Patient Safety Events During Pediatric Hospitalizations
* Center for Quality Improvement and Patient Safety
Center for Organization and Delivery Studies, Agency for Healthcare Research and Quality, Rockville, Maryland
Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
Objective. Our objective was to describe potential patient safety events for hospitalized children, using the patient safety indicators (PSIs), and examine associations with these events.
Methods. PSI algorithms, developed by researchers at the Agency for Healthcare Research and Quality to identify potential in-hospital patient safety problems using administrative data, were applied to 3.8 million discharge records for children under 19 years from 22 states in the 1997 Healthcare Cost and Utilization Project. Prevalence of PSI events and associations with patient-level and hospital-level characteristics, length of stay, in-hospital mortality, and total charges were examined.
Results. The prevalence of pediatric patient safety events is significant with the highest rate found for birth trauma at 1.5 cases per every 100 births. The majority of these events for birth trauma consist of long bone and skull fractures, excluding the clavicle. Compared with records without PSI events, discharges with PSI events had 2- to 6-fold longer lengths of stay, 2- to 18-fold higher rates of in-hospital mortality, and 2- to 20-fold higher total charges. Bivariate and multivariate analyses found that all PSI events except birth trauma were directly associated with factors related to greater severity of illness and large urban teaching institutions. Birth trauma, however, was directly associated with black and Hispanic ethnicity but was not consistently associated with technologically sophisticated teaching institutions.
Conclusions. The prevalence of birth trauma and other potential patient safety events for hospitalized children is high and comparable to hospitalized adults. These events are associated with increased length of stay, in-hospital mortality, and total charges. Associated factors differ significantly for birth trauma compared with other PSI events. Institutional application of the PSIs may be useful to identify processes of care that warrant further evaluation as the health care industry tackles the problem of patient safety, particularly for children.
Key Words: safety • medical error • in-patients • hospitals; child
Abbreviations: PSI, patient safety indicator • IOM, Institute of Medicine • AHRQ, Agency for Healthcare Research and Quality • ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification • APR-DRG, All-Patient Refined-Diagnosis Related Group • COTH, Council of Teaching Hospital • CI, confidence interval • OR, odds ratio
Received for publication Jun 12, 2002; Accepted Nov 22, 2002.
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