Would you have done something differently? A novel marker for improving emergency care

Area of Science:

• Healthcare Quality Improvement
• Emergency Medicine
• Patient Safety

Background:

• Traditional healthcare quality reviews often lack value, reacting to behavior rather than systemic processes.
• There's a need for proactive markers to enhance patient care within healthcare systems.

Purpose of the Study:

• To assess if the "would have done something differently" (WYHDSD) question can serve as a valuable marker for improving emergency department (ED) patient care processes.
• To evaluate the utility of physician self-reflection in quality assurance.

Main Methods:

• Prospective data collection from an academic medical center ED (55,000 annual visits) over four years.
• Review of specific patient cases (e.g., return visits, ICU transfers, deaths, complaints) using a structured electronic tool.
• Physician reviewers, not involved in patient care, were mandated to answer WYHDSD and provide narrative details if affirmative.

Main Results:

• Out of 6773 reviewed cases, 815 prompted a "would have done something differently" response.
• In 297 cases, reviewers indicated they would have acted differently despite no identified errors or adverse events.
• The majority (261/297) of these WYHDSD responses were linked to communication, data acquisition, systems issues, or knowledge gaps.

Conclusions:

• The WYHDSD question shows potential as a quality marker in EDs.
• This method can identify areas for improvement in patient care systems, even when standard reviews find no errors or adverse events.
• Focusing on physician self-reflection can uncover critical system-level issues for enhanced patient safety.