at three EDs.
RESULTS: Of the 81 physicians surveyed, 40 (49%) responded. Most participants indicated that they frequently review their RVRs (83%), that RVRs are valuable to their practice of medicine (80%), and that RVRs alter their practice in future encounters (57%). Respondents reported seeking other forms of outcome feedback including speaking with other EPs (83%) and reviewing discharge summaries of admitted patients (87%). There was no correlation between demographic data and use of RVRs.
CONCLUSION: EPs value RVRs as a form of feedback. RVRs could be improved by reducing the observational interval and optimizing report relevance and differential weighting.

Key words: Return visit reports, Emergency medicine, Outcome feedback, Emergency department information system

Rakesh Gupta, Isaac Siemens, Sam Campbell. The use of outcome feedback by emergency medicine physicians: Results of a physician survey[J]. World Journal of Emergency Medicine, 2019, 10(1): 14-18.

Figures/Tables 4

Table 1

Overview of survey questions

Question number	Question content
1	Age ≤35 36-45 46-55 ≥56
2	Gender Male Female Other
3	For how many years have you been practicing emergency medicine as an attending physician? ≤7 8-15 16-23 ≥24
4	Training type CCFP (EM) FRCPC Other (type in box)
5	At which site have you worked the most shifts in the past year? Cobequid (community site) Dartmouth (community site) Halifax (academic site)
6	Approximately how many emergency department shifts did you work per month over the last year? 1-5 6-10 11-15 16-20 20+
7*	Please rate the following statements about the regular return visit reports sent to your e-mail: I review the return visit reports that I receive I examine the diagnoses of patients listed in my return visit report I seek additional information about the outcomes of patients listed in my return visit report
8*	Please rate the following statement about the regular return visit reports sent to your e-mail: Information about return visits alters my practice in future patient encounters
9*	Please rate the following statement about the regular return visit reports sent to your e-mail: Return visit reports are valuable to my practice of medicine
10*	Please rate the following statement about the regular return visit reports sent to your e-mail: Receiving information about patient outcomes is valuable to my practice of medicine
11*	Please rate the following statement about the regular return visit reports sent to your e-mail: The return visits reports I receive should be improved
12	Approximately how much time, in total, do you spend reviewing an average Return Visit Report and seeking additional information about the patients listed on it? (please type estimated number of minutes per report using only numerals)
13	In what other ways do you obtain information about your patient outcomes? Phoning the patient at home Speaking to the patient’s family physician Speaking to other emergency physicians Speaking to physicians from admitting service Reviewing the discharge summary from admitting service Other (indicate in box below)
14	Do you have any additional comments about return visit reports or this study? (enter text)

Table 1

Table 2

Table 3

Table 4

Parameters	Number (%) of physicians
Parameters	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
Return Visit Reports are valuable to my practice of medicine	1 (3)	1 (3)	4 (13)	13 (43)	11 (37)
Receiving information about patient outcomes is valuable to my practice of medicine	1 (3)	0 (0)	3 (10)	10 (33)	16 (53)
Information about return visits alters my practice in future patient encounters	1 (3)	1 (3)	11 (37)	13 (43)	4 (13)
I review the Return Visit Reports that I receive	2 (7)	0 (0)	3 (10)	5 (17)	20 (67)
I examine the diagnoses of patients listed in my return visit report	2 (7)	0 (0)	2 (7)	3 (10)	23 (77)
I seek additional information about the outcomes of patients listed in my return visit report	2 (7)	2 (7)	14 (47)	5 (17)	7 (23)

1	Lavoie CF, Schachter H, Stewart AT, McGowan J. Does outcome feedback make you a better emergency physician? A systematic review and research framework proposal. CJEM. 2009; 11(6):545-52. doi: 10.1017/s1481803500011829 pmid: 19922715
2	Croskerry P. The Feedback Sanction. Acad Emerg Med. 2000; 7(11):1232-8. doi: 10.1111/j.1553-2712.2000.tb00468.x pmid: 11073471
3	Lavoie C, Plint AC, Clifford TJ, Gaboury I. “I never hear what happens, even if they die:” A survey of emergency physicians about outcome feedback. CJEM. 2009; 11(6):523-8. doi: 10.1017/s1481803500011787 pmid: 19922711
4	Lavoie C, Croskerry P. Outcome Feedback and Patient Safety. In: Croskerry P, Cosby KS, Schenkel SM, Wears RL. Patient Safety in Emergency Medicine. Philadelphia, PA, Lippincott, Williams and Wilkins. 2009. 251-8.

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