Pediatric Patient Safety in Hospitals: A National Picture in 2000
* Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland
Objective. To describe potential patient safety events for hospitalized children, examine associated factors, and explore impacts of safety events.
Methods. The newly released Patient Safety Indicators (PSIs), 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 hospital discharge data. All 5.7 million discharge records for children younger than 19 years from 27 states in the 2000 Healthcare Cost and Utilization Project were analyzed for PSI events. Prevalence of PSI events and associations with patient-level and hospital-level characteristics were examined. Multivariate regression adjusting for patient severity of illness was used to estimate impacts of safety events in terms of excess length of stay, charges, and in-hospital mortality.
Results. The prevalence of pediatric patient safety events is significant. PSI events occurred more frequently in the very young and those on Medicaid insurance, some of the most vulnerable hospitalized children. Regression analysis found that almost all PSIs are associated with significant and substantial increases in length of stay, charges, and in-hospital death. Using the estimates derived here and the actual number of cases identified in the 2000 data, we estimate that patient safety events incurred >$1 billion in excess charges for children alone in 2000.
Conclusions. Patient safety problems for hospitalized children occur frequently and with substantial impacts to our health care industry. Unmeasurable by this study are the additional "costs" and "burdens" of safety events that our patients are forced to handle. Additional work to describe and quantify better these outcomes in addition to ones measured here can help solidify the "business case" for patient safety efforts.
Key Words: safety • quality of health care • medical error • infant • child • adolescent • inpatients • hospitals
Abbreviations: AHRQ, Agency for Healthcare Research and Quality • PSI, Patient Safety Indicator • LOS, length of stay • DRG, diagnosis-related group • OR, odds ratio • CI, confidence interval
Received for publication Sep 9, 2003; Accepted Jan 26, 2004.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  N. Menachemi, R. G. Brooks, E. Schwalenstocker, and L. Simpson Use of Health Information Technology by Children's Hospitals in the United States Pediatrics, January 1, 2009; 123(Supplement_2): S80 - S84. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. McDonald, S. M. Davies, C. A. Haberland, J. J. Geppert, A. Ku, and P. S. Romano Preliminary Assessment of Pediatric Health Care Quality and Patient Safety in the United States Using Readily Available Administrative Data Pediatrics, August 1, 2008; 122(2): e416 - e425. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. P. Kronman, M. Hall, A. D. Slonim, and S. S. Shah Charges and Lengths of Stay Attributable to Adverse Patient-Care Events Using Pediatric-Specific Quality Indicators: A Multicenter Study of Freestanding Children's Hospitals Pediatrics, June 1, 2008; 121(6): e1653 - e1659. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Leong, J. Afrow, H. P. Weber, and H. Howell Attitudes Toward Patient Safety Standards in U.S. Dental Schools: A Pilot Study J Dent Educ., April 1, 2008; 72(4): 431 - 437. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. S. Takata, W. Mason, C. Taketomo, T. Logsdon, and P. J. Sharek Development, Testing, and Findings of a Pediatric-Focused Trigger Tool to Identify Medication-Related Harm in US Children's Hospitals Pediatrics, April 1, 2008; 121(4): e927 - e935. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. E. Walsh, C. P. Landrigan, W. G. Adams, R. J. Vinci, J. B. Chessare, M. R. Cooper, P. M. Hebert, E. G. Schainker, T. J. McLaughlin, and H. Bauchner Effect of Computer Order Entry on Prevention of Serious Medication Errors in Hospitalized Children Pediatrics, March 1, 2008; 121(3): e421 - e427. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Pate Medical Errors Negatively Impact Physicians' Mental Health and Job Satisfaction AAP Grand Rounds, November 1, 2007; 18(5): 52 - 53. [Full Text] [PDF]
|
|
|
|
 |
|
 O. J. Benavidez, K. Gauvreau, P. D. Nido, E. Bacha, and K. J. Jenkins Complications and Risk Factors for Mortality During Congenital Heart Surgery Admissions Ann. Thorac. Surg., July 1, 2007; 84(1): 147 - 155. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. A. Mark, D. W. Harless, and W. F. Berman Nurse Staffing and Adverse Events in Hospitalized Children Policy Politics Nursing Practice, May 1, 2007; 8(2): 83 - 92. [Abstract] [PDF]
|
|
|
|
|
|
K. E. Walsh, W. G. Adams, H. Bauchner, R. J. Vinci, J. B. Chessare, M. R. Cooper, P. M. Hebert, E. G. Schainker, and C. P. Landrigan Medication Errors Related to Computerized Order Entry for Children Pediatrics, November 1, 2006; 118(5): 1872 - 1879. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Sharek, J. D. Horbar, W. Mason, H. Bisarya, C. W. Thurm, G. Suresh, J. E. Gray, W. H. Edwards, D. Goldmann, and D. Classen Adverse Events in the Neonatal Intensive Care Unit: Development, Testing, and Findings of an NICU-Focused Trigger Tool to Identify Harm in North American NICUs Pediatrics, October 1, 2006; 118(4): 1332 - 1340. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J R Meurer, H Yang, C E Guse, M C Scanlon, P M Layde, and the Wisconsin Medical Injury Prevention Program Re Medical injuries among hospitalized children. Qual. Saf. Health Care, June 1, 2006; 15(3): 202 - 207. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K L Dunn, P Reddy, A Moulden, and G Bowes Medical record review of deaths, unexpected intensive care unit admissions, and clinician referrals: detection of adverse events and insight into the system Arch. Dis. Child., February 1, 2006; 91(2): 169 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. McBride, V. W. Chiang, D. A. Goldmann, and C. P. Landrigan Preventable Adverse Events in Infants Hospitalized With Bronchiolitis Pediatrics, September 1, 2005; 116(3): 603 - 608. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Agarwal, S. Swanson, A. Murphy, K. Yaeger, P. Sharek, and L. P. Halamek Comparing the Utility of a Standard Pediatric Resuscitation Cart With a Pediatric Resuscitation Cart Based on the Broselow Tape: A Randomized, Controlled, Crossover Trial Involving Simulated Resuscitation Scenarios Pediatrics, September 1, 2005; 116(3): e326 - e333. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R Ursprung, J E Gray, W H Edwards, J D Horbar, J Nickerson, P Plsek, P H Shiono, G K Suresh, and D A Goldmann Real time patient safety audits: improving safety every day Qual. Saf. Health Care, August 1, 2005; 14(4): 284 - 289. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Sedman, J. M. Harris II, K. Schulz, E. Schwalenstocker, D. Remus, M. Scanlon, and V. Bahl Relevance of the Agency for Healthcare Research and Quality Patient Safety Indicators for Children's Hospitals Pediatrics, January 1, 2005; 115(1): 135 - 145. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Chung and M. A. Schuster Access And Quality In Child Health Services: Voltage Drops Health Aff., September 1, 2004; 23(5): 77 - 87. [Abstract] [Full Text] [PDF]
|
|
