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Acad Pediatr. 2018 Mar;18(2):220-227. doi: 10.1016/j.acap.2017.08.005. Epub 2017 Aug 10.

Diagnostic Errors in Primary Care Pediatrics: Project RedDE.

Author information

1
Department of Pediatrics, The Children's Hospital at Montefiore and the Albert Einstein College of Medicine, Bronx, NY. Electronic address: mrinke@montefiore.org.
2
Center for Innovations in Quality, Effectiveness and Safety, Michael E. Debakey Veterans Affairs Medical Center, Department of Medicine, Baylor College of Medicine, Houston, Tex.
3
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
4
Columbia University College of Physicians and Surgeons, New York, NY.
5
Department of Pediatrics, The Children's Hospital at Montefiore and the Albert Einstein College of Medicine, Bronx, NY.
6
A. Mandatory Inc, Ithaca, NY.
7
Johns Hopkins University School of Medicine, Baltimore, Md.
8
Vanderbilt University Medical Center, Nashville, Tenn.
9
Jersey Shore University Medical Center, Neptune, NJ; The American Academy of Pediatrics and Quality Improvement Innovation Networks, Elk Grove Village, Ill.
10
The American Academy of Pediatrics and Quality Improvement Innovation Networks, Elk Grove Village, Ill.
11
Medical University of South Carolina, Charleston, SC.

Abstract

OBJECTIVE:

Diagnostic errors (DEs), which encompass failures of accuracy, timeliness, or patient communication, cause appreciable morbidity but are understudied in pediatrics. Pediatricians have expressed interest in reducing high-frequency/subacute DEs, but their epidemiology remains unknown. The objective of this study was to investigate the frequency of two high-frequency/subacute DEs and one missed opportunity for diagnosis (MOD) in primary care pediatrics.

METHODS:

As part of a national quality improvement collaborative, 25 primary care pediatric practices were randomized to collect 5 months of retrospective data on one DE or MOD: elevated blood pressure (BP) and abnormal laboratory values (DEs), or adolescent depression evaluation (MOD). Relationships between DE or MOD proportions and patient age, gender, and insurance status were explored with mixed-effects logistic regression models.

RESULTS:

DE or MOD rates in pediatric primary care were found to be 54% for patients with elevated BP (n = 389), 11% for patients with abnormal laboratory values (n = 381), and 62% for adolescents with an opportunity to evaluate for depression (n = 400). When examining the number of times a pediatrician may have recognized an abnormal condition but either knowingly or unknowingly did not act according to recommended guidelines, providers did not document recognition of an elevated BP in 51% of patients with elevated BP, and they did not document recognition of an abnormal laboratory value without a delay in 9% of patients with abnormal laboratory values.

CONCLUSIONS:

DEs and MODs occur at an appreciable frequency in pediatric primary care. These errors may contribute to care delays and patient harm.

KEYWORDS:

depression; diagnostic errors; hypertension; laboratory; pediatrics

PMID:
28804050
PMCID:
PMC5809238
[Available on 2019-03-01]
DOI:
10.1016/j.acap.2017.08.005

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