Table 2.
Factors Associated with Diagnostic Error in the Pediatric Intensive Care Unit
| Authors | Year | How Factors Contributing to Diagnostic Error Were Determined | Most Common Factors Associated with Diagnostic Error |
|---|---|---|---|
| Cognitive Factors | |||
| Bhat PN, et al. (20) | 2018 | Self-reported perceptions of pediatric cardiac ICU clinicians | Inadequate data assessment; Anchoring on one diagnosis; Provider inexperience |
| Cifra CL, et al. (15) | 2015 | Analysis at PICU morbidity and mortality conference | Problems in hypothesis generation (inadequate differential diagnoses) |
| Cifra CL, et al. (12) | 2018 | Retrospective chart review using a standard validated tool to determine occurrence of diagnostic error | Suboptimal diagnostic evaluations given available clinical information |
| Su L, et al. (21) | 2015 | Qualitative review of clinical videos in real time at the bedside | Unexpected clinical events; False reassurance from the presence of other clinicians; Lack of specialized knowledge |
| Fischer JE, et al. (22) | 2003 | Retrospective chart review | Conditions that can present along a spectrum of acuity (e.g., sepsis) |
| Systems Factors | |||
| Cifra CL, et al. (12) | 2018 | Retrospective chart review using a standard validated tool to determine occurrence of diagnostic error | Night shift admissions |
| Bhat PN, et al. (20) | 2018 | Self-reported perceptions of pediatric cardiac ICU clinicians | Delays in obtaining diagnostic studies due to inability to travel off-unit for unstable patients; Suboptimal care coordination related to deficiencies in communication and teamwork; Frequent interruptions to workflow |
| Combined Cognitive and Systems Factors | |||
| Avesar M, et al. (23) | 2019 | Analysis of clinician behavior during simulated clinical vignettes | Work environment and culture (systems) influence clinicians’ decisions to challenge existing diagnosis (cognitive) |
| Cifra CL, et al. (24) | 2017 | Analysis of ethnographic data (clinician observations and interviews) gathered during patient admission to the PICU | The characteristics of referral communication between clinicians, patterns of communication of patient data by trainees to intensivists, and manner in which health information technology organizes and presents clinical data (systems) influences intensivists’ diagnostic decision-making (cognitive) |
PICU - pediatric intensive care unit