Finding Diagnostic Errors in Children Admitted to the PICU

Maria Caridad Davalos; Kenya Samuels; Ashley N.D. Meyer; Satid Thammasitboon; Moushumi Sur; Kevin Roy; Aymer Al-Mutairi; Hardeep Singh

doi:10.1097/PCC.0000000000001059

Finding Diagnostic Errors in Children Admitted to the PICU

Maria Caridad Davalos, Kenya Samuels, Ashley N.D. Meyer, Satid Thammasitboon, Moushumi Sur, Kevin Roy, Aymer Al-Mutairi, Hardeep Singh

Research output: Contribution to journal › Article › peer-review

41 Scopus citations

Abstract

Objectives: To determine whether the Safer Dx Instrument, a structured tool for finding diagnostic errors in primary care, can be used to reliably detect diagnostic errors in patients admitted to a PICU. Design and Setting: The Safer Dx Instrument consists of 11 questions to evaluate the diagnostic process and a final question to determine if diagnostic error occurred. We used the instrument to analyze four "high-risk" patient cohorts admitted to the PICU between June 2013 and December 2013. Patients: High-risk cohorts were defined as cohort 1: patients who were autopsied; cohort 2: patients seen as outpatients within 2 weeks prior to PICU admission; cohort 3: patients transferred to PICU unexpectedly from an acute care floor after a rapid response and requiring vasoactive medications and/or endotracheal intubation due to decompensation within 24 hours; and cohort 4: patients transferred to PICU unexpectedly from an acute care floor after a rapid response without subsequent decompensation in 24 hours. Interventions: Two clinicians used the instrument to independently review records in each cohort for diagnostic errors, defined as missed opportunities to make a correct or timely diagnosis. Errors were confirmed by senior expert clinicians. Measurements and Main Results: Diagnostic errors were present in 26 of 214 high-risk patient records (12.1%; 95% CI, 8.2-17.5%) with the following frequency distribution: cohort 1: two of 16 (12.5%); cohort 2: one of 41 (2.4%); cohort 3: 13 of 44 (29.5%); and cohort 4: 10 of 113 (8.8%). Overall initial reviewer agreement was 93.6% (κ, 0.72). Infections and neurologic conditions were the most commonly missed diagnoses across all high-risk cohorts (16/26). Conclusions: The Safer Dx Instrument has high reliability and validity for diagnostic error detection when used in high-risk pediatric care settings. With further validation in additional clinical settings, it could be useful to enhance learning and feedback about diagnostic safety in children.

Original language	English (US)
Pages (from-to)	265-271
Number of pages	7
Journal	Pediatric Critical Care Medicine
Volume	18
Issue number	3
DOIs	https://doi.org/10.1097/PCC.0000000000001059
State	Published - Mar 1 2017
Externally published	Yes

Keywords

critical care
diagnostic error
measurement
patient safety
quality improvement

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Critical Care and Intensive Care Medicine

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10.1097/PCC.0000000000001059

Cite this

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title = "Finding Diagnostic Errors in Children Admitted to the PICU",

abstract = "Objectives: To determine whether the Safer Dx Instrument, a structured tool for finding diagnostic errors in primary care, can be used to reliably detect diagnostic errors in patients admitted to a PICU. Design and Setting: The Safer Dx Instrument consists of 11 questions to evaluate the diagnostic process and a final question to determine if diagnostic error occurred. We used the instrument to analyze four {"}high-risk{"} patient cohorts admitted to the PICU between June 2013 and December 2013. Patients: High-risk cohorts were defined as cohort 1: patients who were autopsied; cohort 2: patients seen as outpatients within 2 weeks prior to PICU admission; cohort 3: patients transferred to PICU unexpectedly from an acute care floor after a rapid response and requiring vasoactive medications and/or endotracheal intubation due to decompensation within 24 hours; and cohort 4: patients transferred to PICU unexpectedly from an acute care floor after a rapid response without subsequent decompensation in 24 hours. Interventions: Two clinicians used the instrument to independently review records in each cohort for diagnostic errors, defined as missed opportunities to make a correct or timely diagnosis. Errors were confirmed by senior expert clinicians. Measurements and Main Results: Diagnostic errors were present in 26 of 214 high-risk patient records (12.1%; 95% CI, 8.2-17.5%) with the following frequency distribution: cohort 1: two of 16 (12.5%); cohort 2: one of 41 (2.4%); cohort 3: 13 of 44 (29.5%); and cohort 4: 10 of 113 (8.8%). Overall initial reviewer agreement was 93.6% (κ, 0.72). Infections and neurologic conditions were the most commonly missed diagnoses across all high-risk cohorts (16/26). Conclusions: The Safer Dx Instrument has high reliability and validity for diagnostic error detection when used in high-risk pediatric care settings. With further validation in additional clinical settings, it could be useful to enhance learning and feedback about diagnostic safety in children.",

keywords = "critical care, diagnostic error, measurement, patient safety, quality improvement",

author = "Davalos, {Maria Caridad} and Kenya Samuels and Meyer, {Ashley N.D.} and Satid Thammasitboon and Moushumi Sur and Kevin Roy and Aymer Al-Mutairi and Hardeep Singh",

note = "Publisher Copyright: Copyright {\textcopyright} 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.",

year = "2017",

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doi = "10.1097/PCC.0000000000001059",

language = "English (US)",

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AU - Davalos, Maria Caridad

AU - Samuels, Kenya

AU - Meyer, Ashley N.D.

AU - Thammasitboon, Satid

AU - Sur, Moushumi

AU - Roy, Kevin

AU - Al-Mutairi, Aymer

AU - Singh, Hardeep

PY - 2017/3/1

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AB - Objectives: To determine whether the Safer Dx Instrument, a structured tool for finding diagnostic errors in primary care, can be used to reliably detect diagnostic errors in patients admitted to a PICU. Design and Setting: The Safer Dx Instrument consists of 11 questions to evaluate the diagnostic process and a final question to determine if diagnostic error occurred. We used the instrument to analyze four "high-risk" patient cohorts admitted to the PICU between June 2013 and December 2013. Patients: High-risk cohorts were defined as cohort 1: patients who were autopsied; cohort 2: patients seen as outpatients within 2 weeks prior to PICU admission; cohort 3: patients transferred to PICU unexpectedly from an acute care floor after a rapid response and requiring vasoactive medications and/or endotracheal intubation due to decompensation within 24 hours; and cohort 4: patients transferred to PICU unexpectedly from an acute care floor after a rapid response without subsequent decompensation in 24 hours. Interventions: Two clinicians used the instrument to independently review records in each cohort for diagnostic errors, defined as missed opportunities to make a correct or timely diagnosis. Errors were confirmed by senior expert clinicians. Measurements and Main Results: Diagnostic errors were present in 26 of 214 high-risk patient records (12.1%; 95% CI, 8.2-17.5%) with the following frequency distribution: cohort 1: two of 16 (12.5%); cohort 2: one of 41 (2.4%); cohort 3: 13 of 44 (29.5%); and cohort 4: 10 of 113 (8.8%). Overall initial reviewer agreement was 93.6% (κ, 0.72). Infections and neurologic conditions were the most commonly missed diagnoses across all high-risk cohorts (16/26). Conclusions: The Safer Dx Instrument has high reliability and validity for diagnostic error detection when used in high-risk pediatric care settings. With further validation in additional clinical settings, it could be useful to enhance learning and feedback about diagnostic safety in children.

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KW - patient safety

KW - quality improvement

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Finding Diagnostic Errors in Children Admitted to the PICU

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Keywords

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