The Diagnostic Error Index: A Quality Improvement Initiative to Identify and Measure Diagnostic Errors

ObjectiveTo develop a diagnostic error index (DEI) aimed at providing practical method to identify and measure serious errors.Study designA quality improvement (QI) study quaternary pediatric medical center. Five well-defined domains identified cases of potential errors. Identified underwent an adjudication process by multidisciplinary QI team determine if occurred. Confirmed errors were then aggregated on the DEI. The primary outcome was number monthly errors.ResultsFrom January 2017 through June 2019, 105 identified. Morbidity mortality conferences, institutional root cause analyses, abdominal pain trigger tool most frequent for detecting Appendicitis, fractures, nonaccidental trauma 3 common diagnoses that missed or had delayed identification.ConclusionsA initiative successfully created pragmatic approach utilizing DEI established framework help guide future initiatives reduce To A From identification.