Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network
Background Diagnostic errors, reframed as missed opportunities for improving diagnosis (MOIDs), are poorly understood in the paediatric emergency department (ED) setting. We investigated the clinical experience, harm and contributing factors related to MOIDs reported by physicians working in paediat...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-02-01
|
| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/12/1/e002062.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846099449655328768 |
|---|---|
| author | Hardeep Singh Damian Roland Rianne Oostenbrink Nathan Kuppermann Prashant Mahajan Mark Lyttle Kathy N Shaw Maala Bhatt Todd Chang Richard M Ruddy James M Chamberlain Jim Cranford Joseph A Grubenhoff Robert Velasco Zuniga Apoorva Belle |
| author_facet | Hardeep Singh Damian Roland Rianne Oostenbrink Nathan Kuppermann Prashant Mahajan Mark Lyttle Kathy N Shaw Maala Bhatt Todd Chang Richard M Ruddy James M Chamberlain Jim Cranford Joseph A Grubenhoff Robert Velasco Zuniga Apoorva Belle |
| author_sort | Hardeep Singh |
| collection | DOAJ |
| description | Background Diagnostic errors, reframed as missed opportunities for improving diagnosis (MOIDs), are poorly understood in the paediatric emergency department (ED) setting. We investigated the clinical experience, harm and contributing factors related to MOIDs reported by physicians working in paediatric EDs.Methods We developed a web-based survey in which physicians participating in the international Paediatric Emergency Research Network representing five out of six WHO regions, described examples of MOIDs involving their own or a colleague’s patients. Respondents provided case summaries and answered questions regarding harm and factors contributing to the event.Results Of 1594 physicians surveyed, 412 (25.8%) responded (mean age=43 years (SD=9.2), 42.0% female, mean years in practice=12 (SD=9.0)). Patient presentations involving MOIDs had common undifferentiated symptoms at initial presentation, including abdominal pain (21.1%), fever (17.2%) and vomiting (16.5%). Patients were discharged from the ED with commonly reported diagnoses, including acute gastroenteritis (16.7%), viral syndrome (10.2%) and constipation (7.0%). Most reported MOIDs (65%) were detected on ED return visits (46% within 24 hours and 76% within 72 hours). The most common reported MOID was appendicitis (11.4%), followed by brain tumour (4.4%), meningitis (4.4%) and non-accidental trauma (4.1%). More than half (59.1%) of the reported MOIDs involved the patient/parent–provider encounter (eg, misinterpreted/ignored history or an incomplete/inadequate physical examination). Types of MOIDs and contributing factors did not differ significantly between countries. More than half of patients had either moderate (48.7%) or major (10%) harm due to the MOID.Conclusions An international cohort of paediatric ED physicians reported several MOIDs, often in children who presented to the ED with common undifferentiated symptoms. Many of these were related to patient/parent–provider interaction factors such as suboptimal history and physical examination. Physicians’ personal experiences offer an underexplored source for investigating and mitigating diagnostic errors in the paediatric ED. |
| format | Article |
| id | doaj-art-e6201e9055c74705af460242e1c51850 |
| institution | Kabale University |
| issn | 2399-6641 |
| language | English |
| publishDate | 2023-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-e6201e9055c74705af460242e1c518502024-12-31T13:40:09ZengBMJ Publishing GroupBMJ Open Quality2399-66412023-02-0112110.1136/bmjoq-2022-002062Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research networkHardeep Singh0Damian Roland1Rianne Oostenbrink2Nathan Kuppermann3Prashant Mahajan4Mark Lyttle5Kathy N Shaw6Maala Bhatt7Todd Chang8Richard M Ruddy9James M Chamberlain10Jim Cranford11Joseph A Grubenhoff12Robert Velasco Zuniga13Apoorva Belle14Medicine - Health Services Research, Baylor College of Medicine, Houston, Texas, USA11 SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UKGeneral Paediatrics, ErasmusMC, Rotterdam, The NetherlandsDepartments of Emergency Medicine and Pediatrics, UC Davis School of Medicine and UC Davis Health, Sacramento, California, USAEmergency Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, USA2Faculty of Health and Applied Sciences, University of the West of England, Bristol, UKPediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA2 Department of Pediatrics, CHEO, Ottawa, Ontario, CanadaPaediatric Emergency Medicine, Children`s Hospital of Los Angeles, Los Angeles, California, USA1Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children`s