Appendix A. Modifications to the Diagnosis Error and Evaluation Research (DEER) Taxonomy
aOriginal Modified
Access/ Denied care Access/ Delayed patient presentation in ER or other hospital
Presentation Delayed presentation Presentation Delayed transfer to the PICU
History Failure/delay in eliciting critical piece of history data History Failure/delay in eliciting critical piece of history data Inaccurate/misinterpretation of critical piece of history data Inaccurate/misinterpretation of critical piece of history
data
Suboptimal weighing of critical piece of history data Failure/delay to follow-up on critical piece of history data Failure/delay to follow-up on critical piece of history data
Physical exam Failure/delay in eliciting critical physical exam finding Physical exam Failure/delay in eliciting critical physical exam finding Inaccurate/misinterpreted critical physical exam finding Inaccurate/misinterpreted critical physical exam finding Suboptimal weighing of critical physical exam finding Failure/delay to follow-up on critical physical exam finding
Tests Ordering Tests Ordering
(Lab/Radiology) Failure/delay in ordering needed test(s) (Lab/Radiology) Failure/delay in ordering needed test(s)
Failure/delay in performing ordered test(s) Failure/delay in performing ordered test(s)
Suboptimal test sequencing Ordering of wrong test(s)
Ordering of wrong test(s) Performance
Performance Sample mix-up/mislabeled (e.g. wrong patient)
Sample mix-up/mislabeled (e.g. wrong patient) Technical errors/poor processing of specimen/test Technical errors/poor processing of specimen/test Failed/delayed transmission of result to clinician
Erroneous lab/radiology reading of test
Failed/delayed transmission of result to clinician
Clinical Processing
Failed/delayed follow-up action on test result
Erroneous clinician interpretation of test
Assessment Hypothesis Generation Assessment Clinical Processing of Tests
Failure/delay in considering the correct diagnosis Erroneous radiology reading of test
Suboptimal weighing/prioritizing Erroneous clinician interpretation of test
Too much weight to low(er) probability/priority dx Failed/delayed follow-up action on test result Too little consideration of high(er) probability/priority dx Hypothesis Generation
Too much weight on competing diagnosis Failure/delay in considering the correct diagnosis
Recognizing urgency/complications Suboptimal weighing/prioritizing
Failure to appreciate urgency/acuity of illness Too much weight to low(er) probability/priority dx Failure/delay in recognizing complication(s) Too little consideration of high(er) probability/priority dx
Too much weight on competing diagnosis
Recognizing urgency/complications
Failure to appreciate urgency/acuity of illness
Failure/delay in recognizing complication(s)
Referral/ Failure/delay in ordering needed referral Referral/ Failure/delay in ordering needed referral Consultation Inappropriate/unneeded referral Consultation Suboptimal consultation diagnostic performance Suboptimal consultation diagnostic performance Failed/delayed communication/follow-up of consultation
Failed/delayed communication/follow-up of consultation
Follow-up Failure to refer to setting for close monitoring
Failure/delay in timely follow-up/rechecking of patient Follow-up Failure to communicate pending tests/unresolved diagnoses to accepting providers
ER, emergency room; PICU, Pediatric Intensive Care Unit
aThe DEER taxonomy was modified for applicability to the PICU, plus changes were made to clearly delineate system errors (e.g. technical laboratory errors) vs. cognitive errors (e.g. interpretation of tests by clinicians).
