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.
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
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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.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: David Newman-Toker was supported by the Armstrong Institute Center for Diagnostic Excellence, Johns Hopkins University School of Medicine.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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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).
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