• Susrutha Kotwal, Karthik Meiyappan Udayappan, Nikhil Kutheala, Catherine Washburn, Caitlin Morga, Suzanne M Grieb, Scott M Wright, and Gurpreet Dhaliwal.
• Department of Medicine, Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, MFL Building East Tower, 2nd Floor CIMS Suite, 5200 Eastern Avenue, Baltimore, MD, 21224, USA. Skotwal1@jhmi.edu.
• J Gen Intern Med. 2024 Sep 30.

BackgroundFeedback on the diagnostic process has been proposed as a method of improving clinical reasoning and reducing diagnostic errors. Barriers to the delivery and receipt of feedback include time constraints and negative reactions. Given the shift toward asynchronous, digital communication, it is possible that electronic feedback ("e-feedback") could overcome these barriers.ObjectivesWe developed an e-feedback system for hospitalists around episodes of care escalation (transfers to ICU and rapid responses). The intervention was evaluated by measuring hospitalists' satisfaction with e-feedback and commitment to change.DesignA qualitative survey study conducted at one academic medical center from February to June 2023.ParticipantsHospitalists - physicians and advanced practice providers.ApproachTwo hospitalists, one internal medicine resident, and a nurse reviewed escalations of care on the hospitalist service each week using the Revised Safer Dx framework. Confidential feedback was emailed to the hospitalists involved in the patient's care. Hospitalists were asked to rate and explain their satisfaction with the e-feedback and whether they might modify their clinical practice based on the e-feedback. The open-ended text comments from the hospitalists were analyzed using a thematic analysis framework.ResultsForty-nine out of fifty-eight hospitalists agreed to participate. One hundred five out of one hundred twenty-four (85%) e-feedback surveys that were sent were returned by the hospitalists. Hospitalists were highly satisfied with 67% (n = 70) of the e-feedback reports, moderately satisfied with 23% (n = 24), and not satisfied with 10% (n = 11). Six themes were identified based on analysis of the comments. Themes related to satisfaction with the intervention included appreciation for learning about patient outcomes, general appreciation of feedback on clinical care, and importance of detailed and specific feedback. Themes related to changing clinical practice included reflection on clinical decision-making, value of new insights, and anticipated future behavior change.ConclusionsE-feedback was well received by hospitalists. Their perspectives offer useful insights for enhancing electronic feedback interventions.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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