Objective: Lack of empathic communication between providers and patients may contribute to low va... more Objective: Lack of empathic communication between providers and patients may contribute to low value diagnostic testing in emergency care. Accordingly, we measured the perception of physician empathy and trust in patients undergoing low-value computed tomography (CT) in the emergency department (ED). Methods: Multicenter study of ED patients undergoing CT scanning, acknowledged by ordering physicians as unlikely to show an emergent condition. Near the end of their visit, patients completed the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE), Trust in Physicians Survey (TIPS), and the Group Based Medical Mistrust Scale (GBMMS). We stratified results by patient demographics including gender, race, and education. Results: We enrolled 305 participants across 9 sites with diverse geographic, racial, and ethnic representation. The median scores (interquartile ranges) for the JSPPPE, TIPS, and GBMMS for all patients were 29 (24-33.5), 55 (47-62), and 18 (12-29). Compare...
We assessed emergency department (ED) patient perceptions of how physicians can improve their lan... more We assessed emergency department (ED) patient perceptions of how physicians can improve their language to determine patient preferences for 11 phrases to enhance physician empathy toward the goal of reducing low-value advanced imaging. Multi-center survey study of low-risk ED patients undergoing computerized tomography (CT) scanning. We enroled 305 participants across nine sites. The statement "I have carefully considered what you told me about what brought you here today" was most frequently rated as important (88%). The statement "I have thought about the cost of your medical care to you today" was least frequently rated as important (59%). Participants preferred statements indicating physicians had considered their "vital signs and physical examination" (86%), "past medical history" (84%), and "what prior research tells me about your condition" (79%). Participants also valued statements conveying risks of testing, including potent...
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Aug 4, 2017
Disparities in diagnosis and treatment of racial minorities exist in the emergency department (ED... more Disparities in diagnosis and treatment of racial minorities exist in the emergency department (ED). A better understanding of how physician implicit (unconscious) bias contributes to these disparities may help identify ways to eliminate such racial disparities. The objective of this systematic review was to examine and summarize the evidence on the association between physician implicit racial bias and clinical decision making. Based on PRISMA guidelines, a structured electronic literature search of PubMed, CINAHL, Scopus, and PsycINFO databases was conducted. Eligible studies were those that: 1) Included physicians; 2) Included the Implicit Association Test as a measure of implicit bias; 3) Included an assessment of physician clinical decision making; and 4) Were published in peer reviewed journals between 1998 and 2016. Articles were reviewed for inclusion by two independent investigators. Data extraction was performed by one investigator and checked for accuracy by a second inves...
Emergency department (ED) overcrowding remains a growing concern despite continued efforts by hos... more Emergency department (ED) overcrowding remains a growing concern despite continued efforts by hospitals to improve efficiency while also maintaining quality of care and medical education. The purpose of this study was to examine whether the total number of trainees rotating in the ED affects length of stay (LOS). This was a single-center study conducted at an urban university teaching hospital and level I trauma center that averages 65,000 adult ED visits per year. Data were collected retrospectively during a 13-month period from September 2012 to September 2013. The mean daily LOS was generated by the hospital's electronic medical record system, and the total number of trainees (medical students, postgraduate year-1 students/interns, and nurse practitioners) rotating in the ED each day was collected from monthly shift calendars. Correlations were used to examine the relation between LOS and number of trainees rotating in the ED. Independent sample t tests were conducted to comp...
The emergency medicine milestones were developed to provide more objective resident assessment th... more The emergency medicine milestones were developed to provide more objective resident assessment than current methods. However, little is known about the best practices for applying the milestones in resident assessment. We examined the utility of end-of-shift evaluations (ESEs) constructed using the milestones in resident assessment. We developed 14 daily ESEs, each of which included 9 or 10 emergency medicine milestones. Postgraduate year (PGY)-1 and PGY-2 residents were assessed on milestone levels 1 through 3; PGY-3 and PGY-4 residents were assessed on levels 3 through 5. Each milestone was rated on a nominal scale (yes, no, or not applicable). The Clinical Competency Committee combined the ESE data with data from other assessments to determine each resident's proficiency level for the emergency medicine subcompetencies. We used descriptive statistics to summarize resident ESEs and milestone levels. We analyzed differences in ESE score across PGY levels using t tests and analy...
