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Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors.

Justin B Searns1, Manon C Williams2, Christine E MacBrayne3

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Handshake stewardship programs (HS-ASP) can identify and help prevent diagnostic errors in hospitalized children. This novel approach offers valuable interventions for improving patient safety and care quality.

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Area of Science:

  • Medical Informatics
  • Patient Safety
  • Pediatric Hospital Medicine

Background:

  • Antimicrobial stewardship programs (ASPs) have limited documented impact on diagnostic error recognition and prevention.
  • Handshake stewardship (HS-ASP) is an innovative ASP model involving prospective, in-person antimicrobial usage reviews and recommendations.
  • Diagnostic errors represent a significant concern in hospitalized pediatric populations.

Purpose of the Study:

  • To evaluate the capacity of the HS-ASP model to identify and intervene on potential diagnostic errors in children admitted to a quaternary care children's hospital.

Main Methods:

  • Retrospective review of "Great Catch" (GC) interventions identified by the HS-ASP team at Children's Hospital Colorado from October 2014 to May 2018.
  • Categorization of GCs based on HS-ASP recommendations, specifically noting diagnostic recommendations.
  • Independent scoring of each GC using the "Safer Dx Instrument" (cut-off score ≤1.50) to assess for diagnostic errors, with interrater reliability measured.

Main Results:

  • A total of 162 GC interventions were recorded during the study period.
  • Of these, 65 (40%) involved diagnostic recommendations from HS-ASP.
  • Nineteen GCs (12%) met the criteria for diagnostic error (Safer Dx Score ≤1.50), with HS-ASP making a diagnostic recommendation in 95% of these cases.

Conclusions:

  • The HS-ASP model demonstrates potential for identifying and intervening in diagnostic errors among hospitalized children.
  • This approach may enhance patient safety by addressing critical diagnostic inaccuracies in pediatric care.