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. 2024 Jun 20;31(7):1503-1513.
doi: 10.1093/jamia/ocae112.

Pneumonia diagnosis performance in the emergency department: a mixed-methods study about clinicians' experiences and exploration of individual differences and response to diagnostic performance feedback

Jorie M Butler  1   2   3   4 , Teresa Taft  1 , Peter Taber  1   3 , Elizabeth Rutter  5 , Megan Fix  5 , Alden Baker  6 , Charlene Weir  1 , McKenna Nevers  7 , David Classen  7 , Karen Cosby  8 , Makoto Jones  3   7 , Alec Chapman  9 , Barbara E Jones  3   10
Affiliations

Pneumonia diagnosis performance in the emergency department: a mixed-methods study about clinicians' experiences and exploration of individual differences and response to diagnostic performance feedback

Jorie M Butler et al. J Am Med Inform Assoc. .

Abstract

Objectives: We sought to (1) characterize the process of diagnosing pneumonia in an emergency department (ED) and (2) examine clinician reactions to a clinician-facing diagnostic discordance feedback tool.

Materials and methods: We designed a diagnostic feedback tool, using electronic health record data from ED clinicians' patients to establish concordance or discordance between ED diagnosis, radiology reports, and hospital discharge diagnosis for pneumonia. We conducted semistructured interviews with 11 ED clinicians about pneumonia diagnosis and reactions to the feedback tool. We administered surveys measuring individual differences in mindset beliefs, comfort with feedback, and feedback tool usability. We qualitatively analyzed interview transcripts and descriptively analyzed survey data.

Results: Thematic results revealed: (1) the diagnostic process for pneumonia in the ED is characterized by diagnostic uncertainty and may be secondary to goals to treat and dispose the patient; (2) clinician diagnostic self-evaluation is a fragmented, inconsistent process of case review and follow-up that a feedback tool could fill; (3) the feedback tool was described favorably, with task and normative feedback harnessing clinician values of high-quality patient care and personal excellence; and (4) strong reactions to diagnostic feedback varied from implicit trust to profound skepticism about the validity of the concordance metric. Survey results suggested a relationship between clinicians' individual differences in learning and failure beliefs, feedback experience, and usability ratings.

Discussion and conclusion: Clinicians value feedback on pneumonia diagnoses. Our results highlight the importance of feedback about diagnostic performance and suggest directions for considering individual differences in feedback tool design and implementation.

Keywords: diagnosis; feedback; individual differences; sociotechnical; usability.

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Conflict of interest statement

Jorie M. Butler is a consultant for the University of California, San Francisco. This role is not related to any material in this article.

Figures

Figure 1.
Figure 1.
Agreement in initial and discharge pneumonia diagnosis in patients admitted ED clinician.
Figure 2.
Figure 2.
Agreement in initial and discharge pneumonia diagnosis in patients admitted by ED clinician.
Figure 3.
Figure 3.
Diagnostic Accuracy Assessment for Emergency Department. ED diagnoses of Pneumonia are shown in upper left, and discharge diagnoses in upper right. The Chest imaging in center displays the number of diagnoses confirmed/disconfirmed with chest imaging.
Figure 4.
Figure 4.
Individual beliefs and relationships to feedback comfort.
Figure 5.
Figure 5.
Individual beliefs and relationships to usability ratings.
See this image and copyright information in PMC

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