U.S. hospital study finds patient uncertainty a common cause for repeat ED visits

Philadelphia-based Jefferson University Hospital researchers developed a tool called the Uncertainty Scale (U-Scale) to understand the role uncertainty plays in ED readmissions. The tool, based on patient input, stems from a mapping exercise on what types of uncertainty people have when they are experiencing symptoms that may result in an ED visit. Some of the major themes or categories that emerged were:

• Concern over treatment quality, which may lead a patient to return in hopes of a second opinion;
• Concern about lack of a diagnosis, thus leaving a patient with no satisfying explanation for their symptoms;
• Lack of clarity regarding self-management, such that patients are unsure how to deal with symptoms at home;
• Lack of self-efficacy, manifesting as patients not knowing where to go for help for certain symptoms;
• Lack of clarity about the decision to seek care, meaning that patients do not know which symptoms are serious enough to warrant seeing a health professional;
• Psychosocial factors, including worries that getting medical care might interfere with home and work commitments; and
• General worries and concerns.

Jefferson is now developing a curriculum to teach physician residents to have more effective discharge conversations with patients when tests don't identify a cause for their symptoms.