Use of e-triggers to identify diagnostic errors in the paediatric ED

Area of Science:

• Pediatric Healthcare
• Patient Safety
• Diagnostic Accuracy

Background:

• Diagnostic errors (DxEs) are a significant cause of patient harm in children, yet are underreported.
• Current adverse event reporting systems fail to capture most pediatric DxEs.
• Electronic triggers (e-triggers) show promise for identifying DxEs but haven't been applied in emergency departments (EDs).

Purpose of the Study:

• To evaluate an e-trigger and manual screening for identifying probable DxEs in children with unplanned admissions after an ED visit.
• To compare the e-trigger's performance against existing incident reporting systems.

Main Methods:

• Retrospective cohort study of children (0-22 years) admitted within 14 days of an ED visit (2018-2019).
• E-trigger identified patients; manual screening assessed diagnostic discrepancies.
• SaferDx Instrument used for DxE review; cases cross-referenced with incident reporting systems.

Main Results:

• E-trigger identified 1915 unplanned admissions (7.7%).
• 92 probable DxEs were identified (0.4% of all admissions, 20.3% of screened cases).
• Existing systems captured only 6.5% of identified DxEs.

Conclusions:

• E-trigger with manual screening effectively identifies children at risk for DxEs.
• Current surveillance systems significantly underreport pediatric DxEs.
• Further research needed to pinpoint specific clinical presentations prone to DxEs.