Bridging the feedback gap: a sociotechnical approach to informing clinicians of patients' subsequent clinical course and outcomes.

To improve their diagnosis and management skills, clinicians need consistent, timely and accurate feedback. Feedback helps clinicians become better calibrated, leading to more appropriate clinical decisions. Miscalibration—when clinicians’ confidence in the accuracy of their decisions does not align with their actual accuracy—may lead to overconfidence and diagnostic error.1 Consistent structured feedback leads to improved outcomes such as accurate diagnosis of acute chest pain,2 improved prehospital emergency care3 and lower costs of hospitalisation.4 Despite its benefits, significant gaps exist in delivering feedback to clinicians. In particular, clinicians do not consistently receive patient outcome feedback, that is, information on the subsequent clinical course and outcomes of patients that they have diagnosed and treated. For example, emergency department (ED) physicians in Canada reported receiving outcome feedback on only 15% of cases they encountered.5 Among US internal medicine residents, 58% reported almost never or only sometimes ultimately learning about their patients’ outcomes.6 Scientific knowledge on how to effectively provide clinicians with patient outcome feedback is underdeveloped. In contrast with traditional audit and feedback where clinicians receive aggregated metrics of clinical performance compared against explicit standards,7 patient outcome feedback provides clinicians with objective clinical information on their patient’s eventual diagnoses, treatment and clinical course. Rather than conferring black-and-white external judgements, patient outcome feedback provides clinicians with narratives regarding what happened to the patients they treated, which are crucial data for self-evaluation of clinical performance. Developing effective feedback pathways is difficult. Fragmented healthcare systems with organisational and regulatory barriers, such as seen in the USA, make feedback-related information flow challenging. Even integrated healthcare networks such as the US Veterans Affairs health system8 and those in other countries, like the UK, Australia and Canada, only have sporadic disease-specific feedback programmes.9 To our knowledge, none of these systems have …