Declaring Uncertainty: Using Quality Improvement Methods to Change the Conversation of Diagnosis.

Autor:	Ipsaro AJ; Divisions of Hospital Medicine, anna.ipsaro@cchmc.org., Patel SJ; Divisions of Hospital Medicine.; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and., Warner DC; Divisions of Hospital Medicine.; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and., Marshall TL; Divisions of Hospital Medicine.; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and., Chan ST; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and.; Emergency Medicine, and., Rohrmeier K; Departments of Patient Services and., Richardson D; Departments of Patient Services and., Kammer A; Departments of Patient Services and., Luksic E; Departments of Patient Services and., Bell KD; Northeast Node, National Drug Abuse Treatment Clinical Trials Network, Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire., Hagedorn PA; Divisions of Hospital Medicine.; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and.; Biomedical Informatics and.; Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Jazyk:	angličtina
Zdroj:	Hospital pediatrics [Hosp Pediatr] 2021 Apr; Vol. 11 (4), pp. 334-341. Date of Electronic Publication: 2021 Mar 01.
DOI:	10.1542/hpeds.2020-000174
Abstrakt:	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. Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. (Copyright © 2021 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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