Brady Patrick W, Ruddy Richard M, Ehrhardt Jennifer, Corathers Sarah D, Kirkendall Eric S, Walsh Kathleen E
Division of Hospital Medicine, 12303 Cincinnati Children's Hospital , Cincinnati, OH, USA.
Department of Pediatrics, 12303 University of Cincinnati College of Medicine , Cincinnati, OH, USA.
Diagnosis (Berl). 2024 Mar 25;11(3):266-272. doi: 10.1515/dx-2023-0166. eCollection 2024 Aug 1.
We sought within an ambulatory safety study to understand if the Revised Safer Dx instrument may be helpful in identification of diagnostic missed opportunities in care of children with type 1 diabetes (T1D) and autism spectrum disorder (ASD).
We reviewed two months of emergency department (ED) encounters for all patients at our tertiary care site with T1D and a sample of such encounters for patients with ASD over a 15-month period, and their pre-visit communication methods to better understand opportunities to improve diagnosis. We applied the Revised Safer Dx instrument to each diagnostic journey. We chose potentially preventable ED visits for hyperglycemia, diabetic ketoacidosis, and behavioral crises, and reviewed electronic health record data over the prior three months related to the illness that resulted in the ED visit.
We identified 63 T1D and 27 ASD ED visits. Using the Revised Safer Dx instrument, we did not identify any potentially missed opportunities to improve diagnosis in T1D. We found two potential missed opportunities (Safer Dx overall score of 5) in ASD, related to potential for ambulatory medical management to be improved. Over this period, 40 % of T1D and 52 % of ASD patients used communication prior to the ED visit.
Using the Revised Safer Dx instrument, we uncommonly identified missed opportunities to improve diagnosis in patients who presented to the ED with potentially preventable complications of their chronic diseases. Future researchers should consider prospectively collected data as well as development or adaptation of tools like the Safer Dx.
在一项门诊安全研究中，我们试图了解修订后的“更安全诊断”工具是否有助于识别1型糖尿病（T1D）和自闭症谱系障碍（ASD）患儿护理过程中的诊断遗漏机会。
我们回顾了在我们三级医疗中心所有T1D患者两个月的急诊科就诊情况，以及15个月期间ASD患者此类就诊情况的样本，及其就诊前的沟通方式，以更好地了解改善诊断的机会。我们将修订后的“更安全诊断”工具应用于每个诊断过程。我们选择了因高血糖、糖尿病酮症酸中毒和行为危机而可能可预防的急诊科就诊病例，并回顾了与导致此次急诊科就诊的疾病相关的前三个月电子健康记录数据。
我们确定了63例T1D患者和27例ASD患者的急诊科就诊病例。使用修订后的“更安全诊断”工具，我们未发现T1D患者中有任何可能遗漏的改善诊断的机会。我们在ASD患者中发现了两个潜在的遗漏机会（“更安全诊断”总分5分），与门诊医疗管理有待改善的可能性有关。在此期间，40%的T1D患者和52%的ASD患者在急诊科就诊前进行了沟通。
使用修订后的“更安全诊断”工具，我们很少发现患有慢性疾病潜在可预防并发症并前往急诊科就诊的患者存在遗漏的改善诊断机会。未来的研究人员应考虑前瞻性收集的数据，以及开发或改编像“更安全诊断”这样的工具。
