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Aldridge P, Baldock AJ, Baird J, Elson A, McGregor S. Recurrent themes from paediatric mortality and morbidity: a network perspective 2021-2023. Arch Dis Child 2024; 109:354-355. [PMID: 38233097 DOI: 10.1136/archdischild-2023-326633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Patrick Aldridge
- Frimley Park Hospital, Frimley Health NHS Foundation Trust, Frimley, UK
| | | | - Jim Baird
- Paediatrics, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Alex Elson
- Thames Valley & Wessex Operational Delivery Network, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah McGregor
- Thames Valley & Wessex Operational Delivery Network, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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2
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Krockow EM, Patel S, Roland D. Decision Challenges for Managing Acute Paediatric Infections: Implications for Antimicrobial Resistance. Antibiotics (Basel) 2023; 12:antibiotics12050828. [PMID: 37237731 DOI: 10.3390/antibiotics12050828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Overprescribing of antibiotics in paediatrics accounts for a significant proportion of inappropriate antibiotic use in human healthcare, thereby contributing to the global health emergency of antimicrobial resistance. Antimicrobial stewardship efforts are complicated by the unique social dynamics in paediatric healthcare, with a specific challenge being the prominent role of parents and carers who act as intermediaries between prescribers and paediatric patients. In this Perspective article concentrating on healthcare of the United Kingdom, we describe this complicated interplay of different decision stakeholders (patients, parents and prescribers), outline four dimensions of decision challenges (social, psychological, systemic and specific diagnostic and treatment challenges) and provide a number of theory-based strategies for supporting different stakeholders during the decision process, ultimately with the aim of improving antimicrobial stewardship. Key decision challenges for patients and carers include limited knowledge and experience of managing infections, which were exacerbated during the COVID-19 pandemic and frequently result in health anxiety and inappropriate health-seeking behaviours. Challenges for medical prescribers span societal pressures from prominent patient litigation cases, cognitive biases, and system pressures to specific diagnostic problems (e.g., age limitations of current clinical scoring systems). Strategies for mitigating decision challenges in paediatric infection management will need to include a range of context- and stakeholder-specific actions, including improvements of integrated care and public health education as well as better clinical decision tools and access to evidence-based guidelines.
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Affiliation(s)
- Eva M Krockow
- School of Psychology and Vison Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Sanjay Patel
- Department of Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton SO16 6YD, UK
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester LE1 5WW, UK
- SAPPHIRE Group, Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, UK
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3
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Rørbech JT, Jensen CS, Dreyer P, Herholdt-Lomholdt SM. Beyond objective measurements: Danish nurses' identification of hospitalized pediatric patients at risk of clinical deterioration - A qualitative study. J Pediatr Nurs 2022; 66:e67-e73. [PMID: 35710888 DOI: 10.1016/j.pedn.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/15/2022] [Accepted: 05/22/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE While the use of Pediatric Track and Trigger Tools as a standard to discriminate high level of urgency in pediatric care has received considerable attention, less focus has been given to other important factors such as nurses' clinical observations and judgement. The purpose of this study was to explore nurses' observational practice and focus on which non-measurable signs and symptoms nurses find important when identifying inpatient pediatric patients at risk of clinical deterioration. DESIGN AND METHODS This was an inductive qualitative study based on an interpretive description methodology. Data were obtained through participant observation of experienced nurses working in a Danish pediatric unit and focus group interviews with pediatric nurses. Field notes were taken, and focus group interviews were audio taped and transcribed. A thematic text condensation method was used to analyse data. RESULTS Findings revealed the following four main themes of non-measurable signs and symptoms that nurses find important when identifying children at risk of clinical deterioration: Colour and skin tone; sounds; movement patterns; behavioural signs. CONCLUSIONS This study suggest that pediatric patients show signs and symptoms that go beyond the objective measurements integrated in Pediatric Track and Trigger Tools and they should not be ignored as they are highly valuable to nurses who are responsible for observing inpatient pediatric patients at risk of clinical deterioration. IMPLICATIONS More empirical research on nurses' observational practice is recommended, especially research to identify the signs and symptoms - both measurable and non-measurable - that are significant to nurses at the bedside.
