The effect of feedback on the diagnostic process of physicians at the emergency department: a systematic review

In the emergency department (ED), the diagnostic process is complex. Discrepancies between the initial diagnosis in the ED and the final discharge diagnosis occur in 12-15%. Emergency physicians are often unaware of these discrepancies. Systematic feedback could serve as a valuable tool to enhance the diagnostic process. The potential methods and impact of such feedback remain poorly understood. This systematic review (PROSPERO: CRD42024491077) aimed to obtain insight into the types and timing of feedback provided to ED physicians about the diagnostic process and examined the effect on ED physicians' performance and confidence. Studies were included if they examined feedback on the diagnostic process to physicians in the ED. Five large international databases (MEDLINE, EMBASE, Cochrane libraries, Google Scholar, and Web of Science) were searched. Quality assessment was performed using Grading of Recommendations Assessment, Development and Evaluation. In total 1897 articles were screened, of which 11 were included in this review. Most of them were qualified as low-grade evidence. Feedback was given through in-person sessions, monthly group meetings, rapid diagnostic discussions, and computer-based feedback. Six studies reported feedback methods to improve diagnostic accuracy. Furthermore, reduction of adverse outcomes after feedback introduction was reported by two articles. Confidence was reported in one study. This review showed that - although there were few studies and generally of low quality - structured feedback may positively influence the diagnostic performance of ED physicians. The feedback strategies identified in this review could be used for future studies on their effectiveness. Furthermore, rigorous study designs, standardized outcome measures, and scalable feedback methods are needed.