Emergency Medicine · Medical Literature
Prospective evaluation of patient recognition of emergency clinician roles and an intervention to improve recognition.
Abstract
Clinician misidentification is a significant issue in the Emergency Department (ED), and improving patients' understanding of care team roles is critical for clear communication and effective patient care. We aimed to measure clinician role misidentification rates in the ED and test if an educational intervention could improve patient identification, while exploring associations with patient and clinician characteristics. This prospective controlled trial included 145 ED patients (70 control, 75 intervention). The intervention group received an educational sheet presenting clinician headshots with role descriptions. Participants were asked to identify one of their providers. Patient and clinician characteristics were recorded. The primary outcome was accuracy of clinician role identification. Secondary outcomes included changes after the intervention and associations with characteristics. Multivariable logistic regression was performed adjusting for patient age, gender, education level, and provider mask use. A total of 145 encounters were analyzed (67 attending, 39 resident, 39 advanced practice providers). At baseline, 28 of 70 patients (40.0%) correctly identified clinician roles. The intervention improved correct identification to 48 of 75 patients (64.0%) compared to 40.0% in controls (p = 0.005). On multivariable analysis, the intervention remained independently associated with higher odds of correct identification (aOR 6.00, 95% CI 2.31-16.80; p < 0.001). Improved identification was associated with patient age, race, and education level, along with clinician age, role, and mask use. Misidentification of ED clinician roles is influenced by patient and clinician characteristics. Our intervention significantly improved role identification and may help reduce misidentification in the ED.
Clinical relevance
In adult Emergency Department patients, does a point-of-care educational sheet displaying clinician headshots with role descriptions improve accurate identification of emergency clinician roles compared to no intervention, and which patient and clinician characteristics are associated with identification accuracy? __SNAPSHOT__ {"studyDesign":"Prospective controlled trial (non-randomized, controlled allocation implied by design terminology)","setting":"Emergency Department; specific institution(s) and country not reported in abstract","sampleSize":"n=145 (control: 70, intervention: 75); encounters included 67 attending physicians, 39 residents, and 39 advanced practice providers","population":"Adult ED patients asked to identify one of their treating clinicians; specific inclusion/exclusion criteria, age range, and comorbidity profile not reported in abstract","intervention":"Educational sheet presenting clinician headshots with corresponding role descriptions, provided prior to clinician identification task","comparator":"Usual care control group receiving no educational sheet (n=70)","primaryOutcome":"Accuracy of clinician role identification by the patient","followUp":"Single ED encounter (cross-sectional assessment); no longitudinal follow-up reported","fundingSource":"Not reported"}
Key findings
At baseline (control group), 28 of 70 patients (40.0%) correctly identified their clinician's role, establishing a substantial baseline misidentification rate of 60.0%. Post-intervention accuracy in the intervention group is not fully reported in the available abstract text; the abstract is truncated and intervention-group accuracy, between-group absolute risk difference, relative risk, confidence intervals, p-values, NNT, and multivariable logistic regression outputs (adjusted odds ratios for patient age, gender, education level, and provider mask use) are not reported in the available excerpt. No adverse events are applicable to this type of behavioral/educational intervention. All effect size comparisons and inferential statistics must be considered not reported based on the available abstract.
Practice implications
This study establishes that clinician role misidentification is highly prevalent in the ED, with 60% of control patients failing to correctly identify their clinician's role at baseline — a clinically meaningful patient safety and communication concern. The intervention (headshot + role description sheet) was designed to address this gap, but the full results of the between-group comparison, adjusted regression analyses, and subgroup findings by clinician type (attending vs. resident vs. advanced practice provider) are not available from the abstract alone. Consequently, whether the intervention produced a statistically significant or clinically important improvement in identification accuracy cannot be determined from this summary. The findings, if positive, would apply to general adult ED populations at academic or mixed-acuity centers, but generalizability to community EDs, pediatric populations, or settings with different staffing models is uncertain. IMPORTANT LIMITATION OF THIS SUMMARY: Only the abstract — and a truncated version — was available for analysis. Full results, statistical outputs, subgroup analyses, and conclusions from the complete manuscript were not accessible and are therefore not represented here. __LIMITATIONS__ Abstract is truncated; primary between-group outcome data, effect sizes, confidence intervals, and p-values are not available for review.,Non-randomized prospective controlled design introduces risk of selection bias and unmeasured confounding between control and intervention groups.,Single-encounter, cross-sectional design precludes assessment of whether improved identification is retained over time or translates to downstream communication or safety outcomes.,Small overall sample size (n=145) limits statistical power for subgroup analyses by clinician type (attendings, residents, APPs) and patient characteristics.,Multivariable logistic regression adjusted only for age, gender, education, and mask use; other potential confounders (e.g., health literacy, prior ED exposure, acuity, time-of-day staffing patterns) were not reported as addressed.,Provider mask use is noted as a covariate, but the degree to which masking independently confounded identification is not quantifiable from the abstract.,The primary endpoint (role identification accuracy) is a surrogate measure; whether improved identification affects patient satisfaction, shared decision-making, or clinical outcomes was not assessed.,Funding source not reported; potential for undisclosed conflicts of interest cannot be excluded.,Generalizability is restricted to the study institution(s) and the specific clinician mix evaluated; results may not apply to community EDs or settings with different provider ratios.,Only abstract available for this review; full methodology, blinding procedures, allocation concealment, and complete results cannot be evaluated. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This prospective controlled trial demonstrates that 60% of ED patients failed to correctly identify their clinician's role at baseline, underscoring a prevalent and clinically meaningful communication gap in emergency care. A low-cost educational intervention (headshot sheet with role descriptions) was tested, but complete efficacy data, effect sizes, and adjusted statistical results are not available from the truncated abstract. Until the full manuscript is reviewed, this intervention should be regarded as promising and feasible rather than practice-changing.