Survey seeks keys to reducing pediatric diagnostic errors

HOUSTON — Electronic medical records, better follow-up care and more collaboration with patients and their families would help pediatricians avoid errors in diagnosing illnesses, said pediatricians surveyed as part of research led by Baylor College of Medicine and the Houston Veterans Affairs Health Services Research and Development Center of Excellence.

The work, which also included researchers from The University of Texas Health Science Center at Houston and Cincinnati Children’s Hospital Medical Center, will appear in the July issue of the journal Pediatrics and was published online Monday.

The team surveyed pediatricians from Houston and Cincinnati about errors in diagnosis. The Internet-based survey asked:

What types of errors in diagnosis they thought occurred most often in practice.

How frequently diagnostic errors and resultant patient harm, if any, occurred.

How and why such errors in diagnosis occur.

What measures could reduce errors in diagnosis.

“These responses have helped us look at what might make a pediatrician more vulnerable to misdiagnosing a patient,” said Dr. Geeta Singhal, corresponding author of the study and an assistant professor of pediatrics at BCM. “This survey is a good start to raise awareness about some of the issues we uncovered.”

The team found that about half of the physicians estimated that diagnostic errors occur relatively frequently (at least once or twice a month) but patient harm was less frequent (harm was estimated to occur at least once or twice a year by less than half). Residents (physicians in training) reported more frequent errors than pediatricians in practice.

The most common error was misdiagnosis of a viral illness as a bacterial illness. For example, Singhal said, a patient might receive antibiotics for what a physician thinks is strep throat, a bacterial infection. If the infection is caused by a virus, patients might receive unnecessary antibiotics, which is not only costly but can lead to possible side effects.

Need for better records, care coordination
Failure to gather information through history, physical examination or chart review was a major issue, the researchers wrote.

In addition to improved patient follow-up, the surveyed physicians thought that electronic medical records would improve diagnosis, Singhal said. This might relate to their benefits of better care coordination and information availability.

“Since this project was initiated (survey was administered between November 2008 and May 2009), major national changes related to electronic medical record use have occurred,” said Dr. Hardeep Singh, a lead author and assistant professor of medicine and health services research at the Veterans Affairs Health Services Research and Development Center of Excellence and BCM. “The federal government has now incentivized the use of these systems, and we are bound to see more physicians using them.”  

Improvement of medical school, resident curriculum
The researchers also noted most respondents said that they discussed their errors with their colleagues, although many reported they never received formal training specifically about diagnostic errors.  

“We need to raise awareness about this issue in a formal training environment,” said Singhal, who has a special interest in medical education. “We need to consider a medical school and resident curriculum specifically related to diagnostic errors and patient safety.”

Patient empowerment
The patient and parents or guardians can also play a role in helping prevent errors in diagnosis, Singhal said.

“The study showed us that as physicians, we also need to do more to empower our patients to be in control of their care,” said Singhal. “The patients, their families or caregivers and the pediatricians need to collaborate on this aspect.”

Singhal said helping patients and families and caregivers understand what questions to ask, how to communicate symptoms and discuss their medical history is important.    

In addition to Singhal and Singh, co-authors on the study include Dr. P. Adam Kelly, Dr. Kenneth Pietz and Lindsey Wilson, all with BCM and the Veterans Affairs Health Services Research and Development Center of Excellence; Dr. Eric Thomas, with the UT Houston Memorial Hermann Center for Healthcare Quality and Safety, and Dr. Dena Elkeeb with Cincinnati Children’s Hospital.

This study was supported by the National Institutes of Health. The study is available at http://pediatrics.aappublications.org/.