Missed Opportunities for Improving Diagnosis in Pediatric Emergency Care

项目概要： 在最近发布的报告《改善医疗诊断》中，医学研究所（IOM）强调， 大多数人一生中至少会经历一次诊断错误，有时会造成毁灭性的后果。 后果与其他医疗机构相比，在急诊科（ED）工作的临床医生 特别容易由于在忙碌中的时间紧迫的决策而做出诊断错误， 混乱的环境。除此之外，向儿童提供紧急护理因其独特的 需要，如基于体重的药物剂量，他们无法用语言表达他们的症状，往往，他们的 依赖父母/监护人，即使是在获得医疗保健方面。每年大约有2500万人 儿科艾德就诊。保守估计5%的患病率，转化为~ 1.25 百万潜在的诊断错误的儿科ED每年的情况下，迄今为止，还没有系统的 儿科急诊诊断错误的研究。 诊断错误，当定义为无法根据现有的诊断结果做出正确或及时的诊断时， 证据（即错过改善诊断或MOID的机会），已在成人中进行了研究， 门诊设置。我们的研究团队成员使用基于电子健康记录的触发器来检测 MOIDS和研究导致诊断错误的因素。 我们的长期目标是更好地了解儿科ED中的MOID，以最终降低其患病率。到 为了实现这一目标，在本项目中，我们将组建一个多学科专家小组，进行诊断决策 制定儿科急诊医学沿着患者/家庭咨询委员会，以制定儿科艾德 相关的模型来识别触发器，并随后使用它们来测量频率以及贡献 四个儿科急诊诊断错误的因素。 我们的项目是重要的，创新的，及时的，因为它将奠定基础，发展的错误 检测工具，可用于向临床医生提供及时反馈，跟踪机构或临床医生 性能，并衡量错误缓解策略的影响。

PROJECT SUMMARY: In its recently released report, "Improving Diagnosis in Health Care", the Institute of Medicine (IOM) highlighted that most individuals will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Compared to other healthcare settings, clinicians working in emergency departments (EDs) are particularly vulnerable to making diagnostic errors due to time-pressured decision-making in a busy and often chaotic environment. In addition to this, provision of emergency care to children is complicated by their unique needs such as weight-based dosing of medications, their inability to verbalize their symptoms and often, their dependence on parents/guardians even for accessing healthcare. There are approximately 25 million annual pediatric ED visits in the United States. A conservative estimate of 5% prevalence, translates into ~ 1.25 million potential annual cases of diagnostic errors in the pediatric ED. To date, there has been no systematic research on diagnostic errors in the pediatric emergencies. Diagnostic errors, when defined as the inability to make a correct or timely diagnosis based on available evidence (i.e. missed opportunities for improving diagnosis or MOIDs), have been investigated in adult, outpatient settings. Members of our research team have used electronic health record based triggers to detect MOIDs and study the factors that cause diagnostic errors. Our long-term goal is to better understand MOIDs in pediatric EDs to ultimately decrease their prevalence. To accomplish that, in this project, we will assemble a multidisciplinary panel of experts in diagnostic decision making, pediatric emergency medicine along with patient/family advisory boards to develop a pediatric ED relevant model to identify triggers and subsequently use them to measure the frequency as well as contributing factors of diagnostic errors in four pediatric EDs. Our project is significant, innovative, and timely because it will lay the foundation for development of error detection tools that can be used to provide timely feedback to clinicians, track institutional or clinician performance, and measure impact of error mitigation strategies.