Abstract
Few studies describe the impact of antimicrobial stewardship programs (ASPs) on recognizing and preventing diagnostic errors. Handshake stewardship (HS-ASP) is a novel ASP model that prospectively reviews hospital-wide antimicrobial usage with recommendations made in person to treatment teams. The purpose of this study was to determine if HS-ASP could identify and intervene on potential diagnostic errors for children hospitalized at a quaternary care children's hospital. Previously self-identified "Great Catch" (GC) interventions by the Children's Hospital Colorado HS-ASP team from 10/2014 through 5/2018 were retrospectively reviewed. Each GC was categorized based on the types of recommendations from HS-ASP, including if any diagnostic recommendations were made to the treatment team. Each GC was independently scored using the "Safer Dx Instrument" to determine presence of diagnostic error based on a previously determined cut-off score of≤1.50. Interrater reliability for the instrument was measured using a randomized subset of one third of GCs. During the study period, there were 162GC interventions. Of these, 65 (40%) included diagnostic recommendations by HS-ASP and 19 (12%) had a Safer Dx Score of≤1.50, (Κ=0.44; moderate agreement). Of those GCs associated with diagnostic errors, the HS-ASP team made a diagnostic recommendation to the primary treatment team 95% of the time. Handshake stewardship has the potential to identify and intervene on diagnostic errors for hospitalized children.
Highlights
Diagnostic errors occur frequently and often go unrecognized unless they harm patients via delayed, incorrect, or missed diagnoses [1, 2]
Each GC was categorized based on the types of recommendations from HS-antimicrobial stewardship programs (ASPs), including if any diagnostic recommendations were made to the treatment team
Antimicrobial stewardship programs (ASPs) identify and intervene on a wide variety of patient safety incidents related to antimicrobial usage
Summary
Diagnostic errors occur frequently and often go unrecognized unless they harm patients via delayed, incorrect, or missed diagnoses [1, 2]. Developing systems to identify and intervene on diagnostic errors in real time could significantly improve patient safety and clinical care [7,8,9,10]. Antimicrobial stewardship programs (ASPs) identify and intervene on a wide variety of patient safety incidents related to antimicrobial usage. ASPs routinely correct inappropriate antimicrobial choice or dosage, prevent use of unnecessary antimicrobials, decrease adverse drug events, and develop clinical pathways that standardize patient care. Under the HS-ASP model, a physician and pharmacist review relevant clinical data in the electronic health record (EHR) for all hospitalized patients receiving any antimicrobial at 24 and 72 h after starting treatment. Recommendations are communicated in person to medical and surgical teams Monday through Friday
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