Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-28T18:56:38.914Z Has data issue: false hasContentIssue false
  • English
  • Français

Diagnostic errors in paediatric cardiac intensive care

Published online by Cambridge University Press:  07 February 2018

Priya N. Bhat Open the ORCID record for Priya N. Bhat [Opens in a new window] ,
John M. Costello ,
Ranjit Aiyagari ,
Paul J. Sharek ,
Claudia A. Algaze ,
Mjaye L. Mazwi ,
Stephen J. Roth  and
Andrew Y. Shin
Priya N. Bhat
Affiliation:
Department of Pediatrics, Divisions of Pediatric Cardiology and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
John M. Costello
Affiliation:
Department of Pediatrics, Divisions of Pediatric Cardiology and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Ranjit Aiyagari
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
Paul J. Sharek
Affiliation:
Department of Pediatrics, Division of Hospitalist Medicine, Stanford University School of Medicine, Palo Alto, California, USA
Claudia A. Algaze
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
Mjaye L. Mazwi
Affiliation:
Department of Pediatrics, Divisions of Pediatric Cardiology and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Stephen J. Roth
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
Andrew Y. Shin*
Affiliation:
Department of Pediatrics, Division of Hospitalist Medicine, Stanford University School of Medicine, Palo Alto, California, USA Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
*
Author for correspondence: A. Shin, MD, Stanford Children's Health, 750 Welch Road, Suite 305, Palo Alto, CA 94304, Unites States of America; Tel: +1 650 725 8261; Fax: +1 650 725 8343; E-mail: drewshin@stanford.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Diagnostic errors cause significant patient harm and increase costs. Data characterising such errors in the paediatric cardiac intensive care population are limited. We sought to understand the perceived frequency and types of diagnostic errors in the paediatric cardiac ICU.

Methods

Paediatric cardiac ICU practitioners including attending and trainee physicians, nurse practitioners, physician assistants, and registered nurses at three North American tertiary cardiac centres were surveyed between October 2014 and January 2015.

Results

The response rate was 46% (N=200). Most respondents (81%) perceived that diagnostic errors harm patients more than five times per year. More than half (65%) reported that errors permanently harm patients, and up to 18% perceived that diagnostic errors contributed to death or severe permanent harm more than five times per year. Medication side effects and psychiatric conditions were thought to be most commonly misdiagnosed. Physician groups also ranked pulmonary overcirculation and viral illness to be commonly misdiagnosed as bacterial illness. Inadequate care coordination, data assessment, and high clinician workload were cited as contributory factors. Delayed diagnostic studies and interventions related to the severity of the patient’s condition were thought to be the most commonly reported process breakdowns. All surveyed groups ranked improving teamwork and feedback pathways as strategies to explore for preventing future diagnostic errors.

Conclusions

Paediatric cardiac intensive care practitioners perceive that diagnostic errors causing permanent harm are common and associated more with systematic and process breakdowns than with cognitive limitations.

