Assessing the Revised Safer Dx Instrument ® in the understanding of ambulatory system design changes for type 1 diabetes and autism spectrum disorder in pediatrics.

Autor:	Brady PW; 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.; James M. Anderson Center for Health Systems Excellence, 12303 Cincinnati Children's Hospital , Cincinnati, OH, USA., Ruddy RM; Department of Pediatrics, 12303 University of Cincinnati College of Medicine , Cincinnati, OH, USA.; Division of Emergency Medicine, 12303 Cincinnati Children's Hospital , Cincinnati, OH, USA., Ehrhardt J; Division of Development and Behavioral Pediatrics, 12303 Cincinnati Children's Hospital , Cincinnati, OH, USA., Corathers SD; Division of Hospital Medicine, 12303 Cincinnati Children's Hospital , Cincinnati, OH, USA.; James M. Anderson Center for Health Systems Excellence, 12303 Cincinnati Children's Hospital , Cincinnati, OH, USA.; Division of Endocrinology, 12303 Cincinnati Children's Hospital , Cincinnati, OH, USA., Kirkendall ES; Department of Pediatrics, 12279 Wake Forest School of Medicine , Winston-Salem, NC, USA.; Center for Healthcare Innovation, 12279 Wake Forest School of Medicine , Winston-Salem, NC, USA., Walsh KE; Department of General Pediatrics, Harvard Medical School, Boston, MA, USA.; Division of General Pediatrics, 1811 Boston Children's Hospital ,, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	Diagnosis (Berlin, Germany) [Diagnosis (Berl)] 2024 Mar 25; Vol. 11 (3), pp. 266-272. Date of Electronic Publication: 2024 Mar 25 (Print Publication: 2024).
DOI:	10.1515/dx-2023-0166
Abstrakt:	Objectives: 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). Methods: 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. Results: 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. Conclusions: 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. (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)
Databáze:	MEDLINE
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