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JAMA Pediatr. 2017 Apr 1;171(4):372-381. doi: 10.1001/jamapediatrics.2016.4812.

Families as Partners in Hospital Error and Adverse Event Surveillance.

Author information

1
Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
2
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
3
Centre for Quality Improvement and Patient Safety, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
4
Center for Families, Boston Children's Hospital, Boston, Massachusetts.
5
Department of Nursing, Cardiovascular, and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts.
6
Family-Centered Care, Lucile Packard Children's Hospital, Palo Alto, California.
7
Section of Critical Care, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
8
Section of Hospital Medicine, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
9
Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio.
10
Department of Pediatrics, Benioff Children's Hospital, University of California-San Francisco School of Medicine, San Francisco.
11
Division of Pediatric Hospital Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
12
Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City.
13
Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
14
Department of Medicine, Harvard Medical School, Boston, Massachusetts.
15
The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
16
Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah.
17
Section of General Pediatrics, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
18
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
19
Boston Children's Hospital, Boston, Massachusetts.
20
St Christopher's Hospital for Children, Philadelphia, Pennsylvania.
21
Alvarado-Little Consulting LLC, Albany, New York.
22
Lucile Packard Children's Hospital, Stanford, California.
23
Doernbecher Children's Hospital, Oregon Health and Science University, Portland.
24
Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City.
25
Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia.
26
St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri.
27
Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
28
Lucile Packard Children's Hospital, Stanford University, Stanford, California.
29
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
30
Primary Children's Hospital, Salt Lake City, Utah.
31
Benioff Children's Hospital, San Francisco, California.
32
Walter Reed National Military Medical Center, Bethesda, Maryland.
33
New York University Langone Medical Center, New York University School of Medicine, New York.
34
Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
35
Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
36
St Louis Children's Hospital, St Louis, Missouri.
37
Mothers Against Medical Error, Columbia, South Carolina.
38
Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
39
St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
40
Justin's HOPE Project, Task Force for Global Health, Decatur, Georgia.
41
Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas.
42
Children's National Health System, George Washington University School of Medicine, Washington, DC.
43
Kapi'olani Medical Center for Women and Children, University of Hawai'i John A. Burns School of Medicine, Honolulu.
44
Ohio State University, Columbus.
45
Harvard Medical School, Boston, Massachusetts.
46
Cohen Children's Medical Center, Hofstra Northwell School of Medicine, East Garden City, New York.
47
Brigham and Women's Hospital, Boston, Massachusetts.
48
Northwestern University Feinberg School of Medicine, Evanston, Illinois.

Abstract

Importance:

Medical errors and adverse events (AEs) are common among hospitalized children. While clinician reports are the foundation of operational hospital safety surveillance and a key component of multifaceted research surveillance, patient and family reports are not routinely gathered. We hypothesized that a novel family-reporting mechanism would improve incident detection.

Objective:

To compare error and AE rates (1) gathered systematically with vs without family reporting, (2) reported by families vs clinicians, and (3) reported by families vs hospital incident reports.

Design, Setting, and Participants:

We conducted a prospective cohort study including the parents/caregivers of 989 hospitalized patients 17 years and younger (total 3902 patient-days) and their clinicians from December 2014 to July 2015 in 4 US pediatric centers. Clinician abstractors identified potential errors and AEs by reviewing medical records, hospital incident reports, and clinician reports as well as weekly and discharge Family Safety Interviews (FSIs). Two physicians reviewed and independently categorized all incidents, rating severity and preventability (agreement, 68%-90%; κ, 0.50-0.68). Discordant categorizations were reconciled. Rates were generated using Poisson regression estimated via generalized estimating equations to account for repeated measures on the same patient.

Main Outcomes and Measures:

Error and AE rates.

Results:

Overall, 746 parents/caregivers consented for the study. Of these, 717 completed FSIs. Their median (interquartile range) age was 32.5 (26-40) years; 380 (53.0%) were nonwhite, 566 (78.9%) were female, 603 (84.1%) were English speaking, and 380 (53.0%) had attended college. Of 717 parents/caregivers completing FSIs, 185 (25.8%) reported a total of 255 incidents, which were classified as 132 safety concerns (51.8%), 102 nonsafety-related quality concerns (40.0%), and 21 other concerns (8.2%). These included 22 preventable AEs (8.6%), 17 nonharmful medical errors (6.7%), and 11 nonpreventable AEs (4.3%) on the study unit. In total, 179 errors and 113 AEs were identified from all sources. Family reports included 8 otherwise unidentified AEs, including 7 preventable AEs. Error rates with family reporting (45.9 per 1000 patient-days) were 1.2-fold (95% CI, 1.1-1.2) higher than rates without family reporting (39.7 per 1000 patient-days). Adverse event rates with family reporting (28.7 per 1000 patient-days) were 1.1-fold (95% CI, 1.0-1.2; P = .006) higher than rates without (26.1 per 1000 patient-days). Families and clinicians reported similar rates of errors (10.0 vs 12.8 per 1000 patient-days; relative rate, 0.8; 95% CI, .5-1.2) and AEs (8.5 vs 6.2 per 1000 patient-days; relative rate, 1.4; 95% CI, 0.8-2.2). Family-reported error rates were 5.0-fold (95% CI, 1.9-13.0) higher and AE rates 2.9-fold (95% CI, 1.2-6.7) higher than hospital incident report rates.

Conclusions and Relevance:

Families provide unique information about hospital safety and should be included in hospital safety surveillance in order to facilitate better design and assessment of interventions to improve safety.

PMID:
28241211
PMCID:
PMC5526631
DOI:
10.1001/jamapediatrics.2016.4812
[Indexed for MEDLINE]
Free PMC Article

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