Frontline Providers and Patient's Perspectives on Improving Diagnostic Safety in the Emergency Department: A Qualitative Study

Background Few studies have described the insights of frontline healthcare providers and patients on how the diagnostic process can be improved in the emergency department (ED), a setting at high risk for diagnostic errors. We aimed to identify the perspectives of providers and patients on the diagnostic process and identify potential interventions to improve diagnostic safety. Methods We conducted semi-structured interviews with 10 ED physicians, 15 ED nurses, and 9 patients/caregivers at two separate health systems. Interview questions were guided by the ED-Adapted National Academies of Sciences, Engineering, and Medicine Diagnostic Process Framework and explored participant perspectives on the ED diagnostic process, identified vulnerabilities, and solicited interventions to improve diagnostic safety. We performed qualitative thematic analysis on transcribed interviews. Results We categorized vulnerabilities in the diagnostic process and intervention opportunities based on the ED-Adapted framework into five domains: (1) Team Dynamics and Communication (e.g., suboptimal communication between referring physicians and the ED team); (2) Information Gathering Related to Patient Presentation (e.g., obtaining the history from the patients or their caregivers; *(3) ED Organization, System, and Processes (e.g., staff schedules and handoffs); (4) Patient Education and Self-management (e.g., patient education at discharge from the ED); and (5) Electronic Health Record and Patient Portal Use (e.g., automatic release of test results into the patient portal). We identified 33 potential interventions, of which 17 were provider focused and 16 were patient focused. Conclusion Frontline providers and patients identified several vulnerabilities and potential interventions to improve ED diagnostic safety. Refining, implementing, and evaluating the efficacy of these interventions is required.