title: A national physician survey of diagnostic error in paediatrics.
abstract: This cross-sectional survey explored paediatric physician perspectives regarding diagnostic errors. All paediatric consultants and specialist registrars in Ireland were invited to participate in this anonymous online survey. The response rate for the study was 54 % (n = 127). Respondents had a median of 9-year clinical experience (interquartile range (IQR) 4-20 years). A diagnostic error was reported at least monthly by 19 (15.0 %) respondents. Consultants reported significantly less diagnostic errors compared to trainees (p value = 0.01). Cognitive error was the top-ranked contributing factor to diagnostic error, with incomplete history and examination considered to be the principal cognitive error. Seeking a second opinion and close follow-up of patients to ensure that the diagnosis is correct were the highest-ranked, clinician-based solutions to diagnostic error. Inadequate staffing levels and excessive workload were the most highly ranked system-related and situational factors. Increased access to and availability of consultants and experts was the most highly ranked system-based solution to diagnostic error.
  
  
  CONCLUSIONS
  We found a low level of self-perceived diagnostic error in an experienced group of paediatricians, at variance with the literature and warranting further clarification. The results identify perceptions on the major cognitive, system-related and situational factors contributing to diagnostic error and also key preventative strategies.
  
  
  BACKGROUND
  • Diagnostic errors are an important source of preventable patient harm and have an estimated incidence of 10-15 %. • They are multifactorial in origin and include cognitive, system-related and situational factors. What is New: • We identified a low rate of self-perceived diagnostic error in contrast to the existing literature. • Incomplete history and examination, inadequate staffing levels and excessive workload are cited as the principal contributing factors to diagnostic error in this study.
authors.affiliation: Department of Respiratory Medicine, Children's University Hospital, Temple Street, Dublin 1, Ireland. lucyperrem@gmail.com.
authors.forename: Lucy M
authors.initials: LM
authors.lastname: Perrem
authors.affiliation: Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Fanshawe
authors.affiliation: Department of Paediatrics, Midlands Regional Hospital Mullingar, Mullingar, County Westmeath, Ireland.
authors.forename: Farhana
authors.initials: F
authors.lastname: Sharif
authors.affiliation: Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
authors.forename: Annette
authors.initials: A
authors.lastname: Plüddemann
authors.affiliation: Department of Paediatrics, Mayo General Hospital, Castlebar, Co., Mayo, Ireland.
authors.forename: Michael B
authors.initials: MB
authors.lastname: O'Neill
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007494:Ireland; D008297:Male; D000072143:Pediatricians / Q000523:psychology*; D010372:Pediatrics / Q000706:statistics & numerical data; D057566:Self Report; D011795:Surveys and Questionnaires
keywords: Attitude of health personnel; Clinical competence; Diagnostic errors; Misdiagnosis; Physician practise patterns