Measuring Harm in Hospitalized Children via a Trigger Tool

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BackgroundThe 1999 report To Err Is Human published by the Institute of Medicine estimated that between 44,000 and 98,000 deaths occur each year in US hospitals due to medical errors. However, processes to detect medically induced harm remain inaccurate and inconsistent. Hospitalized pediatric patients are at high risk for adverse events, with published rates ranging between 1% and 11% of all hospitalizations. ObjectiveThe study aimed to use the Global Assessment of Pediatric Patient Safety (GAPPS) tool to detect adverse events in a pediatric inpatient setting of an academic medical center children's hospital and compare to internal incident reporting methods. MethodsNurse reviewers used the GAPPS tool during a retrospective chart review of 100 patients discharged from the children's hospital. Among the total 100 cases, 20 adverse events were discovered with the tool. Adverse events were validated by physician reviewers, and the severity of harm and preventability were assigned. The number of adverse events was then compared to internal incident reporting for the same time frame. ResultsThe detection rate is 4.87% within 411 patient-days. In contrast, the hospital had only 1.22% incident reports. ConclusionsThe GAPPS tool can detect four times more adverse events than the hospital incident reporting system. The results are likely to be replicated for other children's hospitals to increase identification of adverse events and harm to patients.