Introduction There is a growing emphasis on including patients' perspectives on outcomes as a measure of quality care. To date, this has been challenging in the emergency department (ED) setting. To better understand the root of this challenge, we looked to ED physicians' perspectives on their role, relationships and responsibilities to inform future development and implementation of patient-reported outcome measures (PROMs).
Methods ED physicians from hospitals across Canada were invited to participate in interviews using a snowballing sampling technique. Semistructured interviews were conducted by phone with questions focused on the role and practice of ED physicians, their relationship with their patients and their thoughts on patient-reported feedback as a mechanism for quality improvement. Transcripts were analysed using a modified constant comparative method and interpretive descriptive framework.
Results Interviews were completed with 30 individual physicians. Respondents were diverse in location, training and years in practice. Physicians reported being interested in ‘objective’ postdischarge information including adverse events, readmissions, other physicians’ notes, etc in a select group of complex patients, but saw ‘patient-reported’ feedback as less valuable due to perceived biases. They were unsure about the impact of such feedback mainly because of the episodic nature of their work. Concerns about timing, as well as about their legal and ethical responsibilities to follow-up if poor patient outcomes are reported, were raised.
Conclusions Data collection and feedback are key elements of a learning health system. While patient-reported outcomes may have a role in feedback, ED physicians are conflicted about the actionability of such data and ethical implications, given the inherently episodic nature of their work. These findings have important implications for PROM design and implementation in this unique clinical setting.
- Emergency department
- Qualitative research
- Audit and feedback
- Patient-centred care
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Contributors KND and MBS conceived of and designed the study, conducted the data collection and analysis and drafted the manuscript. AL, MS and SV contributed expertise to the design of the study, interpretation of the data and editing of the manuscript for submission.
Competing interests None declared.
Ethics approval St Michael's Research Ethics Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Unfortunately, the additional unpublished data related to this study are contained in confidential qualitative interview transcripts, and therefore are not available for sharing.
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