About 70 children die of sepsis per year in Australia and New Zealand. It is therefore important to have systems in place for early detection of severe infection. Developing an approach to avoid diagnostic error is an important task for each GP. In this episode, we hear from an RVTS Medical Educator, Taras Mikulin, who looks at a General Practice risk management system for use in Childhood Sepsis. Taras discusses a practical 6 step system approach to avoiding diagnostic error.
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The systems approach discussed is outlined below –
|Cognitive Bias / Error||Clinical risk management||Mode of Action|
|Anchoring bias||Develop a differential diagnosis||Invokes System 2 reasoning|
|Premature closure||Diagnostic decision tool||Reduces unconscious incompetence|
|Incomplete history||Checklist||Avoidings missing information|
|Miss deterioration||Early warning system||Safety-netting|
|Failure to ask for help||Escalate||Shares knowledge|
|Lack of follow-up||Double check outcome||Accepts responsibility|
Following these 6 steps will decrease the risk of error through conscious clinical reasoning, expanding your differentials, using a checklist to avoid missing important information, safety-netting, escalating care and decision-making as required and reviewing the outcome from each case to learn from the process.
Taras mentions these useful resources that can be used in General Practice. You can download them and use them as required.
Please review the references below for further information.
We look forward to hearing your thoughts on this approach.
- Ann Van den Bruel et al. Signs and symptoms for diagnosis of serious infections in children: a prospective study in primary care. British J. Gen. Pract. 2007; 57:538-546
- Jan Y Verbakel et al. Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care. BMJ Open 2015; 5: e008657. doi:10.1136/bmjopen-2015-00865
- Ching NS et al. Prospective Surveillance of Pediatric Invasive Group A Streptococcus Infection. J Pediatric Infect Dis Soc 2017; doi:10.1093/jpids/pix099.[Epub ahead of print]
- Lambert et al. Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review. BMJ Open 2016; doi:10.1136/bmjopen-2016-014497