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Affiliation(s)
- Josefine Tang Rørbech
- Department of Paediatrics and Adolescent Medicine, Unit for Research and Development in Nursing for Children and Young People, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Claus Sixtus Jensen
- Department of Paediatrics and Adolescent Medicine, Unit for Research and Development in Nursing for Children and Young People, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Research Centre for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
| | - Pia Dreyer
- Professor in clinical nursing, Intensive care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
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Ndwiga C, Warren CE, Okondo C, Abuya T, Sripad P. Experience of care of hospitalized newborns and young children and their parents: A scoping review. PLoS One 2022; 17:e0272912. [PMID: 36037213 PMCID: PMC9423633 DOI: 10.1371/journal.pone.0272912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 07/28/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Several global initiatives put parent involvement at the forefront of enabling children's well-being and development and to promote quality of care for newborns and hospitalized young children aged 0-24 months. Scanty evidence on mistreatment such as delays or neglect and poor pain management among newborns exists, with even less exploring the experience of their parents and their hospitalized young children. To address this gap, authors reviewed research on experience of care for hospitalized young children and their parents, and potential interventions that may promote positive experience of care. METHODS A scoping review of English language articles, guidelines, and reports that addressed the experiences of care for newborns and sick young children 0-24 months in health facilities was conducted. Multiple databases: PubMed, PROSPERO, COCHRANE Library and Google Scholar were included and yielded 7,784 articles. Documents published between 2009 and November 2020, in English and with evidence on interventions that addressed family involvement and partnership in care for their sick children were included. RESULTS The scoping review includes 68 documents across 31 countries after exclusion. Mistreatment of newborns comprises physical abuse, verbal abuse, stigma and discrimination, failure to meet professional standards, poor rapport between providers and patients, poor legal accountability, and poor bereavement and posthumous care. No literature was identified describing mistreatment of hospitalized children aged 60 days- 24 months. Key drivers of mistreatment include under-resourced health systems and poor provider attitudes. Positive experience of care was reported in contexts of good parent-provider communication. Three possible interventions on positive experience of care for hospitalized young children (0-24 months) emerged: 1) nurturing care; 2) family centered care and 3) provider and parental engagement. Communication and counseling, effective provider-parental engagement, and supportive work environments were associated with reduced anxiety and stress for parents and hospitalized young children. Few interventions focused on addressing providers' underlying attitudes and biases that influence provider behaviors, and how they affect engaging with parents. CONCLUSION Limited evidence on manifestations of mistreatment, lack of respectful care, drivers of poor experience and interventions that may mitigate poor experience of care for hospitalized young children 0-24 months especially in low resource settings exists. Design and testing appropriate models that enhance socio-behavioral dimensions of care experience and promote provider-family engagement in hospitals are required.
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Affiliation(s)
| | | | | | | | - Pooja Sripad
- Population Council, Washington, DC, United States of America
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5
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Ramesh S, Ayres B, Eyck PT, Dawson JD, Reisinger HS, Singh H, Herwaldt LA, Cifra CL. Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit. Diagnosis (Berl) 2022; 9:379-384. [PMID: 35393849 PMCID: PMC9427695 DOI: 10.1515/dx-2021-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/08/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Intensivists and subspecialists often collaborate in diagnosing patients in the pediatric intensive care unit (PICU). Our objectives were to characterize critically ill children for whom subspecialty consultations were requested, describe consultation characteristics, and determine consultations' impact on PICU diagnosis. METHODS We performed a retrospective study using chart review in a single tertiary referral PICU including children admitted for acute illness. We collected data on patients with and without subspecialty consultations within the first three days of PICU admission and determined changes in PICU clinicians' diagnostic evaluation or treatment after consultations. RESULTS PICU clinicians requested 152 subspecialty consultations for 87 of 101 (86%) patients. Consultations were requested equally for assistance in diagnosis (65%) and treatment (66%). Eighteen of 87 (21%) patients with consultations had a change in diagnosis from PICU admission to discharge, 11 (61%) attributed to subspecialty input. Thirty-nine (45%) patients with consultations had additional imaging and/or laboratory testing and 48 (55%) had medication changes and/or a procedure performed immediately after consultation. CONCLUSIONS Subspecialty consultations were requested during a majority of PICU admissions. Consultations can influence the diagnosis and treatment of critically ill children. Future research should investigate PICU interdisciplinary collaborations, which are essential for teamwork in diagnosis.
