Related Experiment Video
Updated: Jun 30, 2025
Testing Sensory and Multisensory Function in Children with Autism Spectrum Disorder
Published on: April 22, 2015
Assessing the Revised Safer Dx Instrument® in the understanding of ambulatory system design changes for type 1
Patrick W Brady1,2,3, Richard M Ruddy2,4, Jennifer Ehrhardt5
1Division of Hospital Medicine, 12303 Cincinnati Children's Hospital , Cincinnati, OH, USA.
Insights
The Revised Safer Dx instrument rarely identified missed diagnostic opportunities in children with type 1 diabetes (T1D) or autism spectrum disorder (ASD) presenting with preventable complications. Further research should explore prospective data and adaptable diagnostic tools.
Area of Science:
- Pediatric Healthcare
- Chronic Disease Management
- Diagnostic Accuracy
Background:
- Children with type 1 diabetes (T1D) and autism spectrum disorder (ASD) can experience preventable emergency department (ED) visits due to complications.
- Identifying missed diagnostic opportunities is crucial for improving care and reducing healthcare burdens.
Purpose of the Study:
- To evaluate the utility of the Revised Safer Dx instrument in identifying diagnostic missed opportunities in children with T1D and ASD presenting with potentially preventable ED visits.
- To assess the frequency of missed diagnostic opportunities in ambulatory care for these pediatric populations.
Main Methods:
- Retrospective review of ED encounters for children with T1D and ASD over specified periods.
- Application of the Revised Safer Dx instrument to analyze diagnostic journeys for potentially preventable ED visits (hyperglycemia, DKA, behavioral crises).
- Examination of pre-visit communication methods and electronic health records.
Main Results:
- 63 T1D and 27 ASD ED visits were identified.
- The Revised Safer Dx instrument identified no missed diagnostic opportunities in T1D cases.
- Two potential missed opportunities were identified in ASD cases, suggesting areas for improved ambulatory medical management.
- 40% of T1D and 52% of ASD patients utilized pre-visit communication.
Conclusions:
- The Revised Safer Dx instrument infrequently identified missed diagnostic opportunities in children with T1D and ASD experiencing preventable complications.
- Future research should consider prospective data collection and the development or adaptation of diagnostic tools like Safer Dx for improved identification of care gaps.
Objectives:
We sought within an ambulatory safety study to understand if the Revised Safer Dx instrument may be helpful in identification of diagnostic missed opportunities in care of children with type 1 diabetes (T1D) and autism spectrum disorder (ASD).
Methods:
We reviewed two months of emergency department (ED) encounters for all patients at our tertiary care site with T1D and a sample of such encounters for patients with ASD over a 15-month period, and their pre-visit communication methods to better understand opportunities to improve diagnosis. We applied the Revised Safer Dx instrument to each diagnostic journey. We chose potentially preventable ED visits for hyperglycemia, diabetic ketoacidosis, and behavioral crises, and reviewed electronic health record data over the prior three months related to the illness that resulted in the ED visit.
Results:
We identified 63 T1D and 27 ASD ED visits. Using the Revised Safer Dx instrument, we did not identify any potentially missed opportunities to improve diagnosis in T1D. We found two potential missed opportunities (Safer Dx overall score of 5) in ASD, related to potential for ambulatory medical management to be improved. Over this period, 40 % of T1D and 52 % of ASD patients used communication prior to the ED visit.
Conclusions:
Using the Revised Safer Dx instrument, we uncommonly identified missed opportunities to improve diagnosis in patients who presented to the ED with potentially preventable complications of their chronic diseases. Future researchers should consider prospectively collected data as well as development or adaptation of tools like the Safer Dx.
Related Concept Videos
01:19Autism Spectrum Disorder
These core symptoms manifest differently among individuals, ranging from mild to severe. The disorder's complexity extends beyond its clinical presentation, encompassing a diverse range of biological, cognitive, and sociocultural influences.
01:27Diagnostic and Statistical Manual of Mental Disorders (DSM)
01:26Modeling in Therapy
Participant Modeling
Participant modeling involves therapists demonstrating calm and effective behaviors in...