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Accepted (AM)Open Access (License Unspecified), Open
Journal article
Families as Partners in Hospital Error and Adverse Event Surveillance
JAMA pediatrics, Vol.171(4), pp.372-381
01 Apr 2017
PMCID: PMC5526631
PMID: 28241211
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
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.
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.
Error and AE rates.
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.
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.
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Details
- Title
- Families as Partners in Hospital Error and Adverse Event Surveillance
- Creators
- Alisa Khan - Harvard UniversityMaitreya Coffey - University of TorontoKatherine P Litterer - Boston Children's HospitalJennifer D Baird - Boston Children's HospitalStephannie L Furtak - Boston Children's HospitalBriana M Garcia - Boston Children's HospitalMichele A Ashland - Lucile Packard Children's HospitalSharon Calaman - Drexel UniversityNicholas C Kuzma - Drexel UniversityJennifer K O'Toole - University of Cincinnati Medical CenterAarti Patel - University of Cincinnati Medical CenterGlenn Rosenbluth - University of California, San FranciscoLauren A Destino - Stanford UniversityJennifer L Everhart - Stanford UniversityBrian P Good - University of UtahJennifer H Hepps - Uniformed Services University of the Health SciencesAnuj K Dalal - Harvard UniversityStuart R Lipsitz - Harvard UniversityCatherine S Yoon - Brigham and Women's HospitalKatherine R Zigmont - Brigham and Women's HospitalRajendu Srivastava - Intermountain HealthcareAmy J Starmer - Harvard UniversityTheodore C Sectish - Harvard UniversityNancy D Spector - Drexel UniversityDaniel C West - University of California, San FranciscoChristopher P Landrigan - Harvard UniversityBrenda K Allair - Boston Children's Hospital, Boston, MassachusettsClaire Alminde - St Christopher's Hospital for Children, Philadelphia, PennsylvaniaWilma Alvarado-Little - Lucile Packard Children's HospitalMarisa Atsatt - Oregon Health & Science UniversityMegan E Aylor - University of UtahJames F Bale, Jr - Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake CityDorene Balmer - Washington University in St. LouisKevin T Barton - University of TorontoCarolyn Beck - University of TorontoZia Bismilla - Lucile Packard Children's HospitalRebecca L Blankenburg - Cincinnati Children's Hospital Medical CenterDebra Chandler - Primary Children's HospitalAmanda Choudhary - Primary Children's HospitalEileen Christensen - Boston Children's HospitalSally Coghlan-McDonald - Washington University in St. LouisF Sessions Cole - Primary Children's HospitalElizabeth Corless - Primary Children's Hospital, Salt Lake City, UtahSharon Cray - Walter Reed National Military Medical CenterRoxi Da Silva - Cincinnati Children's Hospital Medical CenterDevesh Dahale - New York UniversityBenard Dreyer - Boston Children's HospitalAmanda S Growdon - Primary Children's HospitalLeAnn Gubler - Cincinnati Children's Hospital Medical CenterAmy Guiot - St. Louis Children's HospitalRoben Harris - St Louis Children's Hospital, St Louis, MissouriHelen Haskell - University of UtahIrene Kocolas - St. Louis Children's HospitalElizabeth Kruvand - St. Louis Children's HospitalMichele Marie Lane - University of TorontoKathleen Langrish - Uniformed Services University of the Health SciencesChristy J W Ledford - Drexel UniversityKheyandra Lewis - Uniformed Services University of the Health SciencesJoseph O Lopreiato - University of UtahChristopher G Maloney - Boston Children's HospitalAmanda Mangan - Walter Reed National Military Medical CenterPeggy Markle - Lucile Packard Children's HospitalFernando Mendoza - Lucile Packard Children's Hospital, Stanford University, Stanford, CaliforniaDale Ann Micalizzi - The University of Texas Southwestern Medical CenterVineeta Mittal - Cincinnati Children's Hospital Medical CenterMaria Obermeyer - Boston Children's HospitalKatherine A O'Donnell - George Washington UniversityMary Ottolini - University of Hawaii at ManoaShilpa J Patel - The Ohio State UniversityRita Pickler - Boston Children's HospitalJayne Elizabeth Rogers - Lucile Packard Children's HospitalLee M Sanders - St. Louis Children's HospitalKimberly Sauder - Cincinnati Children's Hospital Medical CenterSamir S Shah - Boston Children's HospitalMeesha Sharma - Harvard UniversityArabella Simpkin - Hofstra UniversityAnupama Subramony - Drexel UniversityE Douglas Thompson, Jr - St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PennsylvaniaLaura Trueman - Primary Children's HospitalTanner Trujillo - Washington University in St. LouisMichael P Turmelle - Primary Children's HospitalCindy Warnick - Primary Children's HospitalChelsea Welch - Washington University in St. LouisAndrew J White - Brigham and Women's HospitalMatthew F Wien - Boston Children's HospitalAriel S Winn - Lucile Packard Children's HospitalStephanie Wintch - Northwestern UniversityMichael Wolf - New York UniversityH Shonna Yin - Uniformed Services University of the Health SciencesClifton E Yu - Uniformed Services University of the Health Sciencesthe Patient and Family Centered I-PASS Study Group
- Publication Details
- JAMA pediatrics, Vol.171(4), pp.372-381
- Publisher
- American Medical Association
- Grant note
- K12 HS022986 / AHRQ HHS T32 HS000063 / AHRQ HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Identifiers
- 991019168098504721
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- Pediatrics