Keywords

Diagnostic errorspaediatric intensive care
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 5 , May 2018 , pp. 675 - 682
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Newman-Toker, DE, Pronovost, PJ. Diagnostic errors – the next frontier for patient safety. JAMA 2009; 301: 1060–1062.CrossRefGoogle ScholarPubMed
2. Leape, LL, Berwick, DM, Bates, DW. JAMA 2002; 288: 2405.CrossRefGoogle Scholar
3. Winters, B, Custer, J, Galvagno, SM Jr, et al. Diagnostic errors in the intensive care unit: a systematic review of autopsy studies. BMJ Qual Saf 2012; 21: 894–902.Google Scholar
4. Leape, LL, Brennan, TA, Laird, N, et al. The nature of adverse events in hospitalized patients. N Engl J Med 1991; 324: 377–384.CrossRefGoogle ScholarPubMed
5. Gandhi, TK, Kachalia, A, Thomas, EJ, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med 2006; 145: 488–496.Google Scholar
6. Tehrani, SS, Lee, H, Mathews, SC, et al. 25-Year summary of US malpractice claims for diagnostic errors 1986-2010: an analysis from the National Practitioner Data Bank. BMJ Qual Saf 2013; 22: 672–680.Google Scholar
7. McAbee, GN, Donn, SM, Mendelson, RA, et al. Medical diagnoses commonly associated with pediatric malpractice lawsuits in the United States. Pediatrics 2008; 122: e1282–e1286.Google Scholar
8. Carroll, AE, Buddenbaum, JL. Malpractice claims involving pediatricians: epidemiology and etiology. Pediatrics 2007; 120: 10–17.CrossRefGoogle ScholarPubMed
9. Balogh, EP, Miller, BT, Ball, JR, Eds. Improving Diagnosis in Health Care. The National Academies Press, Washington, DC, 2015.CrossRefGoogle Scholar
10. Graber, ML, Franklin, N, Gordon, R. Diagnostic error in internal medicine. Arch Intern Med 2005; 165: 1493–1499.Google Scholar
11. Schiff, GD, Hasan, O, Kim, S, et al. Diagnostic error in medicine. Arch Intern Med 2009; 169: 1881–1887.Google Scholar
12. Custer, J, Winters, B, Goode, V, et al. Diagnostic errors in the pediatric and neonatal ICU: a systematic review. Pediatr Crit Care Med 2015; 16: 29–36.Google Scholar
13. Shojania, KG, Burton, EC, McDonald, KM, et al. Changes in rates of autopsy-detected diagnostic errors over time. JAMA 2003; 289: 2849–2856.Google Scholar
14. Singh, H, Thomas, EJ, Wilson, L, et al. Errors of diagnosis in pediatric practice: a multisite survey. Pediatrics 2010; 126: 70–79.CrossRefGoogle Scholar
15. Amaral, F, Granzotti, JA. Initial diagnostic errors in children suspected of having heart disease. prevalence and long-term consequences. Arq Bras Cardiol 2003; 81: 152–155.Google Scholar
16. Taggart, NW, Haglund, CM, Tester, DJ, et al. Diagnostic miscues in congenital long-QT syndrome. Circulation 2007; 115: 2613–2620.CrossRefGoogle ScholarPubMed
17. Benavidez, OJ, Gavreau, K, Jenkins, KJ, et al. Diagnostic errors in pediatric echocardiography: development of taxonomy and identification of risk factors. Circulation 2008; 117: 2995–3001.Google Scholar
18. Ng, B, Hokanson, J. Missed congenital heart disease in neonates. Congenit Heart Dis 2010; 5: 292–296.Google Scholar
19. Jacques, F, Anand, V, Hickey, E, et al. Medical errors: the performance gap in hypoplastic left heart syndrome and physiologic equivalents? J Thorac Cardiovasc Surg 2013; 145: 1465–1475.Google Scholar
20. Chang, RK, Gurvitz, M, Rodriguez, S. Missed diagnosis of critical congenital heart disease. Arch Pediatr Adolesc Med 2008; 162: 969–974.Google Scholar
21. Hansen, ML, Gunn, PW, Kaelber, DC. Underdiagnosis of hypertension in children and adolescents. JAMA 2007; 298: 874–879.CrossRefGoogle ScholarPubMed
22. Saraf, RP, Suresh, PV, Maheshwari, S, et al. Pediatric echocardiograms performed at primary centers: Diagnostic errors and missing links!. Ann Pediatr Cardiol 2015; 8: 20–24.Google Scholar
23. Cifra, CL, Jones, KL, Ascenzi, J, et al. Diagnostic errors in a PICU: insights from the morbidity and mortality conference. Pediatr Crit Care Med 2015; 16: 468–476.Google Scholar
24. Goldstein, B, Metlay, L, Cox, C, et al. Association of pre mortem diagnosis and autopsy findings in pediatric intensive care unit versus emergency department versus ward patients. Crit Care Med 1996; 24: 683–686.Google Scholar
