The impact of a consultant paediatrician onsite on diagnostic accuracy
Research type
Research Study
Full title
A study to look at the impact of Consultant Paediatrician presence onsite in a district general emergency department on diagnostic errors and adverse events in acute paediatric admissions.
IRAS ID
169034
Contact name
David Inwald
Contact email
Sponsor organisation
Northwick Park Hospital, London North West NHS trust
Duration of Study in the UK
0 years, 4 months, 2 days
Research summary
This is a study to look at the impact of consultant presence in emergency department on diagnostic errors in acute paediatric admissions and the cognitive processes of trainee doctors involved. RCPCH defines “Consultant delivered Care” (CDC) as consultants being responsible for all aspects of patients care by providing hands care or closely supervising other members of the team in the clinical setting. The “time for training” report outlines that a strong consultant presence enhances training as well as managing patient safety and service demands better. The RCPCH in “facing the future set standards for paediatric service to provide consultant supervision during periods of peak activity.
The evidence for this CDC care models is observational and concentrates on outcomes such as admission rates and duration rather than training or patient safety. Diagnostic errors occur in around 5% of paediatric admissions in a district general hospital. They contribute to 23% of cases of harm to patients and 46% of successful paediatric litigation's in the UK. It has been previously noted that trainees hesitate to involve seniors despite availability and are prone to making cognitive errors in the diagnostics process.
This follow-on study utilises the methodology of a previous study at the same site looking at incidence of diagnostic errors and factor analysis in paediatric emergency admissions. Introduction of an onsite consultant for part of the day at the study site allows for comparisons of outcomes during this CDC period to cases managed outside the CDC period and to previous study findings. This will involve screening all paediatric medical admissions for discrepancy in diagnosis due to a misdiagnosis. Systemic and cognitive factors involved will be investigated through notes reviews and structured interviews of involved clinicians . The findings would be relevant to optimizing the role consultants on-site with regards to patient safety and training.
REC name
London - Queen Square Research Ethics Committee
REC reference
15/LO/0078
Date of REC Opinion
20 Jan 2015
REC opinion
Favourable Opinion