Primary care pediatricians' interest in diagnostic error reduction
Michael L Rinke1, Hardeep Singh2, Sarah Ruberman3
11Department of Pediatrics, The Children's Hospital at Montefiore and the Albert Einstein College of Medicine, Bronx, NY, USA.
Insights
Pediatricians frequently encounter diagnostic errors, particularly those involving high-frequency, non-life-threatening conditions. Electronic health records (EHRs) show potential in reducing certain diagnostic errors, but their full impact needs further exploration.
Area of Science:
- Pediatric Medicine
- Medical Informatics
- Patient Safety
Background:
- Diagnostic errors in children are understudied, creating a knowledge gap on pediatricians' interest in error reduction.
- There is a need to understand the incidence of diagnostic errors and the factors influencing pediatricians' focus on improvement.
Purpose of the Study:
- To assess the incidence of diagnostic errors reported by pediatricians.
- To identify specific diagnostic errors pediatricians are most interested in improving.
- To evaluate the role of electronic health records (EHRs) in reducing diagnostic errors.
Main Methods:
- An electronic survey was distributed to general pediatricians.
- The survey focused on diagnostic error incidence, areas of interest for improvement, and the impact of EHRs.
- Response rates and data from completed questionnaires were analyzed.
Main Results:
- 35% of surveyed pediatricians reported monthly diagnostic errors; 33% reported annual errors resulting in adverse events.
- Pediatricians expressed most interest in improving missed diagnoses of hypertension, delayed referrals, and abnormal lab value follow-up.
- While some EHRs aided in reducing errors related to obesity, hypertension, and lab follow-up, 36% reported no benefit from their EHR in error reduction.
Conclusions:
- Pediatricians acknowledge a significant number of diagnostic errors, with a preference for addressing high-frequency, less severe conditions.
- Electronic health records show promise in mitigating specific diagnostic errors, indicating a need for enhanced EHR integration 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.
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