25. Davalos, MC, Samuels, K, Meyer, AND, et al. Finding diagnostic errors in children admitted to the PICU. Pediatr Crit Care Med 2017; 18: 265–271.Google Scholar
26. Thiagarajan, RR, Bird, GL, Harrington, K, et al. Improving safety for children with cardiac disease. Cardiol Young 2007; 17 (Suppl 2): 127–132.CrossRefGoogle ScholarPubMed
27. Graber, ML. The incidence of diagnostic error in medicine. BMJ Qual Saf 2013; 22: ii21–ii27.Google Scholar
28. Singh, H, Sittig, DF. Advancing the science of measurement of diagnostic errors in healthcare: the Safer Dx framework. BMJ Qual Saf 2015; 24: 103–110.CrossRefGoogle ScholarPubMed
29. Schiff, GD, Kim, S, Abrams, R, et al. Diagnosing Diagnosis Errors: Lessons from a Multi-institutional Collaborative Project. Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology). Agency for Healthcare Research and Quality (US), Rockville, MD, 2005.Google Scholar
30. Shin, AY, Jin, B, Hao, S, et al. Utility of clinical biomarkers to predict central line-associated bloodstream infections after congenital heart surgery. Pediatr Infect Dis J 2015; 34: 251–254.Google Scholar
31. Gerber, JS, Newland, JG, Coffin, SE, et al. Variability in antibiotic use at children’s hospitals. Pediatrics 2010; 126: 1067–1073.Google Scholar
32. Maher, KO, Chang, AC, Shin, A, et al. Innovation in pediatric cardiac intensive care: an exponential convergence toward transformation of care. World J Pediatr Congenit Heart Surg 2015; 6: 588–596.Google Scholar
33. Bronicki, RA, Chang, AC. Management of the postoperative pediatric cardiac surgical patient. Crit Care Med 2011; 39: 1974–1984.CrossRefGoogle ScholarPubMed
34. Mazwi, ML, Brown, DW, Marshall, AC, et al. Unplanned reinterventions are associated with postoperative mortality in neonates with critical congenital heart disease. J Throac Cardiovasc Surg 2013; 145: 671–677.Google Scholar
35. Thammasitboon, S, Cutrer, WB. Diagnostic decision-making and strategies to improve diagnosis. Curr Probl Pediatr Adolesc Health Care 2013; 43: 232–241.Google Scholar
36. Wilson, KA, Burke, CS, Priest, HA, et al. Promoting health care safety through training high reliability teams. Qual Saf Health Care 2005; 14: 303–309.Google Scholar
37. Weick, KE, Sutcliffe, KM. Managing the Unexpected: Resilient Performance in an Age of Uncertainty, 2nd ed. Jossey-Bass, San Francisco, USA, 2007.Google Scholar
38. Hartzband, P, Groopman, J. Off the record- avoiding the pitfalls of going electronic. N Engl J Med 2008; 358: 1656–1658.Google Scholar
39. Welke, KF, O’Brien, SM, Peterson, ED, et al. The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database. J Thorac Cardiovasc Surg 2009; 137: 1133–1140.Google Scholar
40. Preston, L, Turner, J, Booth, A, et al. Is there a relationship between surgical case volume and mortality in congenital heart disease services? A rapid evidence review. BMJ Open 2015; 5: e009252.Google Scholar
41. Pasquali, SK, Jacobs, JP, He, X, et al. The complex relationship between center volume and outcome in patients undergoing the Norwood operation. Ann Thorac Surg 2012; 93: 1556–1562.Google Scholar
42. Källberg, AS, Ehrenberg, A, Florin, J, Östergren, J, Göransson, K. Physicians’ and nurses’ perceptions of patient safety risks in the emergency department. Int Emerg Nurs 2017; 33: 14–19.Google Scholar
43. Sklar, DP, Crandall, CS, Zola, T, Cunningham, R. Emergency physician perceptions of patient safety risks. Ann Emerg Med 2010; 55: 336–340.Google Scholar
44. Magid, DJ, Sullivan, AF, Cleary, PD, et al. The safety of emergency care systems: results of a survey of clinicians in 65 US emergency departments. Ann Emerg Med 2009; 53: 715–723.Google Scholar
45. Bowie, P, Halley, L, Blamey, A, Gillies, J, Houston, N. Qualitative evaluation of the Safety and Improvement in Primary Care (SIPC) pilot collaborative in Scotland: perceptions and experiences of participating care teams. BMJ Open 2016; 6: e009526.Google Scholar
46. Thomas, DB, Newman-Toker, DE. Diagnosis is a team sport- partnering with allied health professionals to reduce diagnostic errors. Diagnosis (Berl) 2016; 3: 49–59.Google Scholar
Supplementary material: PDF

Bhat et al. supplementary material 1

Bhat et al. supplementary material

Download Bhat et al. supplementary material 1(PDF)
PDF 436 KB