| Different clinical approach or incomplete work-up |
13 (100) |
32 (42) |
Residents often described reliance on physical examination rather than tests (85% of responses from entire data set). “Given the prevalence of congenital heart disease, it is common to simultaneously treat patient for pneumonia and heart failure if they present with symptoms that are unclear.” “The decision was made by the Bolivian physician to treat . . . without test. I think given limitations and expense to family this does make the most sense.” |
| Negative patient outcome or death |
12 (92) |
19 (25) |
“The 1 unit of blood was all the family could afford [for the child with malaria complications], and the child died shortly thereafter.” “Unfortunately, because were unable to do a washout of his abdomen, he continued to be severely septic and died the following day.” –patient with shunt infection “There [was] no surfactant [and] limited ventilator support, so the chances for a positive outcome were nearly impossible.” |
| Delay in diagnosis |
6 (46) |
8 (11) |
“17-hydroxy levels [for neonate with ambiguous genitalia] were checked and sent [away] for results . . . gender and sex were pending when I left.” “8-year-old boy diagnosed with osteomyelitis after 3 weeks in the hospital when x-rays finally showed bony changes.” |
| LR leading to innovation or advocacy |
5 (38) |
11 (14) |
“I made a spacer out of a water bottle.” “6-month-old with severe shunt infection . . . we were unable to get an OR time so we did a shunt removal under ketamine sedation . . . Very unique experience.” “[The] visit was extremely motivating for me” and led me to “develop standardized” checklist for clinic. “[I] thought it was a clever use of the available technology that I hadn't thought of.” –using iron in scabies eradication. |
| Triage or patient transfer |
3 (23) |
6 (8) |
“Given 3 hypoxemic children with evolving disease, unreliable pulse oximetry checks, and only 2 oxygen concentrators, how do you decide which children to give O2? We chose the 2 with the greater hypoxemia and fortunately all children did well.” “The most impactful cases were those that involved navigating the geopolitical, psychosocial, and economic issues that were barriers to our patient's ability to access health care. These were the cases that involved the need for patients to be referred to outside hospitals for treatment abroad.” |
