Michael L Rinke1, Hardeep Singh2, Sarah Ruberman3, Jason Adelman4, Steven J Choi1, Heather O'Donnell1, Ruth E K Stein1, Tammy M Brady5, Moonseong Heo6, Christoph U Lehmann7, Steven Kairys8, Elizabeth Rice-Conboy9, Keri Theissen9, David G Bundy10. 1. 1Department of Pediatrics, The Children's Hospital at Montefiore and the Albert Einstein College of Medicine, Bronx, NY, USA. 2. 2Center for Innovations in Quality, Effectiveness and Safety, Michael E. Debakey Veterans Affairs Medical Center, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. 3. 3Albert Einstein College of Medicine, Bronx, NY, USA. 4. 4Columbia University College of Physicians and Surgeons, New York, NY, USA. 5. 5Johns Hopkins University School of Medicine, Baltimore, MD, USA. 6. 6Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. 7. 7Vanderbilt University School of Medicine, Nashville, TN, USA. 8. 8Jersey Shore University Medical Center, Neptune, NJ, USA9The American Academy of Pediatrics Division of Quality, Quality Improvement Innovation Networks, Elk Grove Village, IL, USA. 9. 9The American Academy of Pediatrics Division of Quality, Quality Improvement Innovation Networks, Elk Grove Village, IL, USA. 10. 10Medical University of South Carolina, Charleston, SC, USA.
Abstract
BACKGROUND: Diagnostic errors causing harm in children are understudied, resulting in a knowledge gap regarding pediatricians' interest in reducing their incidence. METHODS: Electronic survey of general pediatricians focusing on diagnostic error incidence, errors they were interested in trying to improve, and errors reduced by their electronic health record (EHR). RESULTS: Of 300 contacted pediatricians, 77 (26%) responded, 58 (19%) served ambulatory patients, and 48 (16%) completed the entire questionnaire. Of these 48, 17 (35%) reported making a diagnostic error at least monthly, and 16 (33%) reported making a diagnostic error resulting in an adverse event at least annually. Pediatricians were "most" interested in "trying to improve" missed diagnosis of hypertension (17%), delayed diagnosis due to missed subspecialty referral (15%), and errors associated with delayed follow-up of abnormal laboratory values (13%). Among the 44 pediatricians with an EHR, 16 (36%) said it reduced the likelihood of missing obesity and 14 (32%) said it reduced the likelihood of missing hypertension. Also, 15 (34%) said it helped avoid delays in follow-up of abnormal laboratory values. A third (36%) reported no help in diagnostic error reduction from their EHR. CONCLUSIONS: Pediatricians self-report an appreciable number of diagnostic errors and were most interested in preventing high frequency, non-life-threatening errors. There exists a need to leverage EHRs to support error reduction efforts.
BACKGROUND: Diagnostic errors causing harm in children are understudied, resulting in a knowledge gap regarding pediatricians' interest in reducing their incidence. METHODS: Electronic survey of general pediatricians focusing on diagnostic error incidence, errors they were interested in trying to improve, and errors reduced by their electronic health record (EHR). RESULTS: Of 300 contacted pediatricians, 77 (26%) responded, 58 (19%) served ambulatory patients, and 48 (16%) completed the entire questionnaire. Of these 48, 17 (35%) reported making a diagnostic error at least monthly, and 16 (33%) reported making a diagnostic error resulting in an adverse event at least annually. Pediatricians were "most" interested in "trying to improve" missed diagnosis of hypertension (17%), delayed diagnosis due to missed subspecialty referral (15%), and errors associated with delayed follow-up of abnormal laboratory values (13%). Among the 44 pediatricians with an EHR, 16 (36%) said it reduced the likelihood of missing obesity and 14 (32%) said it reduced the likelihood of missing hypertension. Also, 15 (34%) said it helped avoid delays in follow-up of abnormal laboratory values. A third (36%) reported no help in diagnostic error reduction from their EHR. CONCLUSIONS: Pediatricians self-report an appreciable number of diagnostic errors and were most interested in preventing high frequency, non-life-threatening errors. There exists a need to leverage EHRs to support error reduction efforts.
Entities:
Keywords:
diagnostic error; pediatrics; primary care
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