Updates to referring clinicians regarding critically ill children admitted to the pediatric intensive care unit: a state-wide survey
-
Christina L. Cifra
,
Cody R. Tigges
Abstract
Background
Front-line clinicians are expected to make accurate and timely diagnostic decisions before transferring patients to the pediatric intensive care unit (PICU) but may not always learn their patients’ outcomes. We evaluated the characteristics of post-transfer updates received by referring clinicians regarding PICU patients and determined preferences regarding content, delivery, and timing of such updates.
Methods
We administered an electronic cross-sectional survey to Iowa clinicians who billed for ≥5 pediatric patients or referred ≥1 patient to the University of Iowa (UI) PICU in the year before survey administration.
Results
One hundred and one clinicians (51 non-UI, 50 UI-affiliated) responded. Clinicians estimated that, on average, 8% of pediatric patients they saw over 1 year required PICU admission; clinicians received updates on 40% of patients. Seventy percent of UI clinicians obtained updates via self-initiated electronic record review, while 37% of non-UI clinicians relied on PICU communication (p = 0.013). Clinicians indicated that updates regarding diagnoses/outcomes will be most relevant to their practice. Among clinicians who received updates, 13% received unexpected information; 40% changed their practice as a result.
Conclusions
Clinicians received updates on less than half of the patients they referred to a PICU, although such updates could potentially influence clinical practice. Study findings will inform the development of a formal feedback system from the PICU to referring clinicians.
Award Identifier / Grant number: #HD027748
Funding statement: Dr. Cifra is supported by a National Institutes of Health Institutional K12 grant (Eunice Kennedy Shriver National Institute of Child Health and Human Development, Funder Id: http://dx.doi.org/10.13039/100009633, #HD027748). Dr. Singh is supported in part by the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA (#CIN 13-413).
Acknowledgments
The authors thank Anna Kisting for her assistance in identifying survey respondents, disseminating the survey, and collating results.
Author contributions: Dr. Cifra and Dr. Tigges conceptualized and designed the study; developed, reviewed, and finalized the survey instrument; organized, analyzed, and interpreted the data; and drafted, reviewed, and revised the manuscript. Dr. Miller contributed to the design of the study and the survey instrument, supervised and coordinated the survey pilot, interpreted the data, and reviewed the manuscript. Dr. Herwaldt and Dr. Singh reviewed the study design, interpreted the data, and critically reviewed the manuscript for important intellectual content. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
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.
References
1. Gregory CJ, Nasrollahzadeh F, Dharmar M, Parsapour K, Marcin JP. Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions. Pediatrics 2008;121:e906–11.10.1542/peds.2007-2089Suche in Google Scholar PubMed
2. Odetola FO, Clark SJ, Gurney JG, Dechert RE, Shanley TP, Freed GL. Effect of interhospital transfer on resource utilization and outcomes at a tertiary pediatric intensive care unit. J Crit Care 2009;24:379–86.10.1016/j.jcrc.2008.11.007Suche in Google Scholar PubMed
3. Philpot C, Day S, Marcdante K, Gorelick M. Pediatric interhospital transport: diagnostic discordance and hospital mortality. Pediatr Crit Care Med 2008;9:15–9.10.1097/01.PCC.0000298658.02753.C1Suche in Google Scholar PubMed
4. Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, Westerman ME, et al. Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics 2003;112:793–9.10.1542/peds.112.4.793Suche in Google Scholar PubMed
5. Akcan Arikan A, Williams EA, Graf JM, Kennedy CE, Patel B, Cruz AT. Resuscitation bundle in pediatric shock decreases acute kidney injury and improves outcomes. J Pediatr 2015;167:1301–5.e1.10.1016/j.jpeds.2015.08.044Suche in Google Scholar PubMed
6. Meyer AN, Singh H. The path to diagnostic excellence includes feedback to calibrate how clinicians think. J Am Med Assoc 2019;321:737–8.10.1001/jama.2019.0113Suche in Google Scholar PubMed
7. Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med 2008;121(5 Suppl):S2–23.10.1016/j.amjmed.2008.01.001Suche in Google Scholar PubMed
8. Croskerry P. The feedback sanction. Acad Emerg Med 2000;7:1232–8.10.1111/j.1553-2712.2000.tb00468.xSuche in Google Scholar PubMed
9. Schiff GD. Minimizing diagnostic error: the importance of follow-up and feedback. Am J Med 2008;121(5 Suppl):S38–42.10.1016/j.amjmed.2008.02.004Suche in Google Scholar PubMed
10. Graff LG, Chern C-H, Radford M. Emergency physicians’ acute coronary syndrome testing threshold and diagnostic performance: acute coronary syndrome critical pathway with return visit feedback. Crit Pathw Cardiol 2014;13:99–103.10.1097/HPC.0000000000000021Suche in Google Scholar PubMed
11. Chern C-H, How C-K, Wang L-M, Lee C-H, Graff L. Decreasing clinically significant adverse events using feedback to emergency physicians of telephone follow-up outcomes. Ann Emerg Med 2005;45:15–23.10.1016/j.annemergmed.2004.08.012Suche in Google Scholar PubMed
12. National Academies of Sciences, Engineering, and Medicine. Introduction. In: Balogh EP, Miller BT, Ball JR, editors. Improving diagnosis in health care. Washington, DC: The National Academies Press, 2015:19–30.Suche in Google Scholar
