Kotwal Susrutha, Udayappan Karthik Meiyappan, Kutheala Nikhil, Washburn Catherine, Morga Caitlin, Grieb Suzanne M, Wright Scott M, Dhaliwal Gurpreet
Department of Medicine, Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, MFL Building East Tower, 2nd Floor CIMS Suite, 5200 Eastern Avenue, Baltimore, MD, 21224, USA.
Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
J Gen Intern Med. 2024 Dec;39(16):3271-3277. doi: 10.1007/s11606-024-09058-1. Epub 2024 Sep 30.
Feedback on the diagnostic process has been proposed as a method of improving clinical reasoning and reducing diagnostic errors. Barriers to the delivery and receipt of feedback include time constraints and negative reactions. Given the shift toward asynchronous, digital communication, it is possible that electronic feedback ("e-feedback") could overcome these barriers.
We developed an e-feedback system for hospitalists around episodes of care escalation (transfers to ICU and rapid responses). The intervention was evaluated by measuring hospitalists' satisfaction with e-feedback and commitment to change.
A qualitative survey study conducted at one academic medical center from February to June 2023.
Hospitalists - physicians and advanced practice providers.
Two hospitalists, one internal medicine resident, and a nurse reviewed escalations of care on the hospitalist service each week using the Revised Safer Dx framework. Confidential feedback was emailed to the hospitalists involved in the patient's care. Hospitalists were asked to rate and explain their satisfaction with the e-feedback and whether they might modify their clinical practice based on the e-feedback. The open-ended text comments from the hospitalists were analyzed using a thematic analysis framework.
Forty-nine out of fifty-eight hospitalists agreed to participate. One hundred five out of one hundred twenty-four (85%) e-feedback surveys that were sent were returned by the hospitalists. Hospitalists were highly satisfied with 67% (n = 70) of the e-feedback reports, moderately satisfied with 23% (n = 24), and not satisfied with 10% (n = 11). Six themes were identified based on analysis of the comments. Themes related to satisfaction with the intervention included appreciation for learning about patient outcomes, general appreciation of feedback on clinical care, and importance of detailed and specific feedback. Themes related to changing clinical practice included reflection on clinical decision-making, value of new insights, and anticipated future behavior change.
E-feedback was well received by hospitalists. Their perspectives offer useful insights for enhancing electronic feedback interventions.
有人提出，对诊断过程的反馈是一种改善临床推理和减少诊断错误的方法。反馈的提供和接收存在诸多障碍，包括时间限制和负面反应。鉴于向异步数字通信的转变，电子反馈（“电子反馈”）有可能克服这些障碍。
我们为住院医师开发了一个围绕护理升级事件（转至重症监护病房和快速反应）的电子反馈系统。通过衡量住院医师对电子反馈的满意度和改变的意愿来评估该干预措施。
2023年2月至6月在一家学术医疗中心进行的定性调查研究。
住院医师——医生和高级实践提供者。
两名住院医师、一名内科住院医师和一名护士每周使用修订后的更安全诊断框架审查住院医师服务中的护理升级情况。保密反馈通过电子邮件发送给参与患者护理的住院医师。要求住院医师对电子反馈的满意度进行评分并解释原因，以及他们是否可能根据电子反馈改变其临床实践。使用主题分析框架对住院医师的开放式文本评论进行分析。
58名住院医师中有49名同意参与。发送的124份电子反馈调查问卷中有105份（85%）被住院医师返回。住院医师对67%（n = 70）的电子反馈报告高度满意，23%（n = 24）中度满意，10%（n = 11）不满意。通过对评论的分析确定了六个主题。与对干预措施的满意度相关的主题包括对了解患者结果的感激、对临床护理反馈的总体感激以及详细和具体反馈的重要性。与改变临床实践相关的主题包括对临床决策的反思、新见解的价值以及预期的未来行为改变。
住院医师对电子反馈的接受度很高。他们的观点为加强电子反馈干预提供了有用的见解。
