AHRQ Study: New Tool Identifies Causes of Pediatric Patient Harm

A new tool to identify the most common causes of harm in pediatric inpatient environments could improve patient safety for hospitalized children, according to an AHRQ-funded study. An article published online with an abstract May 18 in Pediatrics described the development and pilot-testing of the tool. Six academic children’s hospitals used the tool to review 100 randomly selected inpatient records from patients discharged from each site in February 2012. Of 600 patient charts evaluated, 240 harmful events (“harms”) were identified, for a rate of 40 harms per 100 patients admitted and 54.9 harms per 1,000 patient days across the six hospitals. The most common patient harms were intravenous catheter infiltrations/burns, respiratory distress, constipation, pain and surgical complications. One of every four pediatric admissions had at least one identified harm. Nearly half (45 percent) of the harms were deemed preventable. The authors concluded that, like adult hospital patients, harm occurs at high rates among hospitalized children.

A trigger tool to detect harm in pediatric inpatient settings. - PubMed - NCBI

2015 Jun;135(6):1036-42. doi: 10.1542/peds.2014-2152. Epub 2015 May 18.

A trigger tool to detect harm in pediatric inpatient settings.

Stockwell DC1, Bisarya H2, Classen DC3, Kirkendall ES4, Landrigan CP5, Lemon V6, Tham E7, Hyman D8, Lehman SM9, Searles E10, Hall M11, Muething SE12, Schuster MA13, Sharek PJ14.

Author information

Abstract

OBJECTIVES:

An efficient and reliable process for measuring harm due to medical care is needed to advance pediatric patient safety. Severalpediatric studies have assessed the use of trigger tools in varying inpatient environments. Using the Institute for Healthcare Improvement's adult-focused Global Trigger Tool as a model, we developed and pilot tested a trigger tool that would identify the most common causes of harm in pediatricinpatient environments.

METHODS:

After formal training, 6 academic children's hospitals used this novel pediatric trigger tool to review 100 randomly selected inpatientrecords per site from patients discharged during the month of February 2012.

RESULTS:

From the 600 patient charts evaluated, 240 harmful events ("harms") were identified, resulting in a rate of 40 harms per 100 patients admitted and 54.9 harms per 1000 patient days across the 6 hospitals. At least 1 harm was identified in 146 patients (24.3% of patients). Of the 240 total events, 108 (45.0%) were assessed to have been potentially or definitely preventable. The most common patient harms were intravenous catheter infiltrations/burns, respiratory distress, constipation, pain, and surgical complications.

CONCLUSIONS:

Consistent with earlier rates of all-cause harm in adult hospitals, harm occurs at high rates in hospitalized children. Availability and use of an all-cause harm identification tool will establish the epidemiology of harm and will provide a consistent approach to assessing the effect of interventions on harms in hospitalized children.