A method to identify pediatric high-risk diagnoses missed in the emergency department
-
Melissa Sundberg
,
Catherine O. Perron
Abstract
Background:
Diagnostic error can lead to increased morbidity, mortality, healthcare utilization and cost. The 2015 National Academy of Medicine report “Improving Diagnosis in Healthcare” called for improving diagnostic accuracy by developing innovative electronic approaches to reduce medical errors, including missed or delayed diagnosis. The objective of this article was to develop a process to detect potential diagnostic discrepancy between pediatric emergency and inpatient discharge diagnosis using a computer-based tool facilitating expert review.
Methods:
Using a literature search and expert opinion, we identified 10 pediatric diagnoses with potential for serious consequences if missed or delayed. We then developed and applied a computerized tool to identify linked emergency department (ED) encounters and hospitalizations with these discharge diagnoses. The tool identified discordance between ED and hospital discharge diagnoses. Cases identified as discordant were manually reviewed by pediatric emergency medicine experts to confirm discordance.
Results:
Our computerized tool identified 55,233 ED encounters for hospitalized children over a 5-year period, of which 2161 (3.9%) had one of the 10 selected high-risk diagnoses. After expert record review, we identified 67 (3.1%) cases with discordance between ED and hospital discharge diagnoses. The most common discordant diagnoses were Kawasaki disease and pancreatitis.
Conclusions:
We successfully developed and applied a semi-automated process to screen a large volume of hospital encounters to identify discordant diagnoses for selected pediatric medical conditions. This process may be valuable for informing and improving ED diagnostic accuracy.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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©2018 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- “To learn by making mistakes”: the analysis of the dark periods of Laboratory Medicine as a tool for planning the future
- Weighting healthcare efficiency against available resources: value is the goal
- Reviews
- Clinical laboratory: bigger is not always better
- Quality, origins and limitations of common therapeutic drug reference intervals
- Original Articles
- A method to identify pediatric high-risk diagnoses missed in the emergency department
- Diagnostic accuracy in Family Medicine residents using a clinical decision support system (DXplain): a randomized-controlled trial
- Complement systems C4, C3 and CH50 not subject to a circadian rhythm
- Case Report
- An unusual circulating steroid profile in a virilized postmenopausal woman
- Erratum
- Erratum to: Using Bayes’ rule in diagnostic testing: a graphical explanation
Artikel in diesem Heft
- Frontmatter
- Editorial
- “To learn by making mistakes”: the analysis of the dark periods of Laboratory Medicine as a tool for planning the future
- Weighting healthcare efficiency against available resources: value is the goal
- Reviews
- Clinical laboratory: bigger is not always better
- Quality, origins and limitations of common therapeutic drug reference intervals
- Original Articles
- A method to identify pediatric high-risk diagnoses missed in the emergency department
- Diagnostic accuracy in Family Medicine residents using a clinical decision support system (DXplain): a randomized-controlled trial
- Complement systems C4, C3 and CH50 not subject to a circadian rhythm
- Case Report
- An unusual circulating steroid profile in a virilized postmenopausal woman
- Erratum
- Erratum to: Using Bayes’ rule in diagnostic testing: a graphical explanation