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Affiliation(s)
- Sonali Ramesh
- Department of Pediatrics, BronxCare Health System, New York, NY, USA
| | - Brennan Ayres
- Touro College of Osteopathic Medicine, New York, NY, USA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA.,Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jeffrey D Dawson
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Heather Schacht Reisinger
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA.,Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Loreen A Herwaldt
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Christina L Cifra
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Sever Z, Schlapbach LJ, Jessup M, George S, Harley A. Parental and healthcare professional concern in the diagnosis of paediatric sepsis: a protocol for a prospective multicentre observational study. BMJ Open 2021; 11:e045910. [PMID: 34593484 PMCID: PMC8487187 DOI: 10.1136/bmjopen-2020-045910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/25/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Paediatric sepsis is a major contributor to morbidity and mortality worldwide. Assessing concern from parents and healthcare professionals to determine disease severity in a child evaluated for sepsis remains a field requiring further investigation. This study aims to determine the diagnostic accuracy of parental and healthcare professional concern in the diagnosis of children evaluated for sepsis. METHODS AND ANALYSIS This prospective multicentre observational study will be conducted over a 24-month period in the paediatric emergency department (ED) at two tertiary Australian hospitals. A cross-sectional survey design will be used to assess the level of concern in parents, nurses and doctors for children presenting to ED and undergoing assessment for sepsis. The primary outcome is a diagnosis of sepsis, defined as suspected infection plus organ dysfunction at time of survey completion. Secondary outcomes include suspected or proven infection and development of organ dysfunction, defined as a Paediatric Sequential Organ Failure Assessment Score >0, within 48 hours of presentation, paediatric intensive care unit admission, confirmed or probable bacterial infection independent of organ dysfunction, and hospital length of stay. ETHICS AND DISSEMINATION Ethics approval was obtained from Children's Health Queensland's Human Research Ethics Committee (HREC/17/QRCH/85). Findings will be shared with relevant stakeholders and disseminated via conferences and peer-reviewed journals TRIAL REGISTRATION NUMBER: WHO Universal Trial Number, U1111-1256-4537; ANZCTR number, ACTRN1262000134092.
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Affiliation(s)
- Zoe Sever
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Luregn J Schlapbach
- Child Health Research Centre and Paediatric Intensive Care Unit, The University of Queensland and Queensland Children's Hospital, Brisbane, Queensland, Australia
- Department of Intensive Care and Neonatology, Children's Research Center, University Children's Hospital Zürich, Zürich, Switzerland
| | - Melanie Jessup
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Shane George
- Departments of Emergency Medicine and Children's Critical Care Service, Gold Coast University Hospital, Southport, Queensland, Australia
- Faculty of Health, School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Amanda Harley
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Child Health Research Centre and Paediatric Intensive Care Unit, The University of Queensland and Queensland Children's Hospital, Brisbane, Queensland, Australia
- Departments of Emergency Medicine and Children's Critical Care Service, Gold Coast University Hospital, Southport, Queensland, Australia
- Critical Care Nursing Management Team, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Abstract
OBJECTIVES To summarize the literature on prevalence, impact, and contributing factors related to diagnostic error in the PICU. DATA SOURCES Search of PubMed, EMBASE, and the Cochrane Library up to December 2019. STUDY SELECTION Studies on diagnostic error and the diagnostic process in pediatric critical care were included. Non-English studies with no translation, case reports/series, studies providing no information on diagnostic error, studies focused on non-PICU populations, and studies focused on a single condition/disease or a single diagnostic test/tool were excluded. DATA EXTRACTION Data on research design, objectives, study sample, and results pertaining to the prevalence, impact, and factors associated with diagnostic error were abstracted from each study. DATA SYNTHESIS Using independent tiered review, 396 abstracts were screened, and 17 studies (14 full-text, 3 abstracts) were ultimately included. Fifteen of 17 studies (88%) had an observational research design. Autopsy studies (autopsy rates were 20-47%) showed a 10-23% rate of missed major diagnoses; 5-16% of autopsy-discovered diagnostic errors had a potential adverse impact on survival and would have changed management. Retrospective record reviews reported varying rates of diagnostic error from 8% in a general PICU population to 12% among unexpected critical admissions and 21-25% of patients discussed at PICU morbidity and mortality conferences. Cardiovascular, infectious, congenital, and neurologic conditions were most commonly misdiagnosed. Systems factors (40-67%), cognitive factors (20-3%), and both systems and cognitive factors (40%) were associated with diagnostic error. Limited information was available on the impact of misdiagnosis. CONCLUSIONS Knowledge of diagnostic errors in the PICU is limited. Future work to understand diagnostic errors should involve a balanced focus between studying the diagnosis of individual diseases and uncovering common system- and process-related determinants of diagnostic error.
