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Use of e-triggers to identify diagnostic errors in the paediatric ED.
- Source :
- BMJ Quality & Safety; Oct2022, Vol. 31 Issue 10, p735-743, 9p
- Publication Year :
- 2022
-
Abstract
- Background Diagnostic errors (DxEs) are an understudied source of patient harm in children rarely captured in current adverse event reporting systems. Applying electronic triggers (e-triggers) to electronic health records shows promise in identifying DxEs but has not been used in the emergency department (ED) setting. Objectives To assess the performance of an e-trigger and subsequent manual screening for identifying probable DxEs among children with unplanned admission following a prior ED visit and to compare performance to existing incident reporting systems. Design/methods Retrospective single-centre cohort study of children ages 0-22 admitted within 14 days of a previous ED visit between 1 January 2018 and 31 December 2019. Subjects were identified by e-trigger, screened to identify cases where index visit and hospital discharge diagnoses were potentially related but pathophysiologically distinct, and then these screened-in cases were reviewed for DxE using the SaferDx Instrument. Cases of DxE identified by e-trigger were cross-referenced against existing institutional incident reporting systems. Results An e-trigger identified 1915 unplanned admissions (7.7% of 24 849 total admissions) with a preceding index visit. 453 (23.7%) were screened in and underwent review using SaferDx. 92 cases were classified as likely DxEs, representing 0.4% of all hospital admissions, 4.8% among those selected by e-trigger and 20.3% among those screened in for review. Half of cases were reviewed by two reviewers using SaferDx with substantial inter-rater reliability (Cohen's K=0.65 (95% CI 0.54 to 0.75)). Six (6.5%) cases had been reported elsewhere: two to the hospital's incident reporting system and five to the ED case review team (one reported to both). Conclusion An e-trigger coupled with manual screening enriched a cohort of patients at risk for DxEs. Fewer than 10% of DxEs were identified through existing surveillance systems, suggesting that they miss a large proportion of DxEs. Further study is required to identify specific clinical presentations at risk of DxEs. [ABSTRACT FROM AUTHOR]
- Subjects :
- APPENDICITIS diagnosis
DIAGNOSIS of brain diseases
MENINGITIS diagnosis
STATISTICS
MUSCULOSKELETAL system diseases
HOSPITAL emergency services
CONFIDENCE intervals
MEDICAL triage
PATHOLOGICAL physiology
CHILDREN'S hospitals
MULTIPLE regression analysis
CHILD abuse
PEDIATRICS
PATIENTS
RETROSPECTIVE studies
ACQUISITION of data
FISHER exact test
MANN Whitney U Test
HOSPITAL admission & discharge
RISK assessment
COMPARATIVE studies
PEARSON correlation (Statistics)
SEPSIS
INFECTION
DESCRIPTIVE statistics
RESEARCH funding
MEDICAL records
EMERGENCY medical services
CHI-squared test
DIAGNOSTIC errors
ELECTRONIC health records
HOSPITAL information systems
SOCIODEMOGRAPHIC factors
DATA analysis software
ODDS ratio
LONGITUDINAL method
DISCHARGE planning
CHILDREN
ADOLESCENCE
Subjects
Details
- Language :
- English
- ISSN :
- 20445415
- Volume :
- 31
- Issue :
- 10
- Database :
- Complementary Index
- Journal :
- BMJ Quality & Safety
- Publication Type :
- Academic Journal
- Accession number :
- 159776599
- Full Text :
- https://doi.org/10.1136/bmjqs-2021-013683