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Diagnostic errors in paediatric cardiac intensive care

Published online by Cambridge University Press:  07 February 2018

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

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.

Type
Original Articles
Copyright
© Cambridge University Press 2018 

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