Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Diagnostic testing is an integral component of patient evaluation in the emergency department (ED). Emergency clinicians frequently use diagnostic testing to more confidently exclude "worst-case" diagnoses rather than to determine the most likely etiology for a presenting complaint. Increased utilization of diagnostic testing has not been associated with reductions in disease-related mortality but has led to increased overall healthcare costs and other unintended consequences (e.g., incidental findings requiring further workup, unnecessary exposure to ionizing radiation or potentially nephrotoxic contrast). ⋯ This article introduces the challenges and opportunities associated with incorporating SDM into emergency care by summarizing the conclusions of the diagnostic testing group at the 2016 Academic Emergency Medicine Consensus Conference on SDM. Three primary domains emerged: 1) characteristics of a condition or test appropriate for SDM, 2) critical elements of and potential barriers to SDM discussions on diagnostic testing, and 3) financial aspects of SDM applied to diagnostic testing. The most critical research questions to improve engagement of patients in their acute care diagnostic decisions were determined by consensus.
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The Society for Academic Emergency Medicine (SAEM) consensus conference provided many platforms for patient advocates to share their experiences and demonstrate the powerful contribution they have to offer to the decision-making process. One such platform was the presentation of a film "The Faces of Medical Error: From Tears to Transparency," shared by Patricia (Patty) and David Skolnik. In this article the Skolniks build on their story shared at the SAEM consensus conference and panel discussion. They provide further insight drawn from 9 years of experience as advocates for patient safety, including their reflections on working with, training, and educating medical professionals, lawmakers, and consumers in shared decision making and informed consent.
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Shared decision making (SDM) is essential to advancing patient-centered care in emergency medicine. Despite many documented benefits of SDM, prior research has demonstrated persistently low levels of patient engagement by clinicians across many disciplines, including emergency medicine. An effective dissemination and implementation (D&I) framework could be used to alter the process of delivering care and to facilitate SDM in routine clinical emergency medicine practice. Here we outline a research and policy agenda to support the D&I strategy needed to integrate SDM into emergency care.