{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T19:05:14Z","timestamp":1793387114754,"version":"4.5.0"},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T00:00:00Z","timestamp":1736899200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS024953"],"award-info":[{"award-number":["R01HS024953"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We applied three electronic triggers to study frequency and contributory factors of missed opportunities for improving diagnosis (MOIDs) in pediatric emergency departments (EDs): return visits within 10\u2009days resulting in admission (Trigger\u20091), care escalation within 24\u2009h of ED presentation (Trigger 2), and death within 24\u2009h of ED visit (Trigger\u20093).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We created an electronic query and reporting template for the triggers and applied them to electronic health record systems of five pediatric EDs for visits from 2019. Clinician reviewers manually screened identified charts and initially categorized them as \u201cunlikely for MOIDs\u201d or \u201cunable to rule out MOIDs\u201d without a detailed chart review. For the latter category, reviewers performed a detailed chart review using the Revised Safer Dx Instrument to determine the presence of a MOID.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2937 ED records met trigger criteria (Trigger\u20091\u20091996 [68%], Trigger 2\u2009829 [28%], Trigger\u20093\u2009112 [4%]), of which 2786 (95%) were categorized as unlikely for MOIDs. The Revised Safer Dx Instrument was applied to 151 (5%) records and 76 (50%) had MOIDs. The overall frequency of MOIDs was 2.6% for the entire cohort, 3.0% for Trigger\u20091, 1.9% for Trigger\u20092, and 0% for Trigger\u20093. Brain lesions, infections, or hemorrhage; pneumonias and lung abscess; and appendicitis were the top three missed diagnoses. The majority (54%) of MOIDs cases resulted in patient harm. Contributory factors were related to patient\u2010provider (52.6%), followed by patient factors (21.1%), system factors (13.2%), and provider factors (10.5%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using electronic triggers with selective record review is an effective process to screen for harmful diagnostic errors in EDs: detailed review of 5% of charts revealed MOIDs in half, of which half were harmful to the patient. With further refining, triggers can be used as effective patient safety tools to monitor diagnostic quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.15087","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T02:59:50Z","timestamp":1736996390000},"page":"226-245","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Epidemiology of diagnostic errors in pediatric emergency departments using electronic triggers"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4278-3560","authenticated-orcid":false,"given":"Prashant","family":"Mahajan","sequence":"first","affiliation":[{"name":"University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"White","sequence":"additional","affiliation":[{"name":"University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Shaw","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah J.","family":"Parker","sequence":"additional","affiliation":[{"name":"University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Chamberlain","sequence":"additional","affiliation":[{"name":"Children's National Health System  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Ruddy","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth R.","family":"Alpern","sequence":"additional","affiliation":[{"name":"Ann and Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Corboy","sequence":"additional","affiliation":[{"name":"Ann and Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3206-4645","authenticated-orcid":false,"given":"Andrew","family":"Krack","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Ku","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6191-643X","authenticated-orcid":false,"given":"Daphne","family":"Morrison Ponce","sequence":"additional","affiliation":[{"name":"Naval Medical Center Portsmouth  Portsmouth Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asha S.","family":"Payne","sequence":"additional","affiliation":[{"name":"Children's National Health System  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Freiheit","sequence":"additional","affiliation":[{"name":"University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Horvath","sequence":"additional","affiliation":[{"name":"University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giselle","family":"Kolenic","sequence":"additional","affiliation":[{"name":"University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8067-1642","authenticated-orcid":false,"given":"Michele","family":"Carney","sequence":"additional","affiliation":[{"name":"University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Klekowski","sequence":"additional","affiliation":[{"name":"University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen J.","family":"O'Connell","sequence":"additional","affiliation":[{"name":"Children's National Health System  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hardeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety Michael E. 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