Feasibility of patient-reported diagnostic errors following emergency department discharge: a pilot study

Kelly T. Gleason; Susan Peterson; Cheryl R. Dennison Himmelfarb; Mariel Villanueva; Taylor Wynn; Paula Bondal; Daniel Berg; Welcome Jerde; David Newman-Toker

doi:10.1515/dx-2020-0014

Article

Feasibility of patient-reported diagnostic errors following emergency department discharge: a pilot study

Kelly T. Gleason , Susan Peterson , Cheryl R. Dennison Himmelfarb , Mariel Villanueva , Taylor Wynn , Paula Bondal , Daniel Berg , Welcome Jerde and David Newman-Toker

Published/Copyright: October 5, 2020

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From the journal Diagnosis Volume 8 Issue 2

Abstract

Objectives

The National Academy of Medicine identified diagnostic error as a pressing public health concern and defined failure to effectively communicate the diagnosis to patients as a diagnostic error. Leveraging Patient’s Experience to improve Diagnosis (LEAPED) is a new program for measuring patient-reported diagnostic error. As a first step, we sought to assess the feasibility of using LEAPED after emergency department (ED) discharge.

Methods

We deployed LEAPED using a cohort design at three EDs within one academic health system. We enrolled 59 patients after ED discharge and queried them about their health status and understanding of the explanation for their health problems at 2-weeks, 1-month, and 3-months. We measured response rates and demographic/clinical predictors of patient uptake of LEAPED.

Results

Of those enrolled (n=59), 90% (n=53) responded to the 2-week post-ED discharge questionnaire (1 and 3-month ongoing). Of the six non-responders, one died and three were hospitalized at two weeks. The average age was 50 years (SD 16) and 64% were female; 53% were white and 41% were black. Over a fifth (23%) reported they were not given an explanation of their health problem on leaving the ED, and of those, a fourth (25%) did not have an understanding of what next steps to take after leaving the ED.

Conclusions

Patient uptake of LEAPED was high, suggesting that patient-report may be a feasible method of evaluating the effectiveness of diagnostic communication to patients though further testing in a broader patient population is essential. Future research should determine if LEAPED yields important insights into the quality and safety of diagnostic care.

Keywords: diagnostic error; measurement; patient-reported outcome measures; patient engagement

Corresponding author: Kelly T. Gleason, RN, PhD, School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD, 21205, USA. Phone: +1 (708)334 4876, E-mail: kgleaso2@jhmi.edu

Funding source: U.S. Department of Health and Human Services

Funding source: National Institutes of Health

Funding source: National Center for Advancing Translational Sciences

Funding source: Institute of Clinical and Translational Research/Institutional Career Development Core/KL2 TR0030

Funding source: National Institute of Nursing Research Hopkins Center

Award Identifier / Grant number: P30NR019083

Research funding: U.S. Department of Health and Human Services, National Institutes of Health, National Center for Advancing Translational Sciences, Institute of Clinical and Translational Research/Institutional Career Development Core/KL2 TR0030. U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Nursing Research Hopkins Center to Promote Resilience in Persons and families living with multiple chronic conditions (the PROMOTE Center), P30NR019083.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: David Newman-Toker was supported by the Armstrong Institute Center for Diagnostic Excellence, Johns Hopkins University School of Medicine.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The Institutional Review Board approved this study (JHM IRB00202800).

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2020-0014).

Received: 2020-01-20

Accepted: 2020-07-22

Published Online: 2020-10-05

Published in Print: 2021-05-26

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Supplementary Material

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https://doi.org/10.1515/dx-2020-0014

Keywords for this article

diagnostic error; measurement; patient-reported outcome measures; patient engagement