13. National Academies of Sciences, Engineering, and Medicine. Summary. In: Balogh EP, Miller BT, Ball JR, editors. Improving diagnosis in health care. Washington, DC: The National Academies Press, 2015:1–18.Suche in Google Scholar
14. Omron R, Kotwal S, Garibaldi BT, Newman-Toker DE. The diagnostic performance feedback “calibration gap”: why clinical experience alone is not enough to prevent serious diagnostic errors. AEM Educ Train 2018;2:339–42.10.1002/aet2.10119Suche in Google Scholar PubMed PubMed Central
15. Bradley EH, Holmboe ES, Mattera JA, Roumanis SA, Radford MJ, Krumholz HM. Data feedback efforts in quality improvement: lessons learned from US hospitals. Qual Saf Health Care 2004;13:26–31.10.1136/qhc.13.1.26Suche in Google Scholar PubMed PubMed Central
16. Payne VL, Hysong SJ. Model depicting aspects of audit and feedback that impact physicians’ acceptance of clinical performance feedback. BMC Health Serv Res 2016;16:260.10.1186/s12913-016-1486-3Suche in Google Scholar PubMed PubMed Central
17. Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. Qual Saf Health Care 2006;15:433–6.10.1136/qshc.2006.018549Suche in Google Scholar PubMed PubMed Central
18. Mugford M, Banfield P, O’Hanlon M. Effects of feedback of information on clinical practice: a review. Br Med J 1991;303:398–402.10.1136/bmj.303.6799.398Suche in Google Scholar PubMed PubMed Central
19. Brehaut JC, Colquhoun HL, Eva KW, Carroll K, Sales A, MichieS, et al. Practice feedback interventions: 15 suggestions for optimizing effectiveness. Ann Intern Med 2016;164:435–41.10.7326/M15-2248Suche in Google Scholar PubMed
20. Friedman CP, Gatti GG, Franz TM, Murphy GC, Wolf FM, Heckerling PS, et al. Do physicians know when their diagnoses are correct? Implications for decision support and error reduction. J Gen Intern Med 2005;20:334–9.10.1111/j.1525-1497.2005.30145.xSuche in Google Scholar PubMed PubMed Central
21. Grubenhoff JA, Ziniel SI, Bajaj L, Hyman D. Pediatric faculty knowledge and comfort discussing diagnostic errors: a pilot survey to understand barriers to an educational program. Diagn (Berl) 2019;6:101–7.10.1515/dx-2018-0056Suche in Google Scholar PubMed
22. Tudor GR, Finlay DB. Error review: can this improve reporting performance? Clin Radiol 2001;56:751–4.10.1053/crad.2001.0760Suche in Google Scholar PubMed
23. Lipitz-Snyderman A, Kale M, Robbins L, Pfister D, Fortier E, PocusV, et al. Peers without fears? Barriers to effective communication among primary care physicians and oncologists about diagnostic delays in cancer. BMJ Qual Saf 2017;26:892–8.10.1136/bmjqs-2016-006181Suche in Google Scholar PubMed PubMed Central
24. Rosenthal JL, Okumura MJ, Hernandez L, Li S-TT, Rehm RS. Interfacility transfers to general pediatric floors: a qualitative study exploring the role of communication. Acad Pediatr 2016;16:692–9.10.1016/j.acap.2016.04.003Suche in Google Scholar PubMed
Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2019-0048).
©2020 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorials
- The novel coronavirus (2019-nCoV) outbreak: think the unthinkable and be prepared to face the challenge
- COVID Blindness
- Opinion Paper
- Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19)
- Original Articles
- Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): Early report from the United States
- Patient perceptions of misdiagnosis of endometriosis: results from an online national survey
- A survey of outpatient Internal Medicine clinician perceptions of diagnostic error
- Thresholds, rules and defensive strategies: how physicians learn from their prior diagnosis-related experiences
- Updates to referring clinicians regarding critically ill children admitted to the pediatric intensive care unit: a state-wide survey
- Diagnostic error in an ophthalmic emergency department
- Evaluation of the usefulness of the simultaneous assay of fecal hemoglobin (Hb) and transferrin (Tf) in colorectal cancer screening – for the establishment of the Hb and Tf two-step cutoff assay (HTTC assay)
- Case Report
- Factitious thyrotoxicosis: how to find it
- Letters to the Editors
- Letter to the Editor re Olson et al. “Competencies for improving diagnosis: an interprofessional framework for education and training in healthcare”
- Molecular diagnostics at the times of SARS-CoV-2 outbreak
Artikel in diesem Heft
- Frontmatter
- Editorials
- The novel coronavirus (2019-nCoV) outbreak: think the unthinkable and be prepared to face the challenge
- COVID Blindness
- Opinion Paper
- Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19)
- Original Articles
- Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): Early report from the United States
- Patient perceptions of misdiagnosis of endometriosis: results from an online national survey
- A survey of outpatient Internal Medicine clinician perceptions of diagnostic error
- Thresholds, rules and defensive strategies: how physicians learn from their prior diagnosis-related experiences
- Updates to referring clinicians regarding critically ill children admitted to the pediatric intensive care unit: a state-wide survey
- Diagnostic error in an ophthalmic emergency department
- Evaluation of the usefulness of the simultaneous assay of fecal hemoglobin (Hb) and transferrin (Tf) in colorectal cancer screening – for the establishment of the Hb and Tf two-step cutoff assay (HTTC assay)
- Case Report
- Factitious thyrotoxicosis: how to find it
- Letters to the Editors
- Letter to the Editor re Olson et al. “Competencies for improving diagnosis: an interprofessional framework for education and training in healthcare”
- Molecular diagnostics at the times of SARS-CoV-2 outbreak