Objective: Lack of empathic communication between providers and patients may contribute to low va... more Objective: Lack of empathic communication between providers and patients may contribute to low value diagnostic testing in emergency care. Accordingly, we measured the perception of physician empathy and trust in patients undergoing low-value computed tomography (CT) in the emergency department (ED). Methods: Multicenter study of ED patients undergoing CT scanning, acknowledged by ordering physicians as unlikely to show an emergent condition. Near the end of their visit, patients completed the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE), Trust in Physicians Survey (TIPS), and the Group Based Medical Mistrust Scale (GBMMS). We stratified results by patient demographics including gender, race, and education. Results: We enrolled 305 participants across 9 sites with diverse geographic, racial, and ethnic representation. The median scores (interquartile ranges) for the JSPPPE, TIPS, and GBMMS for all patients were 29 (24-33.5), 55 (47-62), and 18 (12-29). Compare...
We assessed emergency department (ED) patient perceptions of how physicians can improve their lan... more We assessed emergency department (ED) patient perceptions of how physicians can improve their language to determine patient preferences for 11 phrases to enhance physician empathy toward the goal of reducing low-value advanced imaging. Multi-center survey study of low-risk ED patients undergoing computerized tomography (CT) scanning. We enroled 305 participants across nine sites. The statement "I have carefully considered what you told me about what brought you here today" was most frequently rated as important (88%). The statement "I have thought about the cost of your medical care to you today" was least frequently rated as important (59%). Participants preferred statements indicating physicians had considered their "vital signs and physical examination" (86%), "past medical history" (84%), and "what prior research tells me about your condition" (79%). Participants also valued statements conveying risks of testing, including potent...
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Aug 4, 2017
Disparities in diagnosis and treatment of racial minorities exist in the emergency department (ED... more Disparities in diagnosis and treatment of racial minorities exist in the emergency department (ED). A better understanding of how physician implicit (unconscious) bias contributes to these disparities may help identify ways to eliminate such racial disparities. The objective of this systematic review was to examine and summarize the evidence on the association between physician implicit racial bias and clinical decision making. Based on PRISMA guidelines, a structured electronic literature search of PubMed, CINAHL, Scopus, and PsycINFO databases was conducted. Eligible studies were those that: 1) Included physicians; 2) Included the Implicit Association Test as a measure of implicit bias; 3) Included an assessment of physician clinical decision making; and 4) Were published in peer reviewed journals between 1998 and 2016. Articles were reviewed for inclusion by two independent investigators. Data extraction was performed by one investigator and checked for accuracy by a second inves...
Emergency department (ED) overcrowding remains a growing concern despite continued efforts by hos... more Emergency department (ED) overcrowding remains a growing concern despite continued efforts by hospitals to improve efficiency while also maintaining quality of care and medical education. The purpose of this study was to examine whether the total number of trainees rotating in the ED affects length of stay (LOS). This was a single-center study conducted at an urban university teaching hospital and level I trauma center that averages 65,000 adult ED visits per year. Data were collected retrospectively during a 13-month period from September 2012 to September 2013. The mean daily LOS was generated by the hospital's electronic medical record system, and the total number of trainees (medical students, postgraduate year-1 students/interns, and nurse practitioners) rotating in the ED each day was collected from monthly shift calendars. Correlations were used to examine the relation between LOS and number of trainees rotating in the ED. Independent sample t tests were conducted to comp...
The emergency medicine milestones were developed to provide more objective resident assessment th... more The emergency medicine milestones were developed to provide more objective resident assessment than current methods. However, little is known about the best practices for applying the milestones in resident assessment. We examined the utility of end-of-shift evaluations (ESEs) constructed using the milestones in resident assessment. We developed 14 daily ESEs, each of which included 9 or 10 emergency medicine milestones. Postgraduate year (PGY)-1 and PGY-2 residents were assessed on milestone levels 1 through 3; PGY-3 and PGY-4 residents were assessed on levels 3 through 5. Each milestone was rated on a nominal scale (yes, no, or not applicable). The Clinical Competency Committee combined the ESE data with data from other assessments to determine each resident's proficiency level for the emergency medicine subcompetencies. We used descriptive statistics to summarize resident ESEs and milestone levels. We analyzed differences in ESE score across PGY levels using t tests and analy...
Uploads
Papers by Erin Dehon