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Diagnosis

Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

Editor-in-Chief: Graber, Mark L. / Plebani, Mario

Ed. by Argy, Nicolas / Epner, Paul L. / Lippi, Giuseppe / Singhal, Geeta / McDonald, Kathryn / Singh, Hardeep / Newman-Toker, David

Editorial Board: Basso , Daniela / Crock, Carmel / Croskerry, Pat / Dhaliwal, Gurpreet / Ely, John / Giannitsis, Evangelos / Katus, Hugo A. / Laposata, Michael / Lyratzopoulos, Yoryos / Maude, Jason / Sittig, Dean F. / Sonntag, Oswald / Zwaan, Laura


CiteScore 2018: 0.69

SCImago Journal Rank (SJR) 2018: 0.359
Source Normalized Impact per Paper (SNIP) 2018: 0.424

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2194-802X
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Updates to referring clinicians regarding critically ill children admitted to the pediatric intensive care unit: a state-wide survey

Christina L. Cifra
  • Corresponding author
  • Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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/ Cody R. Tigges
  • Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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  • Other articles by this author:
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/ Sarah L. Miller / Loreen A. Herwaldt
  • Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
  • Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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  • Other articles by this author:
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/ Hardeep Singh
  • Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
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Published Online: 2019-10-25 | DOI: https://doi.org/10.1515/dx-2019-0048

Abstract

Background

Front-line clinicians are expected to make accurate and timely diagnostic decisions before transferring patients to the pediatric intensive care unit (PICU) but may not always learn their patients’ outcomes. We evaluated the characteristics of post-transfer updates received by referring clinicians regarding PICU patients and determined preferences regarding content, delivery, and timing of such updates.

Methods

We administered an electronic cross-sectional survey to Iowa clinicians who billed for ≥5 pediatric patients or referred ≥1 patient to the University of Iowa (UI) PICU in the year before survey administration.

Results

One hundred and one clinicians (51 non-UI, 50 UI-affiliated) responded. Clinicians estimated that, on average, 8% of pediatric patients they saw over 1 year required PICU admission; clinicians received updates on 40% of patients. Seventy percent of UI clinicians obtained updates via self-initiated electronic record review, while 37% of non-UI clinicians relied on PICU communication (p = 0.013). Clinicians indicated that updates regarding diagnoses/outcomes will be most relevant to their practice. Among clinicians who received updates, 13% received unexpected information; 40% changed their practice as a result.

Conclusions

Clinicians received updates on less than half of the patients they referred to a PICU, although such updates could potentially influence clinical practice. Study findings will inform the development of a formal feedback system from the PICU to referring clinicians.

This article offers supplementary material which is provided at the end of the article.

Keywords: critical care; diagnostic calibration; feedback; interfacility transfer; pediatrics

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About the article

Corresponding author: Christina L. Cifra MD, MS, Clinical Associate Professor, Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 8600-M JCP, Iowa City, IA 52242, USA, Phone:  +(319)-384-8659


Received: 2019-06-24

Accepted: 2019-10-06

Published Online: 2019-10-25


Funding Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development

Award identifier / Grant number: #HD027748

Dr. Cifra is supported by a National Institutes of Health Institutional K12 grant (Eunice Kennedy Shriver National Institute of Child Health and Human Development, Funder Id: http://dx.doi.org/10.13039/100009633, #HD027748). Dr. Singh is supported in part by the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA (#CIN 13-413).


Author contributions: Dr. Cifra and Dr. Tigges conceptualized and designed the study; developed, reviewed, and finalized the survey instrument; organized, analyzed, and interpreted the data; and drafted, reviewed, and revised the manuscript. Dr. Miller contributed to the design of the study and the survey instrument, supervised and coordinated the survey pilot, interpreted the data, and reviewed the manuscript. Dr. Herwaldt and Dr. Singh reviewed the study design, interpreted the data, and critically reviewed the manuscript for important intellectual content. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


Citation Information: Diagnosis, 20190048, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2019-0048.

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