Priorities for improving paediatric diagnosis: findings from a modified Delphi study
Irit R Rasooly, Katherine Wu, Meghan Galligan, Morgan Congdon, Anna Costello, Yasaman Fatemi, Courtney Gidengil, Joseph A Grubenhoff, Harry Hoar, Cara T Jefferies, Amarpreet Kaur, Jillian Krause, Prashant Mahajan, Sanjiv D Mehta, Jonathan G Sawicki, Trisha Marshall, Kenneth A Michelson, Ursula Nawab, Andrew P J Olson, Michael Perry, Grant Joseph Dat Chiu Shafer, Kathy N Shaw, Hardeep Singh, Kathleen Walsh, Christina L CifraBackground
Efforts to improve diagnosis should reflect the unique needs of children; however, there is no consensus on paediatric-specific priority areas.
Methods
An expert panel of 25 United States (US) paediatric diagnostic excellence researchers, patient safety leaders and family partners from 15 institutions participated in a modified Delphi panel. Panellists participated in generating a literature-derived list of topics relevant to improving diagnosis. Panellists then rated agreement on each topic as a research or operational improvement priority. Topics that achieved consensus (≥75% of panellists rating them as high priority) were subsequently rated based on feasibility for implementation at the respondent’s institution.
Results
Literature review identified 24 topics relevant to paediatric diagnostic safety and quality, which were expanded to 62 topics during the initial panel discussion and grouped into 25 survey topics. Consensus was reached on 6 topics as research priorities and 11 as operational improvement priorities. Of these, three were deemed highly feasible for research and three for operational improvement. Research priorities included: identifying paediatric conditions at high risk for diagnostic error, developing communication methods to enhance the diagnostic process and establishing diagnostic process feedback mechanisms. Operational improvement priorities included: identifying care delivery or health services scenarios at high risk for diagnostic error, establishing interdisciplinary, structured review of cases of diagnostic error and encouraging reporting of missed opportunities for improving diagnostic safety.
Conclusion
Experts successfully prioritised important and feasible topics in research and practice for improving paediatric diagnosis in US academic medical centres.