Improving diagnosis in pediatrics is an ongoing patient safety focus. This retrospective study included 129 pediatric emergency transfer cases and examined the relationship between missed opportunity for improvement in diagnosis (MOID; determined using SaferDx) and patient outcomes. Researchers found that MOID occurred in 29% of emergency transfer cases and it was associated with higher risk of mortality and longer post-transfer length of stay.

Diagnostic errors in pediatrics remain a significant focus of patient safety. This study uses two years of unplanned readmissions to a children’s hospital to identify missed opportunities for improving diagnosis (MOID). Clinician decision-making and diagnostic reasoning were identified as key factors for MOID. The authors recommend that future research include larger cohorts to identify populations and conditions at increased risk for MOID-related readmissions.

Missed diagnostic opportunities often involve multiple process breakdowns and can lead to serious avoidable patient harm. Based on a web-based survey of 1,594 emergency medicine physicians, missed diagnostic opportunities most frequently occur in children who present to the emergency department with undifferentiated symptoms (e.g., abdominal pain, fever, vomiting) and often involve issues related to the patient/parent-provider interaction, such as misinterpreting patient history or inadequate physical exam.

Children with emergent care needs are often cared for in complex situations that can diminish safety. This joint policy statement updates preceding recommendations to enhance the safety of care to children presenting at the emergency department. It expands on the application of topics within a high-reliability framework focusing on leadership, managerial factors, and organizational factors that support safety culture and workforce empowerment to support safe emergency care for children.

Effective team communication is a cornerstone to ensuring safe patient care, particularly during stressful situations. To evaluate baseline team communication behavior, clinicians at this institution participated in interprofessional video-recorded simulations of a code response and debriefing, followed by standardized evaluations by external reviewers. Evaluations indicate variable performance on different team communication behaviors (highest for escalating care and thinking out loud, lowest for verbally establishing leadership). The authors suggest that assessing baseline communication behaviors can guide future interventions to promote and improve quality and patient safety.

Diagnostic error is an ongoing patient safety challenge that can result in patient harm. This literature review identified a set of emergency department (ED)-focused electronic health record (EHR) triggers (e.g., death following ED visit, change in treating service after admission, unscheduled return to the ED resulting in admission) and non-EHR based signals (e.g., patient complaints, referral to risk management) with the potential to screen ED visits for diagnostic safety events.

Systemic racism is associated with suboptimal treatment of acute and chronic pain. In pediatric emergency department patients with long-bone fractures, minority children were more likely to receive analgesics and achieve at least a 2-point reduction in pain, but they were less likely to receive opioids and achieve optimal pain reduction.

Using data from a large commercial insurance claims database, this cohort study sought to identify factors associated with potentially missed appendicitis by comparing patients with a potentially missed diagnosis versus patients diagnosed with appendicitis on the same day in the emergency department. The researchers estimated the frequency of missed appendicitis was 6% among adults and 4.4% among children. Patients presenting with abdominal pain and constipation were more likely to have a missed diagnosis of appendicitis than patients presenting with isolated abdominal pain or abdominal pain with nausea and/or vomiting. Stratified analyses based on undifferentiated symptoms found that women and patients with comorbidities were more likely to have missed appendicitis.

… with nearly all being involved in QIPS administration, research or education upon graduation. Interviewed mentors … thought the fellowships were important and the resulting research had departmental, institutional and even national …

Pediatric emergency care presents unique safety challenges for a vulnerable patient population. This review summarizes emergency department (ED) improvement work across the six domains of quality. The authors suggest that pediatric EDs adopt high reliability concepts to enhance collaboration and data-sharing to improve safety. They also call for increased focus on equity and patient-centeredness.

The busy and complex emergency department environment harbors pressures can that hinder diagnostic safety. This review discusses the characteristics of emergency medicine that contribute to overreliance on heuristics and susceptibility to bias in decision making. The authors highlight the need to better monitor diagnostic error in the emergency department to inform the design of improvement activities. A previous WebM&M commentary discussed diagnostic delay in the emergency department.

Deviating from standard work processes has the potential to compromise safety. Using data from the Pediatric Emergency Care Applied Research Network, researchers analyzed incident reports determined to be process variance events. They found that 5.6% of events resulted in some form of temporary patient harm.

Emergency departments harbor conditions that can hinder safe medication administration for pediatric patients. This policy statement identifies and prioritizes improvements such as implementing kilogram-only weight-based dosing, involving pharmacists in frontline emergency care, and utilizing computerized provider order entry and clinical decision support systems.

… Pediatric emergency care … Pediatr Emerg Care … This study analyzed a database of … encountered in a regional pediatric emergency medicine network. Radiologic errors accounted for 7% of all incident …

… BMJ open … BMJ Open … This study of incident reports from pediatric emergency departments found that a small proportion reported …

… identified racial differences in pain management among pediatric patients with appendicitis. Compared to white … receive opioids for severe pain. … Goyal  MK, Kuppermann N, Cleary SD, et al. Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. 2015;169(11):996-1002. …

Leadership WalkRounds—derived from the business management approach of "management by walking around"—are being more widely used as a means of error detection and improving safety culture. This report from a children's hospital, in which structured walkrounds by nursing and physician leaders were implemented on six units, found that this approach increased staff engagement in safety efforts, identified hidden system flaws, and resulted in the successful implementation of multiple quality improvement projects. Although this study did not specifically measure the effect of walkrounds on safety climate, prior studies have found conflicting results, which might imply that different methods of performing walkrounds may influence their success.

Detailing how 22 pediatric emergency departments developed a process for sharing incident reports, this study describes the barriers that had to be overcome and the initial lessons learned from the project.

… Emergency medicine journal : EMJ … Emerg Med J … This study … characterizes the types of medication errors occurring in pediatric emergency departments (EDs), using data gathered …

… Pediatrics … Pediatrics … This survey of staff in 21 pediatric emergency departments found wide variations in perception of …