New Tool Identifies Patient Uncertainty That Might Lead to Return ED Visits

Uncertainty is a key reason why patients who are discharged may return to the emergency department (ED). A new paper in the Journal of Health Psychology highlighted a way to measure patient uncertainty to predict which patients might return to the ED.

According to study co-author Kristin Rising, MD, director of Acute Care Transitions and associate professor of Emergency Medicine at Jefferson (Philadelphia University + Thomas Jefferson University), having a way to predict which patients might end up back in the ED would make it easier to assist them with safer transitions back home after the first ED visit.

“As a field, we’ve had difficulty finding an approach that consistently works to identify and address individual patient needs,” she said in a statement. “The Uncertainty Scale we developed gives us a tool to help do that.”

The Uncertainty Scale, or the U-Scale, was developed by psychologists and other experts based on direct patient input and listening sessions. The researchers worked with 2 groups of about 20 individuals each who had been to the ED recently, and the patients highlighted what types of uncertainty people have after discharge related to their symptoms that may make them go back to the ED.

Themes that emerged from these discussions included:

• Concern about lack of a diagnosis, thus leaving a patient with no satisfying explanation for their symptoms
• Lack of clarity regarding self-management and how to deal with symptoms at home
• Lack of clarity about when symptoms might be a sign of disease worsening and the patient should seek additional care
• Psychosocial factors, including worries that getting medical care might interfere with home and work commitments.

The paper’s lead author, Marianna LaNoue, PhD, associate professor of Family and Community Medicine and the Jefferson College of Population Health, noted that these discussions with patients made it clear that “uncertainty about quality of treatment was potentially associated with a return emergency department visit.”

According to Rising, the research has led her to understand the importance of acknowledging and validating patient struggles related to ongoing uncertainty, especially in instances where tests are normal and a patient’s symptoms are not life-threatening.

“If a patient comes in with a problem and I tell him that testing is normal, and I haven’t found a cause of his symptoms, it might give momentary relief, but that patient still is no closer to understanding what is causing his distress,” Rising said. “It’s not all good news, and we have to acknowledge that we have not improved patients’ sense of uncertainty about their disease with this news.”

The next step for the U-Scale is to use it in diverse populations for continued refinement and validation and to test interventions to alleviate different categories of uncertainty.

Reference

LaNoue MD, Gerolamo AM, Powell R, Nord G, Doty AMB, Rising KL. Development and preliminary validation of a scale to measure patient uncertainty: the “Uncertainty Scale” [published online January 29, 2018]. J Health Psychol. doi: 10.1177/1359105317752827.