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A method to identify pediatric high-risk diagnoses missed in the emergency department

Melissa Sundberg1, Catherine O Perron2, Amir Kimia2

  • 1Boston Children's Hospital, Division of Emergency Medicine, 300 Longwood Ave, Boston, MA 02115, USA.

Diagnosis (Berlin, Germany)
|June 3, 2018
PubMed

Insights

A new computer tool helps find diagnostic errors in pediatric care by comparing emergency room and hospital discharge diagnoses. This process identified discrepancies in 3.1% of high-risk cases, improving diagnostic accuracy.

Area of Science:

  • Pediatric emergency medicine
  • Health informatics
  • Diagnostic accuracy

Background:

  • Diagnostic errors increase patient harm and healthcare costs.
  • The National Academy of Medicine emphasizes innovative electronic approaches to reduce diagnostic errors.
  • Missed or delayed diagnoses in pediatrics require urgent attention.

Purpose of the Study:

  • To develop a process for detecting diagnostic discrepancies between pediatric emergency department (ED) and inpatient discharge diagnoses.
  • To utilize a computer-based tool to facilitate expert review of potential diagnostic errors.
  • To improve diagnostic accuracy in pediatric emergency care.

Main Methods:

  • Identified 10 high-risk pediatric diagnoses based on literature and expert opinion.
  • Developed and applied a computerized tool to link ED encounters with hospital discharge diagnoses.
  • Pediatric emergency medicine experts manually reviewed discordant cases for confirmation.

Main Results:

  • The tool screened 55,233 ED encounters over 5 years, identifying 2161 (3.9%) with high-risk diagnoses.
  • Expert review confirmed diagnostic discordance in 67 (3.1%) of these cases.
  • Kawasaki disease and pancreatitis were the most frequent discordant diagnoses.

Conclusions:

  • A semi-automated process was successfully developed to screen hospital encounters for diagnostic discrepancies in pediatric conditions.
  • This method can identify potential diagnostic errors, informing improvements in ED diagnostic accuracy.
  • The tool offers a valuable approach for quality improvement in pediatric healthcare.
Abstract

Keywords:
emergency departmentmissed diagnosispediatrics

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