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Affiliation(s)
- Christina L. Cifra
- Division of Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Jason W. Custer
- Division of Critical Care, Department of Pediatrics, University of Maryland, Baltimore, Maryland
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - James C. Fackler
- Division of Pediatric Anesthesia and Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Hetherington J, Jones I. What factors influence clinical decision making for paramedics when attending to paediatric emergencies in the community within one ambulance service trust? Br Paramed J 2021; 6:15-22. [PMID: 34335096 PMCID: PMC8312366 DOI: 10.29045/14784726.2021.6.6.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Children’s healthcare needs are complex and diverse. Paramedics are expected to respond to a range of emergency calls across the patient demographic spectrum and to make complex clinical decisions, whilst facing growing pressures to seek provisions of care for their patients within the community. Aim: This study looked to understand the lived experiences of paramedics when attending to paediatric patients, and what factors influenced decision making. Methods: A qualitative study employing semi-structured interviews, to collect and describe the lived experiences of participants. Participants were paramedics working for an ambulance service responding to calls in the community. Participants varied in experience and registrant level of education. Interview data were transcribed verbatim and analysed utilising inductive thematic analysis. Results: Education provoked the most discussion, with a desire for more knowledge and training to improve confidence when attending to patients with low acuity complaints. Confidence was found to be intrinsically linked to experience, with clinicians who were more exposed to paediatrics in their professional or personal life displaying more confidence when attending to this patient group. Emotion of clinicians and/or families contributes to the clinical decision-making process; coupled with a reliance on clinical guidelines, there is a high probability of a paediatric consultation resulting in conveyance to an emergency department. Provision of care was variable geographically, with largely negative experiences observed with attempts for community referrals.
Conclusions: Providing a focus of education more reflective of paramedics’ experiences will address some of the factors discussed by participants. Introducing innovative solutions such as developing guidelines for lower acuity conditions and the introduction of specialist roles could contribute to mitigating the barriers paramedics faced while improving the quality of care provided to paediatric patients. Barriers to confidence existing due to lack of exposure may well still exist, as would options to refer to community services.
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Chan TM, Mercuri M, Turcotte M, Gardiner E, Sherbino J, de Wit K. Making Decisions in the Era of the Clinical Decision Rule: How Emergency Physicians Use Clinical Decision Rules. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1230-1237. [PMID: 31789846 DOI: 10.1097/acm.0000000000003098] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Physicians are often asked to integrate clinical decision rules (CDRs) with their own cognitive processes to reach a diagnosis. Clinicians, researchers, and educators must understand these cognitive processes to evaluate and improve the diagnostic process. The authors sought to explore emergency physicians' diagnostic processes and to examine how they integrated CDRs into their reasoning using simulated cases (with chest pain or leg pain). METHOD From August 2015 to July 2016, 16 practicing emergency physicians from 3 teaching hospitals associated with McMaster University, Ontario, Canada, were interviewed via a novel "teach aloud" protocol. Six videos of simulated patients with chest pain, breathlessness, or leg discomfort were used as prompts for the physicians to demonstrate their diagnostic thinking. Using a constructivist grounded theory analysis, 3 investigators independently reviewed the interview transcripts, meeting regularly to discuss identified themes and subthemes until sufficiency was reached. RESULTS A model to describe how clinicians integrate their own decision making with CDRs was developed, showing that physicians engage in an iterative diagnostic process that repeatedly refines the differential diagnosis list. The steps in the diagnostic process were: refinement of the differential diagnosis, ordering a hierarchy of risk, the decision to test, choosing the tests, and interpreting test results. Physicians applied CDRs when they had already decided to test. CONCLUSIONS To date, CDRs assume a static, linear model of clinical decision making. Findings demonstrate that participants engaged in iterative and dynamic decision-making processes that changed throughout their patient encounter, contingent on multiple contextual features. Understanding these processes could inform future development of CDRs and educational strategies around these decision aids.
