The Seamless Transitions and (Re)admissions Network (STARNet) met in December 2012 to synthesize ongoing hospital-to-home transition work, discuss goals, and develop a plan to centralize transition information in the future. STARNet participants consisted of experts in the field of pediatric hospital medicine quality improvement and research, and included physicians and key stakeholders from hospital groups, private payers, as well as representatives from current transition collaboratives. In this report, we (1) review the current knowledge regarding hospital-to-home transitions; (2) outline the challenges of measuring and reducing readmissions; and (3) highlight research gaps and list potential measures for transition quality. STARNet met with the support of the American Academy of Pediatrics' Quality Improvement Innovation Networks and the Section on Hospital Medicine.
Background
Diagnostic errors causing harm in children are understudied,
resulting in a knowledge gap regarding pediatricians’ interest in
reducing their incidence.
Methods
Electronic survey of general pediatricians focusing on diagnostic
error incidence, errors they were interested in trying to improve, and
errors reduced by their electronic health record (EHR).
Results
Of 300 contacted pediatricians, 77 (26%) responded, 58
(19%) served ambulatory patients, and 48 (16%) completed the
entire questionnaire. Of these 48, 17 (35%) reported making a
diagnostic error at least monthly, and 16 (33%) reported making a
diagnostic error resulting in an adverse event at least annually.
Pediatricians were “most” interested in “trying to
improve” missed diagnosis of hypertension (17%), delayed
diagnosis due to missed subspecialty referral (15%), and errors
associated with delayed follow-up of abnormal laboratory values
(13%). Among the 44 pediatricians with an EHR, 16 (36%) said
it reduced the likelihood of missing obesity and 14 (32%) said it
reduced the likelihood of missing hypertension. Also, 15 (34%) said
it helped avoid delays in follow-up of abnormal laboratory values. A third
(36%) reported no help in diagnostic error reduction from their
EHR.
Conclusions
Pediatricians self-report an appreciable number of diagnostic errors
and were most interested in preventing high frequency, non-life-threatening
errors. There exists a need to leverage EHRs to support error reduction
efforts.
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