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A pause in pediatrics: implementation of a pediatric diagnostic time-out. Diagnosis (Berl) 2022 Aug 01;9(3):348-351

Date

04/14/2022

Pubmed ID

35417931

DOI

10.1515/dx-2022-0010

Scopus ID

2-s2.0-85129674062

Abstract

OBJECTIVES: Diagnostic errors are frequently the product of cognitive biases that arise when heuristic-based approaches fail. The efficiency-thoroughness tradeoff (ETTO) principle states sacrificing thoroughness for efficiency is normal and occurs frequently in medicine. The goal of a diagnostic timeout was to provide an actionable template for when providers transition to an analytical mindset and to help incorporate the ETTO principle during the diagnostic process.

METHODS: A diagnostic time-out was adapted for use in pediatric hospital medicine (PHM). In this prospective study, a group of eight PHM providers piloted the time-out in the hospitalized setting. Data was collected over 12 months and descriptive statistics were used for analysis.

RESULTS: Cases were most frequently chosen for time-out use due to clinician intuition. In more than half the cases the time-out didn't confirm the initial diagnosis and alternate diagnoses for the wrong diagnosis were pursued. There was only one case of the time-out being burdensome from a time perspective. Learners participated in all cases. As a result of the diagnostic time-out, new actions were taken in all cases.

CONCLUSIONS: Implementation of a diagnostic time out provides an actionable template for providers to actively change their mindset to an analytical thinking process to counteract cognitive biases and potentially reduce diagnostic errors in the pediatric inpatient setting.

Author List

Yale SC, Cohen SS, Kliegman RM, Bordini BJ

Authors

Susan Cohen MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Sarah Yale MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Child
Data Collection
Diagnostic Errors
Heuristics
Humans
Pediatrics
Prospective Studies