Finding Diagnostic Errors in Children Admitted to the PICU. Issue 3 (March 2017)

• Record Type: Journal Article
• Authors: Davalos, Maria Caridad; Samuels, Kenya; Meyer, Ashley N. D.; Thammasitboon, Satid; Sur, Moushumi; Roy, Kevin; Al-Mutairi, Aymer; Singh, Hardeep
• Is Part Of: Pediatric critical care medicine. Volume 18:Issue 3(2017)
• Publication Date: 2017-03
• Subjects: critical care -- diagnostic error -- measurement -- patient safety -- quality improvement; Pediatric intensive care -- Periodicals; Pediatric emergencies -- Periodicals; 618.05
• DOI: 10.1097/PCC.0000000000001059
• Languages: English
• ISSNs: 1529-7535

Abstract

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.