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The Diagnostic Error Index: A Quality Improvement Initiative to Identify and Measure Diagnostic Errors
Michael F Perry1, Jennifer E Melvin2, Rena T Kasick1
1Division of Hospital Pediatrics, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH.
The Journal of Pediatrics
|December 10, 2020
Summary
A new Diagnostic Error Index (DEI) was developed to identify and measure serious diagnostic errors in pediatric care. This quality improvement initiative provides a framework for reducing future diagnostic errors.
Area of Science:
- Medical Quality Improvement
- Patient Safety
- Pediatric Healthcare
Background:
- Diagnostic errors represent a significant patient safety concern.
- Accurate measurement is crucial for effective quality improvement initiatives.
Purpose of the Study:
- To develop a practical Diagnostic Error Index (DEI).
- To establish a method for identifying and quantifying serious diagnostic errors.
Main Methods:
- A quality improvement study was conducted at a quaternary pediatric medical center.
- Diagnostic errors were identified through five defined domains and adjudicated by a multidisciplinary team.
- The Diagnostic Error Index (DEI) aggregated confirmed diagnostic errors, with monthly error counts as the primary outcome.
Main Results:
- Over 105 cases of diagnostic error were identified between January 2017 and June 2019.
- Morbidity and mortality conferences, root cause analyses, and an abdominal pain trigger tool were key detection domains.
- Appendicitis, fractures, and nonaccidental trauma were the most common missed or delayed diagnoses.
Conclusions:
- A quality improvement initiative successfully implemented a practical Diagnostic Error Index (DEI).
- The DEI provides a framework to guide future efforts aimed at reducing diagnostic errors.
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