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

Published online by Cambridge University Press:  21 May 2015

Curtis F. Lavoie ,
Howard Schachter ,
Aviva T. Stewart  and
Jessie McGowan
Curtis F. Lavoie*
Affiliation:
Emergency Department, Hôpital Montfort, and the Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ont.
Howard Schachter
Affiliation:
Provincial Centre of Excellence for Child and Youth Mental Health, Children's Hospital of Eastern Ontario Research Institute II, Ottawa, Ont.
Aviva T. Stewart
Affiliation:
Division of Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.
Jessie McGowan
Affiliation:
Institute for Population Health, University of Ottawa, Ottawa, Ont.
*
Emergency Department, Hôpital Montfort, 713 Montreal Rd., Ottawa ON K1K 3E9; curtislavoie@gmail.ca

Abstract

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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.

Keywords

treatment outcomequality of health careemergency medicinedecision support techniquesoutcome feedback
Type
State of the Art • À la fine pointe
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 6 , November 2009 , pp. 545 - 552
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

References

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