RT Journal Article
SR Electronic
T1 Declaring Uncertainty: Using Quality Improvement Methods to Change the Conversation of Diagnosis
JF Hospital Pediatrics
JO hosppeds
FD American Academy of Pediatrics
SP 334
OP 341
DO 10.1542/hpeds.2020-000174
VO 11
IS 4
A1 Ipsaro, Anna J.
A1 Patel, Shivani J.
A1 Warner, Dane C.
A1 Marshall, Trisha L.
A1 Chan, Steven T.
A1 Rohrmeier, Katherine
A1 Richardson, Deborah
A1 Kammer, Amanda
A1 Luksic, Emily
A1 Bell, Kathleen D.
A1 Hagedorn, Philip A.
YR 2021
UL http://hosppeds.aappublications.org/content/11/4/334.abstract
AB BACKGROUND: Diagnostic uncertainty may be a sign that a patient’s working diagnosis is incorrect, but literature on proactively identifying diagnostic uncertainty is lacking. Using quality improvement methodologies, we aimed to create a process for identifying patients with uncertain diagnoses (UDs) on a pediatric inpatient unit and communicating about them with the interdisciplinary health care team.METHODS: Plan-do-study-act cycles were focused on interdisciplinary communication, structured handoffs, and integration of diagnostic uncertainty into the electronic medical record. Our definition of UD was as follows: “you wouldn’t be surprised if the patient had a different diagnosis that required a change in management.” The primary measure, which was tracked on an annotated run chart, was percentage agreement between the charge nurse and primary clinician regarding which patients had a UD. Secondary measures included the percentage of patient days during which patients had UDs. Data were collected 3 times daily by text message polls.RESULTS: Over 13 months, the percentage agreement between the charge nurse and primary clinician about which patients had UDs increased from a baseline of 19% to a median of 84%. On average, patients had UDs during 11% of patient days.CONCLUSIONS: We created a novel and effective process to improve shared recognition of patients with diagnostic uncertainty among the interdisciplinary health care team, which is an important first step in improving care for these patients.