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Pediatric Emergency Department Provider Experience Using the Revised Safer Dx for Self-Directed Feedback on
Joseph A Grubenhoff1,2,3,4,5,6, Mairead Dillon1,2,3,4,5,6, Alexandra T Geanacopoulos1,2,3,4,5,6
1Dr. Grubenhoff: Associate Professor of Pediatrics, Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
Emergency department clinicians can improve diagnostic accuracy through self-directed case reviews. This structured approach showed moderate agreement with expert reviews, aiding diagnostic reasoning calibration and feedback.
Area of Science:
- Medical Education
- Patient Safety
- Diagnostic Accuracy
Background:
- Diagnostic performance calibration requires feedback, which is often lacking for emergency department and urgent care (ED/UC) clinicians.
- This study explored clinician experiences with self-directed diagnostic performance review versus expert review.
Purpose of the Study:
- To evaluate the effectiveness of self-directed diagnostic error (DxE) review by ED/UC clinicians.
- To compare clinician self-review with diagnostic safety expert review.
- To assess clinician satisfaction with a structured review tool.
Main Methods:
- A single-center cohort study involving pediatric ED/UC clinicians reviewing cases with potential DxEs.
- Utilized the Revised Safer Dx tool for structured DxE identification and analysis.
- Compared clinician self-reviews with reviews by two independent diagnostic safety experts using Cohen kappa.
Main Results:
- A 37.4% response rate was observed, with 71 clinicians submitting 97 reviews.
- Moderate agreement (Cohen kappa 0.51-0.54) was found between self-reviews and expert reviews regarding DxEs.
- Over 60% of participants found the Revised Safer Dx useful, and those identifying a DxE were more likely to alter their approach (75.0% vs 5.7%).
Conclusions:
- Self-directed structured review for diagnostic errors by ED/UC clinicians shows moderate agreement with expert opinions, potentially improving diagnostic reasoning.
- Promoting self-directed reviews can enhance feedback mechanisms for ED/UC clinicians, ultimately improving patient safety.
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