# Digital Innovation, Simulation, and Collaboration using Virtual Environment Realities (DISCOVER) for Pediatric Diagnostic

> **NIH AHRQ R18** · CINCINNATI CHILDRENS HOSP MED CTR · 2024 · $500,000

## Abstract

Project Summary
More than a third of pediatric adverse events have been attributed to diagnostic error—the failure
to establish an accurate and timely explanation of a child’s health problem. Within the pediatric
intensive care unit (PICU), a high-stakes, complex, team-driven environment, diagnostic error
rates vary between 8% and 25%. To improve diagnostic accuracy, clinical decision support (CDS)
tools, including artificial intelligence and machine learning algorithms, have been developed but
have failed to be adopted within the PICU. Implementation of CDS into an active high-risk clinical
context without a comprehensive understanding of how providers and staff interface with the
system can lead to patient safety consequences. These consequences can include disrupted
workflows, alert fatigue, and inaccurate documentation that can lead to direct patient harm. We
propose leveraging a currently built highly realistic immersive virtual reality PICU clinical
environment to assess implementation strategies on clinician acceptance of CDS tools to improve
diagnostic excellence within a patient safety learning lab. We will evaluate three aims using a
systems-engineering approach combining the expertise of LiveWell, an award-winning design
collaborative with user-centered design and human factors expertise, with the clinical knowledge,
implementation science expertise, and world-renowned virtual simulation program of Cincinnati
Children’s Hospital Medical Center (CCHMC). We will: redesign how clinicians interface with CDS
tools for diagnosis-intensive events within the pediatric critical care environment including
admission and clinical deterioration; develop and implement design-informed CDS tools for
diagnosis and to evaluate their appropriateness/acceptability and impact on diagnostic
uncertainty, accuracy, and timeliness within a digital twin immersive virtual reality simulation; and
establish best practice guidance for implementation of CDS tools in the critical care environment
to improve diagnostic excellence. Outcomes will include 1) appropriateness, acceptability, and
adoption of design informed CDS tools; 2) impact on diagnostic accuracy and timeliness in the
simulated clinical environment; and 3) a proactive implementation plan for the integration of
design informed CDS tools to improve diagnostic excellence into the critical care environment.

## Key facts

- **NIH application ID:** 10932195
- **Project number:** 5R18HS029626-02
- **Recipient organization:** CINCINNATI CHILDRENS HOSP MED CTR
- **Principal Investigator:** Maya L Dewan
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $500,000
- **Award type:** 5
- **Project period:** 2023-09-30 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10932195

## Citation

> US National Institutes of Health, RePORTER application 10932195, Digital Innovation, Simulation, and Collaboration using Virtual Environment Realities (DISCOVER) for Pediatric Diagnostic (5R18HS029626-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10932195. Licensed CC0.

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