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1. Contributors

Author

Omar Ali, Louella B. Amos, Bethany Auble, Donald Basel, Shannon H. Baumer-Mouradian, Ashley Beattie, Geetanjali Bora, Brett J. Bordini, Brian R. Branchford, Amanda M. Brandow, Ryan Byrne, Gisela G. Chelimsky, Thomas C. Chelimsky, Paula Cody, Gary Cohen, Deborah M. Costakos, Emily M. Densmore, John C. Densmore, Patricia A. Donohoue, Amy L. Drendel, Garrett Elsner, Raquel Farias-Moeller, Shayne D. Fehr, Susan Feigelman, Veronica H. Flood, Jessica Francis, Julia Fritz, Sandra Gage, Bhaskar Gurram, Matthew M. Harmelink, Kristen E. Holland, Stephen R. Humphrey, Anna R. Huppler, Susan L. Jarosz, S. Anne Joseph, Alvina R. Kansra, Virginia Keane, Robert M. Kliegman, Julie M. Kolinski, Chamindra G. Konersman, Kathleen A. Koth, Katja Kovacic, Amornluck Krasaelap, John V. Kryger, Sara M. Lauck, Tracey H. Liljestrom, Ahmad Marashly, Seema Menon, Adrian Miranda, Michelle L. Mitchell, Amy Moskop, Michael Muriello, James J. Nocton, Joshua Noe, Cynthia G. Pan, Andrew N. Pelech, Brittany Player, Jacquelyn M. Powers, Angela L. Rabbitt, Amanda Rogers, John M. Routes, Mark Simms, Rajasree Sreedharan, Alyssa Stephany, Julie Talano, Grzegorz W. Telega, Heather Toth, Scott K. Van Why, Sarah Vepraskas, James W. Verbsky, Bernadette Vitola, Kevin D. Walter, Michael Weisgerber, Peter M. Wolfgram, Sarah C. Yale, and Alicia C. Zolkoske

Published
2023
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3. A pause in pediatrics: implementation of a pediatric diagnostic time-out

Author

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

Subjects
Health Policy, Data Collection, Biochemistry (medical), Clinical Biochemistry, Public Health, Environmental and Occupational Health, Medicine (miscellaneous), Heuristics, Humans, Prospective Studies, Diagnostic Errors, Child, Pediatrics
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.

Published
2022

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