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Affiliation(s)
- Teresa M Chan
- T.M. Chan is associate professor, Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada, assistant dean, Program for Faculty Development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada, and adjunct scientist, McMaster Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
| | - Mathew Mercuri
- M. Mercuri is assistant professor, Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada, and senior research associate, African Centre for Epistemology and Philosophy of Science, Department of Philosophy, University of Johannesburg, Johannesburg, South Africa
| | - Michelle Turcotte
- M. Turcotte is a medical student, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Emily Gardiner
- E. Gardiner is resident physician, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan Sherbino
- J. Sherbino is professor, Division of Emergency Medicine, Department of Medicine, and assistant dean, McMaster Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
| | - Kerstin de Wit
- K. de Wit is assistant professor, Division of Emergency Medicine, Department of Medicine, and associate professor, Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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10
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Abstract
OBJECTIVES Diagnostic errors can harm critically ill children. However, we know little about their prevalence in PICUs and factors associated with error. The objective of this pilot study was to determine feasibility of record review to identify patient, provider, and work system factors associated with diagnostic errors during the first 12 hours after PICU admission. DESIGN Pilot retrospective cohort study with structured record review using a structured tool (Safer Dx instrument) to identify diagnostic error. SETTING Academic tertiary referral PICU. PATIENTS Patients 0-17 years old admitted nonelectively to the PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Four of 50 patients (8%) had diagnostic errors in the first 12 hours after admission. The Safer Dx instrument helped identify delayed diagnoses of chronic ear infection, increased intracranial pressure (two cases), and Bartonella encephalitis. We calculated that 610 PICU admissions are needed to achieve 80% power (α = 0.05) to detect significant associations with error. CONCLUSIONS Our pilot study found four patients with diagnostic error out of 50 children admitted nonelectively to a PICU. Retrospective record review using a structured tool to identify diagnostic errors is feasible in this population. Pilot data are being used to inform a larger and more definitive multicenter study.
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Pinnock R, McDonald J, Ritchie D, Durning SJ. Humans and machines: Moving towards a more symbiotic approach to learning clinical reasoning. MEDICAL TEACHER 2020; 42:246-251. [PMID: 31658842 DOI: 10.1080/0142159x.2019.1679361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Artificial intelligence is a growing phenomenon that is driving major changes to how we deliver healthcare. One of its most significant and challenging contributions is likely to be in diagnosis. Artificial intelligence is challenging the physician's exclusive role in diagnosis and in some areas, its diagnostic accuracy exceeds that of humans. We argue that we urgently need to consider how we will incorporate AI into our teaching of clinical reasoning in the undergraduate curriculum; students need to successfully navigate the benefits and potential issues of new and developing approaches to AI in clinical diagnosis. We offer a pedagogical framework for this challenging change to our curriculum.
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Affiliation(s)
- Ralph Pinnock
- Educational Unit, Dunedin School of Medicine, Otago University, Dunedin, New Zealand
| | - Jenny McDonald
- Centre for Learning & Research in Higher Education (CLeaR), University of Auckland, Auckland, New Zealand
| | - Darren Ritchie
- Dunedin School of Medicine, Otago University, Dunedin, New Zealand
| | - Steven J Durning
- Professor of Medicine and Pathology and Director Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Medicine and Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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12
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Affiliation(s)
- Damian Roland
- SAPPHIRE Group, Health Sciences, Centre for Medicine, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Hospitals, Leicester, UK
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13
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Roland D. Guideline developers are not the only experts: Utilising the FRAM method in sepsis pathways. BMC Med 2018; 16:213. [PMID: 30458769 PMCID: PMC6247527 DOI: 10.1186/s12916-018-1212-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 11/25/2022] Open
Abstract
Improving clinical outcomes and quality of care in diseases such as sepsis, which are heterogeneous in their presenting signs and symptoms, is a challenge. One approach is to utilise the Functional Analysis Resonance Method (FRAM), which enables systems to examine process and sociocontextual issues in treatment and management pathways. McNab et al. applied FRAM to group of primary care (family) practices to understand the barriers and enablers in the management of sepsis and determined a suite of possible interventions that might improve patient care. This commentary reviews the FRAM process and highlights some core issues for systems to consider when tackling diseases like sepsis.Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1164-x.
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Affiliation(s)
- Damian Roland
- SAPPHIRE, Health Sciences, University of Leicester, Leicester, LE1 7RH, UK. .,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK.
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