375 - A qualitative investigation of providers’ and patients’ perspectives on potential interventions to improve diagnostic safety in the emergency department.

Poster Number: 375
Publication Number: 375.212

Courtney W. Mangus, University of Michigan Medical School, Ann arbor, MI, United States; Tyler G. James, University of Michigan Medical School, Ann Arbor, MI, United States; Sarah J. Parker, University of Michigan Medical School, Ann Arbor, MI, United States; CM Cassady, Wayne State University, Ferndale, MI, United States; P. Paul Chandanabhumma, University of Michigan Medical School, Ann Arbor, MI, United States; Michael D. Fetters, University of Michigan Medical School, Pinckney, MI, United States; Fernanda Bellolio, Mayo Clinic, Rochester, MN, United States; Kalyan S. Pasupathy, University of Illinois at Chicago, Chicago, IL, United States; Milisa Manojlovich, University of Michigan, Ann Arbor, MI, United States; Hardeep Singh, Baylor College of Medicine, Houston, TX, United States; Prashant Mahajan, University of Michigan Medical School, Ann Arbor, MI, United States

Background: The emergency department (ED) is a setting prone to diagnostic errors. Few studies have explored perspectives of frontline providers and patients on how the ED diagnostic can be improved.

Objective: Solicit ED provider and patient perspectives to improve diagnostic safety in the ED.

Design/Methods: We conducted semi-structured key informant interviews with providers and patients to obtain their perspectives on the ED diagnostic process, identify vulnerabilities, and solicit ideas for interventions to improve diagnostic safety. Following pilot testing and iterative revisions of the interview guide, we recruited general and pediatric emergency medicine (EM) physicians, nurses, and patients/caregivers at two EDs. We performed qualitative content analysis on transcribed interviews using a specifically designed codebook. Codes were organized into categories, and we synthesized themes to identify opportunities for interventions.

Results:

We conducted semi-structured interviews with 10 physicians (5 general EM, 5 pediatric EM), 15 ED nurses, and 8 patients/caregivers. Table 1 displays participant quotes identifying vulnerabilities in the diagnostic process and opportunities for intervention. We categorized interventions under 1) communication 2) information gathering 3) ED organization and infrastructure 4) patient education and self-management and 5) electronic health record (EHR) use (Table 2). We identified 23 potential interventions of which 15 were care-team focused and 8 were patient focused.


Conclusion(s): Frontline provider and patient insights identified several interventions to improve ED diagnostic safety. Refining, implementing, and evaluating the efficacy of these interventions are required.