Patient and care partner assessments of diagnostic excellence in the emergency department: A cognitive interview study
Background: Diagnostic excellence encompasses both receiving an accurate and timely explanation of a health problem that was communicated well, and the process it took to get to the correct diagnosis. Directly eliciting patients’ perceptions of their diagnostic experience and outcomes after emergenc...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | International Journal of Nursing Studies Advances |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666142X23000139 |
| _version_ | 1797401719397679104 |
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| author | Aaron A. Wiegand Vadim Dukhanin Natalia Gonzalez Kathryn M. McDonald Susan Peterson Kelly T Gleason |
| author_facet | Aaron A. Wiegand Vadim Dukhanin Natalia Gonzalez Kathryn M. McDonald Susan Peterson Kelly T Gleason |
| author_sort | Aaron A. Wiegand |
| collection | DOAJ |
| description | Background: Diagnostic excellence encompasses both receiving an accurate and timely explanation of a health problem that was communicated well, and the process it took to get to the correct diagnosis. Directly eliciting patients’ perceptions of their diagnostic experience and outcomes after emergency visits is a promising method of assessing diagnostic excellence. However, little is known about how patients interpret and respond to questions about their diagnostic experiences and outcomes. Objective: To analyze patient and care partners’ interpretation of questions capturing patient-reported diagnostic excellence in emergency settings. Design: Cognitive interviews using think-aloud and probing methods. Setting(s): Interviews were conducted virtually and via phone calls. Participants were patients or care partners of patients recently discharged from three emergency departments within a single academic health system in the Mid-Atlantic region of the US. Participants: 15 patients and care partners, 18 years or older, with recent emergency department experiences. Methods: Qualitative analysis using a deductive approach was used to code transcripts and analyze participant responses to Patient-Report to Improve Diagnostic Excellence in Emergency Department (PRIME-ED) questionnaire items. Themes of patient and care partners’ questionnaire interpretations are presented descriptively. Results: 80% of participants were female, 47% were between the ages of 18–24 years, 47% of participants were White, and 7% were Hispanic/Latino. Participants shared their interpretations of diagnostic excellence following PRIME-ED domains: diagnostic accuracy and care team skills, their comprehension of the diagnosis, provider communication of uncertainty, and quality of diagnostic communication, including whether they felt the care team communicated well, adapted communication to their needs, listened and took concerns seriously, treated them as an equal, and provided clear, sufficient, and functional communication about follow-up steps. Responses indicated that patients and care partners can identify diagnostic errors, rationalize why their diagnosis was inaccurate, and assess whether diagnostic excellence was achieved. Respondents identified factors that contributed to their assessments of diagnostic accuracy and the quality of diagnostic communication. The quality of diagnostic communication contributed to patient perception of diagnostic accuracy and understanding of the diagnosis. Conclusions: Patient report is a useful tool for assessing diagnostic excellence in emergency settings. Our patient and care partners describe how they assess diagnostic excellence in the emergency department.Registration: N/A.Tweetable abstract: Patients and care partners provide accessible and useful information to assess diagnostic practices and diagnostic excellence in emergency departments. |
| first_indexed | 2024-03-09T02:14:10Z |
| format | Article |
| id | doaj.art-d90bd973220a4baa8605bd38b5d39aeb |
| institution | Directory Open Access Journal |
| issn | 2666-142X |
| language | English |
| last_indexed | 2024-03-09T02:14:10Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Nursing Studies Advances |
