Errors of Diagnosis in Pediatric Practice: A Multisite Survey

We surveyed pediatricians to elicit their perceptions regarding frequency, contributing factors, and potential system- and provider-based solutions to address diagnostic errors. Academic, community, and trainee pediatricians (N = 1362) at 3 tertiary care institutions and 109 affiliated clinics were...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2010-07, Vol.126 (1), p.70-79
Main Authors: SINGH, Hardeep, THOMAS, Eric J, WILSON, Lindsey, ADAM KELLY, P, PIETZ, Kenneth, ELKEEB, Dena, SINGHAL, Geeta
Format: Article
Language:English
Subjects:
Adolescent
Attitude of Health Personnel
Biological and medical sciences
Child
Child, Preschool
Clinical Competence
Company distribution practices
Delayed Diagnosis - statistics & numerical data
Diagnostic errors
Diagnostic Errors - prevention & control
Diagnostic Errors - statistics & numerical data
Distribution
Fault diagnosis
Female
General aspects
Health Care Surveys
Health participants
Humans
Incidence
Infant
Linear Models
Male
Medical errors
Medical malpractice
Medical sciences
Needs Assessment
Patient safety
Pediatricians
Pediatrics
Pediatrics - statistics & numerical data
Pediatrics - trends
Physicians
Polls & surveys
Population Surveillance
Practice Patterns, Physicians' - statistics & numerical data
Practice Patterns, Physicians' - trends
Probability
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Assessment
Surveys
Surveys and Questionnaires
United States
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Summary:We surveyed pediatricians to elicit their perceptions regarding frequency, contributing factors, and potential system- and provider-based solutions to address diagnostic errors. Academic, community, and trainee pediatricians (N = 1362) at 3 tertiary care institutions and 109 affiliated clinics were invited to complete the survey anonymously through an Internet survey administration service between November 2008 and May 2009. The overall response rate was 53% (N = 726). More than one-half (54%) of respondents reported that they made a diagnostic error at least once or twice per month; this frequency was markedly higher (77%) among trainees. Almost one-half (45%) of respondents reported diagnostic errors that harmed patients at least once or twice per year. Failure to gather information through history, physical examination, or chart review was the most-commonly reported process breakdown, whereas inadequate care coordination and teamwork was the most-commonly reported system factor. Viral illnesses being diagnosed as bacterial illnesses was the most-commonly reported diagnostic error, followed by misdiagnosis of medication side effects, psychiatric disorders, and appendicitis. Physicians ranked access to electronic health records and close follow-up of patients as strategies most likely to be effective in preventing diagnostic errors. Pediatricians reported making diagnostic errors relatively frequently, and patient harm from these errors was not uncommon.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2009-3218