Emerging Professional Identity in Patient Hand-Off Routines: A Practical Application of Performative Face Theory.

Recent research of healthcare providers identifies the critical role that professional identity plays in the provision of healthcare, interactions within healthcare teams, and healthcare provider perceptions of their work. However, much remains to be known regarding the role of professional identity in routine interactions for emerging healthcare professionals. This study enriches understandings of this particular issue by exploring pediatric residents' experiences with a structured hand-off tool at a children's hospital in the western United States. This study employed qualitative interview methods and iterative interpretive qualitative data analysis. Participants were 20 residents in a children's hospital. Data analysis indicated that the discourses that disseminate negotiations of face can, and often do, take place during patient hand-off, as the statements exchanged between team members can maintain or threaten face and professional identity. We suggest that shifts in organizational culture and training are necessary to optimize the environment in which residents use structured hand-off. Further, the culture and practice of training emerging physicians should include attention to the important role of hand-off as a critical site of professional identity construction and negotiation.

Diagnostic error in the pediatric hospital: a narrative review.

INTRODUCTION: Diagnostic error is a prevalent type of medical error that is associated with considerable patient harm and increased medical costs. The majority of literature guiding the current understanding of diagnostic error in the hospital setting is from adult studies. However, there is research to suggest this type of error is also prevalent in the pediatric specialty. OBJECTIVES: The primary objective of this study was to define the current understanding of diagnostic error in the pediatric hospital through a structured literature review. METHODS: We searched PubMed and identified studies focusing on three aspects of diagnostic error in pediatric hospitals: the incidence or prevalence, contributing factors, and related interventions. We used a tiered review, and a standardized electronic form to extract data from included articles. RESULTS: Fifty-nine abstracts were screened and 23 full-text studies were included in the final review. Seventeen of the 23 studies focused on the incidence or prevalence, with only 3 studies investigating the utility of interventions. Most studies took place in an intensive care unit or emergency department with very few studies including only patients on the general wards. Overall, the prevalence of diagnostic error in pediatric hospitals varied greatly and depended on the measurement technique and specific hospital setting. Both healthcare system factors and individual cognitive factors were found to contribute to diagnostic error, with there being limited evidence to guide how best to mitigate the influence of these factors on the diagnostic process. CONCLUSION: The general knowledge of diagnostic error in pediatric hospital settings is limited. Future work should incorporate structured frameworks to measure diagnostic errors and examine clinicians' diagnostic processes in real-time to help guide effective hospital-wide interventions.

We are part of the problem: the role of children's hospitals in addressing health inequity.

Racism is an ongoing public health crisis that undermines health equity for all children in hospitals across our nation. The presence and impact of institutionalized racism contributes to health inequity and is under described in the medical literature. In this review, we focus on key interdependent areas to foster inclusion, diversity, and equity in Children's Hospitals, including 1) promotion of workforce diversity 2) provision of anti-racist, equitable hospital patient care, and 3) prioritization of academic scholarship focused on health equity research, quality improvement, medical education, and advocacy. We discuss the implications for clinical and academic practice.Plain Language Summary: Racism in Children's Hospitals harms children. We as health-care providers and hospital systems are part of the problem. We reviewed the literature for the best ways to foster inclusion, diversity, and equity in hospitals. Hospitals can be leaders in improving child health equity by supporting a more diverse workforce, providing anti-racist patient care, and prioritizing health equity scholarship.