Hospital Medical Center, Cincinnati, Ohio, USAEmergency Medicine, Children`s National Medical Center, Washington, District of Columbia, USAEmergency Medicine, University of Michigan, Ann Arbor, Michigan, USAPaediatric Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USAPaediatric Emergency Medicine, Hospital Universitario Rio Hortega, Valladolid, SpainEmergency Medicine, University of Michigan, Ann Arbor, Michigan, USABackground Diagnostic errors, reframed as missed opportunities for improving diagnosis (MOIDs), are poorly understood in the paediatric emergency department (ED) setting. We investigated the clinical experience, harm and contributing factors related to MOIDs reported by physicians working in paediatric EDs.Methods We developed a web-based survey in which physicians participating in the international Paediatric Emergency Research Network representing five out of six WHO regions, described examples of MOIDs involving their own or a colleague’s patients. Respondents provided case summaries and answered questions regarding harm and factors contributing to the event.Results Of 1594 physicians surveyed, 412 (25.8%) responded (mean age=43 years (SD=9.2), 42.0% female, mean years in practice=12 (SD=9.0)). Patient presentations involving MOIDs had common undifferentiated symptoms at initial presentation, including abdominal pain (21.1%), fever (17.2%) and vomiting (16.5%). Patients were discharged from the ED with commonly reported diagnoses, including acute gastroenteritis (16.7%), viral syndrome (10.2%) and constipation (7.0%). Most reported MOIDs (65%) were detected on ED return visits (46% within 24 hours and 76% within 72 hours). The most common reported MOID was appendicitis (11.4%), followed by brain tumour (4.4%), meningitis (4.4%) and non-accidental trauma (4.1%). More than half (59.1%) of the reported MOIDs involved the patient/parent–provider encounter (eg, misinterpreted/ignored history or an incomplete/inadequate physical examination). Types of MOIDs and contributing factors did not differ significantly between countries. More than half of patients had either moderate (48.7%) or major (10%) harm due to the MOID.Conclusions An international cohort of paediatric ED physicians reported several MOIDs, often in children who presented to the ED with common undifferentiated symptoms. Many of these were related to patient/parent–provider interaction factors such as suboptimal history and physical examination. Physicians’ personal experiences offer an underexplored source for investigating and mitigating diagnostic errors in the paediatric ED.https://bmjopenquality.bmj.com/content/12/1/e002062.full |
| spellingShingle | Hardeep Singh Damian Roland Rianne Oostenbrink Nathan Kuppermann Prashant Mahajan Mark Lyttle Kathy N Shaw Maala Bhatt Todd Chang Richard M Ruddy James M Chamberlain Jim Cranford Joseph A Grubenhoff Robert Velasco Zuniga Apoorva Belle Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network BMJ Open Quality |
| title | Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network |
| title_full | Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network |
| title_fullStr | Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network |
| title_full_unstemmed | Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network |
| title_short | Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network |
| title_sort | types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network |
| url | https://bmjopenquality.bmj.com/content/12/1/e002062.full |
| work_keys_str_mv | AT hardeepsingh typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT damianroland typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT rianneoostenbrink typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT nathankuppermann typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT prashantmahajan typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT marklyttle typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT kathynshaw typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT maalabhatt typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT toddchang typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT richardmruddy typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT jamesmchamberlain typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT jimcranford typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT josephagrubenhoff typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT robertvelascozuniga typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork AT apoorvabelle typesofdiagnosticerrorsreportedbypaediatricemergencyprovidersinaglobalpaediatricemergencycareresearchnetwork |