Families as Partners in Hospital Error and Adverse Event Surveillance

Autor: F. Sessions Cole, Wilma Alvarado-Little, Carolyn E Beck, Mary C. Ottolini, Stephannie L. Furtak, Lauren Destino, Irene Kocolas, Jayne Elizabeth Rogers, Amy Guiot, Chelsea Welch, James F. Bale, Jennifer K. O'Toole, Marisa Atsatt, Jennifer L. Everhart, Anuj K. Dalal, Helen Haskell, Elizabeth Kruvand, Christopher G. Maloney, Sally Coghlan-McDonald, Amy J. Starmer, Samir S. Shah, Sharon Calaman, Jennifer Hepps, Roxi Da Silva, Brian Good, Alisa Khan, Dorene F. Balmer, Michael Turmelle, Briana M. Garcia, Michele Marie Lane, Brenda K. Allair, Ariel S. Winn, Katherine R. Zigmont, Devesh Dahale, Meesha Sharma, Lee M. Sanders, Stuart R. Lipsitz, Zia Bismilla, Kheyandra Lewis, Maria Obermeyer, Clifton E. Yu, Aarti Patel, Katherine P. Litterer, Kevin T. Barton, Dale Ann Micalizzi, Elizabeth Corless, Daniel C. West, Claire Alminde, Shilpa J. Patel, Maitreya Coffey, Amanda S. Growdon, Kimberly Sauder, Vineeta Mittal, Peggy Markle, Christopher P. Landrigan, Michael D. Wolf, Roben Harris, Debra Chandler, Katherine O'Donnell, Rebecca Blankenburg, Eileen Christensen, E. Douglas Thompson, Cindy Warnick, Megan Aylor, Jennifer Baird, Amanda Mangan, Christy J.W. Ledford, Catherine Yoon, Theodore C. Sectish, Nancy D. Spector, Anupama Subramony, Nicholas Kuzma, Matthew F. Wien, Arabella L Simpkin, Laura Trueman, LeAnn Gubler, Joseph O. Lopreiato, Glenn Rosenbluth, Tanner Trujillo, Kathleen Langrish, Stephanie Wintch, Amanda Choudhary, Benard P. Dreyer, Michele Ashland, Rita Pickler, Andrew J. White, Rajendu Srivastava, Sharon Cray, H. Shonna Yin, Fernando S. Mendoza
Rok vydání: 2017
Předmět:
Zdroj: JAMA Pediatrics. 171:372
ISSN: 2168-6203
Popis: 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.
Databáze: OpenAIRE
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