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Licensed Unlicensed Requires Authentication Published by De Gruyter December 13, 2021

Evaluation of feedback modalities and preferences regarding feedback on decision-making in a pediatric emergency department

Jessica M.K. Graham, Lilliam Ambroggio, Jan E. Leonard, Sonja I. Ziniel and Joseph A. Grubenhoff
From the journal Diagnosis

Abstract

Objectives

To compare pediatric emergency clinicians’ attitudes toward three feedback modalities and assess clinicians’ case-based feedback preferences.

Methods

Electronic survey sent to pediatric emergency medicine (PEM) physicians and fellows; general pediatricians; and advanced practice providers (APPs) with nine questions exploring effectiveness and emotional impact of three feedback modalities: case-based feedback, bounce-back notifications, and biannual performance reports. Additional questions used a four-point ordinal agreement response scale and assessed clinicians’ attitudes toward case review notification, case-based feedback preferences, and emotional support. Survey responses were compared by feedback modality using Pearson’s chi-squared.

Results

Of 165 eligible providers, 93 (56%) responded. Respondents agreed that case-based feedback was timely (81%), actionable (75%), prompted reflection on decision-making (92%), prompted research on current clinical practice (53%), and encouraged practice change (58%). Pediatric Emergency Care Applied Research Network (PECARN) performance reports scored the lowest on all metrics except positive feedback. No more than 40% of providers indicated that any feedback modality provided emotional support. Regarding case-based feedback, 88% of respondents desired email notification before case review and 88% desired feedback after case review. Clinicians prefer receiving feedback from someone with similar or more experience/training. Clinicians receiving feedback desire succinctness, supporting evidence, consistency, and sensitive delivery.

Conclusions

Case-based feedback scored highest of the three modalities and is perceived to be the most likely to improve decision-making and promote practice change. Most providers did not perceive emotional support from any feedback modality. Emotional safety warrants purposeful attention in feedback delivery. Critical components of case-based feedback include succinctness, supporting evidence, consistency, and sensitive delivery.


Corresponding author: Jessica M.K. Graham, MD, Physician, Pediatric Emergency Medicine, Children’s Hospital of Colorado, Aurora, CO, USA; 13123 E 16th Avenue, Aurora, CO, 80045, E-mail:

Funding source: ELEVATE Fund for Pediatric Emergency Medicine, supported by The Children’s Hospital Colorado Foundationhttp://dx.doi.org/10.13039/100007180

Award Identifier / Grant number: 1802

Acknowledgments

Irina Topoz, M.D., Head of ED Case Review Committee. Lalit Bajaj, M.D., Children’s Hospital Colorado PECARN Hospital Emergency Department Affiliates (HEDA) Principal Investigator.

  1. Research funding: This project was funded by Grant Number: 1802. Elevate: The Children’s Hospital Colorado’s Level 1 Fund to Elevate Pediatric Emergency and Urgent Care, http://dx.doi.org/10.13039/100007180.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2021-0122).


Received: 2021-08-31
Accepted: 2021-11-17
Published Online: 2021-12-13

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