| spelling | doaj.art-d90bd973220a4baa8605bd38b5d39aeb2023-12-07T05:30:26ZengElsevierInternational Journal of Nursing Studies Advances2666-142X2023-12-015100129Patient and care partner assessments of diagnostic excellence in the emergency department: A cognitive interview studyAaron A. Wiegand0Vadim Dukhanin1Natalia Gonzalez2Kathryn M. McDonald3Susan Peterson4Kelly T Gleason5Johns Hopkins University School of Nursing, Baltimore, MD, United States of America; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of AmericaDepartment of Health Policy Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of AmericaJohns Hopkins University, Baltimore, MD, United States of AmericaJohns Hopkins University School of Nursing, Baltimore, MD, United States of America; Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of AmericaDepartment of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of AmericaJohns Hopkins University School of Nursing, Baltimore, MD, United States of America; Corresponding author at: 525 N. Wolfe Street, Baltimore, MD 21205.Background: Diagnostic excellence encompasses both receiving an accurate and timely explanation of a health problem that was communicated well, and the process it took to get to the correct diagnosis. Directly eliciting patients’ perceptions of their diagnostic experience and outcomes after emergency visits is a promising method of assessing diagnostic excellence. However, little is known about how patients interpret and respond to questions about their diagnostic experiences and outcomes. Objective: To analyze patient and care partners’ interpretation of questions capturing patient-reported diagnostic excellence in emergency settings. Design: Cognitive interviews using think-aloud and probing methods. Setting(s): Interviews were conducted virtually and via phone calls. Participants were patients or care partners of patients recently discharged from three emergency departments within a single academic health system in the Mid-Atlantic region of the US. Participants: 15 patients and care partners, 18 years or older, with recent emergency department experiences. Methods: Qualitative analysis using a deductive approach was used to code transcripts and analyze participant responses to Patient-Report to Improve Diagnostic Excellence in Emergency Department (PRIME-ED) questionnaire items. Themes of patient and care partners’ questionnaire interpretations are presented descriptively. Results: 80% of participants were female, 47% were between the ages of 18–24 years, 47% of participants were White, and 7% were Hispanic/Latino. Participants shared their interpretations of diagnostic excellence following PRIME-ED domains: diagnostic accuracy and care team skills, their comprehension of the diagnosis, provider communication of uncertainty, and quality of diagnostic communication, including whether they felt the care team communicated well, adapted communication to their needs, listened and took concerns seriously, treated them as an equal, and provided clear, sufficient, and functional communication about follow-up steps. Responses indicated that patients and care partners can identify diagnostic errors, rationalize why their diagnosis was inaccurate, and assess whether diagnostic excellence was achieved. Respondents identified factors that contributed to their assessments of diagnostic accuracy and the quality of diagnostic communication. The quality of diagnostic communication contributed to patient perception of diagnostic accuracy and understanding of the diagnosis. Conclusions: Patient report is a useful tool for assessing diagnostic excellence in emergency settings. Our patient and care partners describe how they assess diagnostic excellence in the emergency department.Registration: N/A.Tweetable abstract: Patients and care partners provide accessible and useful information to assess diagnostic practices and diagnostic excellence in emergency departments.http://www.sciencedirect.com/science/article/pii/S2666142X23000139Cognitive interviewDiagnostic errorsDiagnostic excellenceEmergency serviceMedical errorsPatient reported measures |
| spellingShingle | Aaron A. Wiegand Vadim Dukhanin Natalia Gonzalez Kathryn M. McDonald Susan Peterson Kelly T Gleason Patient and care partner assessments of diagnostic excellence in the emergency department: A cognitive interview study International Journal of Nursing Studies Advances Cognitive interview Diagnostic errors Diagnostic excellence Emergency service Medical errors Patient reported measures |
| title | Patient and care partner assessments of diagnostic excellence in the emergency department: A cognitive interview study |
| title_full | Patient and care partner assessments of diagnostic excellence in the emergency department: A cognitive interview study |
| title_fullStr | Patient and care partner assessments of diagnostic excellence in the emergency department: A cognitive interview study |
| title_full_unstemmed | Patient and care partner assessments of diagnostic excellence in the emergency department: A cognitive interview study |
| title_short | Patient and care partner assessments of diagnostic excellence in the emergency department: A cognitive interview study |
| title_sort | patient and care partner assessments of diagnostic excellence in the emergency department a cognitive interview study |
| topic | Cognitive interview Diagnostic errors Diagnostic excellence Emergency service Medical errors Patient reported measures |
| url | http://www.sciencedirect.com/science/article/pii/S2666142X23000139 |
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