Iserson Kenneth V
Department of Emergency Medicine The University of Arizona Tucson AZ USA.
AEM Educ Train. 2020 Jul 6;4(4):395-402. doi: 10.1002/aet2.10489. eCollection 2020 Oct.
Emergency physicians (EPs) often lack the information they need about their patients' outcomes so that they can both optimally adjust and refine their diagnostic and treatment processes and recognize their clinical errors. Patient-outcome feedback (POF) provides that information by informing clinicians about a patient's clinical course after that clinician's evaluation and treatment. This feedback may encompass the period after the EP has transferred a patient's care to another EP or after the patient has left the ED or hospital. EPs obtain POF through various and methods, depending on their institutional and medical record systems. Active methods require that clinicians or others spend time and effort acquiring the information; passive methods deliver it automatically. POF is an excellent performance-based measurement that helps clinicians to stimulate their learning and to build their own validated mental library of outcomes with which to make clinical decisions, i.e., heuristics and System 1 thinking. POF offers especially useful feedback about patients who have been admitted, were referred to specialists, had major interventions, had potentially significant tests pending on discharge, or were handed off to another EP. The current health care system makes it difficult for EPs to discover their patients' outcomes, squandering significant educational opportunities. Three stimuli to improve this situation would be to require EPs to receive passive POF as part of hospital accreditation, for reviewing POF to be classified as a Category 1 Continuing Medical Education activity, and to reimburse clinicians for learning activities related to POF. Research indicates that our health care institutions and systems would be well served to provide clinicians with ongoing automatic information about their patients' outcomes.
急诊医生（EPs）常常缺乏有关患者治疗结果的所需信息，以便他们既能最佳地调整和完善诊断及治疗流程，又能识别自身的临床失误。患者治疗结果反馈（POF）通过向临床医生通报该医生评估和治疗后患者的临床病程来提供此类信息。这种反馈可能涵盖急诊医生将患者护理转交给另一位急诊医生之后，或者患者离开急诊科或医院之后的时间段。急诊医生通过各种不同的方法获取患者治疗结果反馈，这取决于他们所在机构的情况和病历系统。主动方法要求临床医生或其他人花费时间和精力去获取信息；被动方法则自动提供信息。患者治疗结果反馈是一种基于表现的出色衡量方式，有助于临床医生促进自身学习，并建立自己经过验证的结果心理库，以此来做出临床决策，即启发式方法和系统1思维。患者治疗结果反馈对于已入院、被转诊至专科医生处、接受了重大干预、出院时有待进行可能具有重大意义的检查或者被转交给另一位急诊医生的患者提供了特别有用的反馈。当前的医疗保健系统使得急诊医生难以了解其患者的治疗结果，从而浪费了大量的教育机会。改善这种状况的三种刺激措施分别是：要求急诊医生将接受被动患者治疗结果反馈作为医院认证的一部分；将审查患者治疗结果反馈归类为第1类继续医学教育活动；以及为与患者治疗结果反馈相关的学习活动向临床医生提供报销。研究表明，为临床医生提供有关其患者治疗结果的持续自动信息，将对我们的医疗保健机构和系统大有裨益。
