Table 5.
Respondents Ranking of Most Common Contributory Factors of Diagnostic Errors in Pediatrics*
| Total (n=727) | Trainee (n=291) | Academic Pediatrician (n=289) | Community Pediatrician (n=165) | |||||
|---|---|---|---|---|---|---|---|---|
| n (%) | Ave. rank | n (%) | Ave. rank | n (%) | Ave. rank | n (%) | Ave. rank | |
| Types of Factors Involved | ||||||||
| System-related errors, organizational issues or problems in communication | 573 (79) | 1.78 | 240 (82) | 1.91 | 213 (79) | 1.76 | 120 (73) | 1.59 |
| Interplay of cognitive and system-related factors | 562 (77) | 1.58 | 219 (75) | 1.58 | 219 (81) | 1.69 | 124 (75) | 1.39 |
| Cognitive errors (inadequate data gathering or faulty medical decision-making) | 524 (72) | 1.29 | 205 (70) | 1.20 | 195 (72) | 1.25 | 124 (75) | 1.51 |
| “No fault” errors (those involving rare disease or related to patient/caregiver nonadherence) | 321 (44) | 0.80 | 125 (43) | 0.73 | 105 (39) | 0.70 | 91 (55) | 1.07 |
| Types of System Factors Involved | ||||||||
| Inadequate care coordination, teamwork &/or communication across clinical sites/providers | 596 (82) | 2.17 | 237 (81) | 2.19 | 225 (83) | 2.23 | 134 (81) | 2.02 |
| Personnel issues (staffing, training/orientation) | 339 (47) | 0.87 | 141 (48) | 0.85 | 129 (48) | 0.90 | 69 (42) | 0.86 |
| Unavailability of resources (diagnostic testing) due to financial/insurance reasons | 219 (30) | 0.51 | 94 (32) | 0.58 | 68 (25) | 0.39 | 57 (35) | 0.56 |
| Inadequate information systems | 206 (28) | 0.49 | 77 (26) | 0.46 | 90 (33) | 0.57 | 39 (24) | 0.41 |
| Types of Cognitive Factors Involved | ||||||||
| Inadequate data gathering or work- up | 568 (78) | 1.70 | 214 (74) | 1.50 | 218 (80) | 1.78 | 136 (82) | 1.92 |
| Inadequate data assessment | 567 (78) | 1.63 | 228 (78) | 1.71 | 205 (76) | 1.57 | 134 (81) | 1.59 |
| Inadequate recognition of critical information previously documented in chart | 479 (66) | 1.22 | 180 (62) | 1.15 | 189 (70) | 1.27 | 110 (67) | 1.26 |
| Inadequate knowledge base | 312 (43) | 0.74 | 140 (48) | 0.87 | 102 (38) | 0.64 | 70 (42) | 0.68 |
| Types of Miscellaneous Factors Involved | ||||||||
| Time/workload issues | 457 (63) | 1.50 | 180 (62) | 1.51 | 169 (62) | 1.44 | 108 (65) | 1.61 |
| Inexperience of the provider | 348 (48) | 0.99 | 136 (47) | 0.92 | 136 (50) | 1.06 | 76 (46) | 0.98 |
| Language barriers | 289 (40) | 0.81 | 119 (41) | 0.85 | 115 (42) | 0.86 | 55 (33) | 0.65 |
| Health literacy of the patient/family | 243 (33) | 0.61 | 86 (30) | 0.55 | 91 (34) | 0.60 | 66 (40) | 0.73 |
*
The Friedman test showed significant differences among the ranked options (p < 0.0001)