Priorities for improving paediatric diagnosis: findings from a modified Delphi study

BACKGROUND: Efforts to improve diagnosis should reflect the unique needs of children; however, there is no consensus on paediatric-specific priority areas. METHODS: An expert panel of 25 United States (US) paediatric diagnostic excellence researchers, patient safety leaders and family partners from 15 institutions participated in a modified Delphi panel. Panellists participated in generating a literature-derived list of topics relevant to improving diagnosis. Panellists then rated agreement on each topic as a research or operational improvement priority. Topics that achieved consensus (≥75% of panellists rating them as high priority) were subsequently rated based on feasibility for implementation at the respondent's institution. RESULTS: Literature review identified 24 topics relevant to paediatric diagnostic safety and quality, which were expanded to 62 topics during the initial panel discussion and grouped into 25 survey topics. Consensus was reached on 6 topics as research priorities and 11 as operational improvement priorities. Of these, three were deemed highly feasible for research and three for operational improvement. Research priorities included: identifying paediatric conditions at high risk for diagnostic error, developing communication methods to enhance the diagnostic process and establishing diagnostic process feedback mechanisms. Operational improvement priorities included: identifying care delivery or health services scenarios at high risk for diagnostic error, establishing interdisciplinary, structured review of cases of diagnostic error and encouraging reporting of missed opportunities for improving diagnostic safety. CONCLUSION: Experts successfully prioritised important and feasible topics in research and practice for improving paediatric diagnosis in US academic medical centres.

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Publication Details

Journal
BMJ Quality & Safety
Published
2026-06-26
DOI
https://doi.org/10.1136/bmjqs-2025-020052
Primary Topic
Clinical Reasoning and Diagnostic Skills
Type
article
Field-Weighted Citation Impact
0.00

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article

Priorities for improving paediatric diagnosis: findings from a modified Delphi study

Joseph A. Grubenhoff, Sanjiv Mehta, Grant Shafer, Harry Hoar et al.
BMJ Quality & Safety
Clinical Reasoning and Diagnostic Skills
article

Priorities for improving paediatric diagnosis: findings from a modified Delphi study

Joseph A. Grubenhoff, Sanjiv Mehta, Grant Shafer, Harry Hoar, Jonathan G. Sawicki, Michael F. Perry, Andrew P. J. Olson, Christina L. Cifra, Prashant Mahajan, Kenneth A. Michelson, Anna Costello, Morgan Congdon, Irit R. Rasooly, Kathleen E. Walsh, Yasaman Fatemi, Hardeep Singh, Cara T. Jefferies, Amarpreet Kaur, Kathy N. Shaw, Katherine Wu, Courtney Gidengil, Jillian Krause, Trisha Marshall, Meghan Galligan, Ursula Nawab
article en

Abstract

BACKGROUND: Efforts to improve diagnosis should reflect the unique needs of children; however, there is no consensus on paediatric-specific priority areas. METHODS: An expert panel of 25 United States (US) paediatric diagnostic excellence researchers, patient safety leaders and family partners from 15 institutions participated in a modified Delphi panel. Panellists participated in generating a literature-derived list of topics relevant to improving diagnosis. Panellists then rated agreement on each topic as a research or operational improvement priority. Topics that achieved consensus (≥75% of panellists rating them as high priority) were subsequently rated based on feasibility for implementation at the respondent's institution. RESULTS: Literature review identified 24 topics relevant to paediatric diagnostic safety and quality, which were expanded to 62 topics during the initial panel discussion and grouped into 25 survey topics. Consensus was reached on 6 topics as research priorities and 11 as operational improvement priorities. Of these, three were deemed highly feasible for research and three for operational improvement. Research priorities included: identifying paediatric conditions at high risk for diagnostic error, developing communication methods to enhance the diagnostic process and establishing diagnostic process feedback mechanisms. Operational improvement priorities included: identifying care delivery or health services scenarios at high risk for diagnostic error, establishing interdisciplinary, structured review of cases of diagnostic error and encouraging reporting of missed opportunities for improving diagnostic safety. CONCLUSION: Experts successfully prioritised important and feasible topics in research and practice for improving paediatric diagnosis in US academic medical centres.

BMJ Quality & Safety
Cincinnati Children's Hospital Medical Center (US), Boston Children's Hospital (US), Seattle Children's Hospital (US), Michael E. DeBakey VA Medical Center (US), University of Minnesota (US), Children's Hospital of Orange County (US), RAND Corporation (US), Nationwide Children's Hospital (US), Primary Children's Hospital (US), Children's Hospital of Philadelphia (US), Baystate Medical Center (US), Harvard University (US), Johns Hopkins University (US), Baylor College of Medicine (US), University of Washington (US), University of California, Irvine (US), University of Michigan (US), University of Utah Hospital (US), Children's Hospital Colorado (US), Johns Hopkins All Children's Hospital (US), Baystate Health (US), Lurie Children's Hospital (US), Center for Innovation (US), Irvine University (US), Boston Children's Museum (US), University of Pennsylvania (US), University of Cincinnati Medical Center (US), University of Colorado Denver (US)
Gordon and Betty Moore Foundation, Children's Hospital of Philadelphia, Agency for Healthcare Research and Quality
Partnerships for the goals
Openalex Percentile: Top 6%
Clinical Reasoning and Diagnostic Skills
DOISourceOpenAlex
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