Failure of Israeli pediatric residency curricula to cover child development and special education issues: results of a national survey on levels of knowledge.

BACKGROUND: There is an increasing prevalence of developmental difficulties among Israeli children. We aimed to assess whether pediatricians are equipped to diagnose and manage them. METHODS: We assessed the knowledge of basic child development issues and availability of services and content of special education systems among a randomly selected national sample of residents and senior Israeli pediatricians. This was done via an 70-itemed survey developed especially for this study which consisted of seven main subjects: developmental milestones, global developmental delay, autism spectrum disorder, attention deficit hyperactivity disorder, protocol for referring to a child development institute, availability and facilities of special education systems, and medical conditions associated with developmental delay. RESULTS: A total of 310 pediatricians (an 86 % usable response rate) participated. The total median knowledge score was 32.1 % (IQR 17.8-53.5 %). Knowledge was significantly better among senior pediatricians (p < .001), those working in an office-based setting (p < .001), and those who were parents (p < .001) or had a family history of a developmental condition (p = .003). Most responders (94 %) felt that their resident training in child development was inadequate, and that they do not have sufficient access to resources and guidelines about child development and special education systems (80 %). CONCLUSIONS: The gap in knowledge on topics of child development and special education systems among Israeli pediatricians stems from inadequacies in the current curricula of pediatric residencies. The alarmingly low scores of our survey on these issues call for prompt revamping of the syllabus to include them.

[AN ELECTRONIC PATIENT RECORD (EPR) - "A STING IN THE TAIL" (E-IATROGENESIS): PRIMUM NON NOCERE].

INTRODUCTION: Use of Electronic Patient records is most efficient but careless use can result in harm to the patient caused by advanced technology - E-Iatrogenesis. Correct use of the electronic systems can reduce the amount of technology-related errors in the Electronic Patient record. Beyond all doubt, handwritten medical records can contribute to human error due to unclear handwriting, unclear phrases, etc. Moreover, physical files can be lost or misplaced thus making it difficult to retrieve patient history.

The virtual neonate in The Neonatal Intensive Care Unit: when twin number three adds up to error not imagination.

BACKGROUND: During the administrative admittance of extreme premature twin neonates to the Hospital Information System (HIS), at an Israeli government general hospital, a third virtual baby was mistakenly admitted in addition to the twins. The third virtual baby's records were in department occupancy and transactions were performed in the HIS, such as "admittance" to Neonatal Intensive Care Unit (NICU), being appended to a mother as well as clinical orders. METHODS: Once noticed, the records of the third virtual baby were merged in the system with the second correct twin (Baby II), whose records were also in the department occupancy list. RESULTS: An error occurred in the interface whilst merging the records, and patient demography was not updated for clinical orders for Baby II. As a result, all new clinical orders for Baby II carried the non existing third baby's identity. CONCLUSIONS: We emphasize that it is advisable to register all newborns as early on in life whilst still in the delivery room, with a permanent identification number as opposed to a temporary identification number to avoid any mismatching if patients records are to be merged or updated. Furthermore, steps that could help prevent such an event could be additional administrative staff to register newborns. However, we conclude, that it would be most helpful to introduce a Radio Frequency Identification (RFID) system based on a permanent identity number. If any discrepancies in patient information are detected, an alarm will be triggered during transfer of the baby from the delivery room to the designated Department. A RFID receptor is located at the exit of the delivery room. While most literature available regarding Hospital Information Technology (HIT) and patient safety, mainly discusses mismatching of patients during medication and laboratory testing not much literature regarding the process of registering newborns as a source of patient mismatching has been found. The authors feel that there is a need to further investigate this aspect as it is a source that can affect not only accuracy in the Electronic Patient Record (EPR) but furthermore has the impact to change the course of a life and set tone for that person's future.