A pause in pediatrics: implementation of a pediatric diagnostic time-out

Sarah C. Yale; Susan S. Cohen; Robert M. Kliegman; Brett J. Bordini

doi:10.1515/dx-2022-0010

Article

A pause in pediatrics: implementation of a pediatric diagnostic time-out

Sarah C. Yale , Susan S. Cohen , Robert M. Kliegman and Brett J. Bordini

Published/Copyright: April 14, 2022

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From the journal Diagnosis Volume 9 Issue 3

Abstract

Objectives

Diagnostic errors are frequently the product of cognitive biases that arise when heuristic-based approaches fail. The efficiency-thoroughness tradeoff (ETTO) principle states sacrificing thoroughness for efficiency is normal and occurs frequently in medicine. The goal of a diagnostic timeout was to provide an actionable template for when providers transition to an analytical mindset and to help incorporate the ETTO principle during the diagnostic process.

Methods

A diagnostic time-out was adapted for use in pediatric hospital medicine (PHM). In this prospective study, a group of eight PHM providers piloted the time-out in the hospitalized setting. Data was collected over 12 months and descriptive statistics were used for analysis.

Results

Cases were most frequently chosen for time-out use due to clinician intuition. In more than half the cases the time-out didn’t confirm the initial diagnosis and alternate diagnoses for the wrong diagnosis were pursued. There was only one case of the time-out being burdensome from a time perspective. Learners participated in all cases. As a result of the diagnostic time-out, new actions were taken in all cases.

Conclusions

Implementation of a diagnostic time out provides an actionable template for providers to actively change their mindset to an analytical thinking process to counteract cognitive biases and potentially reduce diagnostic errors in the pediatric inpatient setting.

Keywords: diagnostic error; diagnostic time-out; pediatrics

Corresponding author: Sarah C. Yale, MD, Department of Pediatrics, Medical College of Wisconsin, Children’s Corporate Center Suite 560, 999 North 92nd Street, Milwaukee, Wisconsin 53226, USA, Phone: 414 337 7050, E-mail: syale@mcw.edu

Acknowledgments

Michelle Mourad, MD for innovation and support of adaptation and use of the diagnostic time-out in the pediatric inpatient setting.

Research funding: None declared.
Author contribution: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The local Institutional Review Board deemed the study exempt from review.

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Received: 2022-02-01

Revised: 2022-02-26

Accepted: 2022-03-21

Published Online: 2022-04-14

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Articles in the same Issue

https://doi.org/10.1515/dx-2022-0010

Keywords for this article

diagnostic error; diagnostic time-out; pediatrics