Abstract
BackgroundLittle is known about adverse events (AEs) in pediatric patients. Record review is a common methodology for identifying AEs, but in pediatrics the record review tools generally have limited focus. The aim of the present study was to develop a broadly applicable record review tool to identify AEs in pediatric inpatients.MethodsUsing a broad literature review and expert opinion with a modified Delphi process, a pediatric trigger tool with 88 triggers, definitions, and descriptions including AE preventability decision support was developed and tested in a random sample of 600 hospitalized pediatric patients admitted in 2010 to a single university children’s hospital. Four registered nurse-physician teams performed complete two-stage retrospective reviews of 150 records each from either neonatal, surgical/orthopedic, medicine, or emergency medicine units.ResultsRegistered nurse review identified 296 of 600 records with triggers indicating potential AEs. Records (n = 121) with only false positive triggers not indicating any potential AEs were not forwarded to the next review stage. On subsequent physician review, 204 (34.0%) of patients were found to have had 563 AEs, range 1–27 AEs/patient. A total of 442 preventable AEs were found in 161 patients (26.8%), range 1–22. Overall, triggers were found 3,598 times in 417 (69.5%) records, with a mean of 6 (median 1, range 0–176) triggers per patient. The overall positive predictive value of the triggers was 22.9%, (range 0.0-100.0%). The final pediatric trigger tool, developed with a second Delphi round, required 29 triggers.ConclusionsAEs are common in pediatric patients and most are preventable. The main contributions of this study are to further develop and adapt trigger definitions, including AE preventability decision support, to introduce new triggers in pediatric care, as well as to apply pediatric triggers in different clinical specialties. Our findings resulted in a national pediatric trigger tool, and might also be adapted internationally. The pediatric trigger tool can help healthcare organizations to measure and analyze the AEs occurring in hospitalized children in order to improve patient safety.
Highlights
Little is known about adverse events (AEs) in pediatric patients
Our findings resulted in a national pediatric trigger tool, and might be adapted internationally
The pediatric trigger tool can help healthcare organizations to measure and analyze the AEs occurring in hospitalized children in order to improve patient safety
Summary
Little is known about adverse events (AEs) in pediatric patients. Record review is a common methodology for identifying AEs, but in pediatrics the record review tools generally have limited focus. Unbeck et al BMC Health Services Research process needs to be developed since definitions and reference values in existing tools are not adapted to pediatric care Development of such definitions has been done for some clinical contexts, and trigger tools have been developed, for example, for neonatal intensive care, pediatric intensive care, critically ill children, otolaryngology, and for the detecting of adverse drug events (ADEs) [6,8,14,15,16,17], but there is limited knowledge about overall AEs in pediatric care. A promising comprehensive trigger tool for hospitalized children in Canada, based on the Harvard medical practice study review methodology, found AEs in 15.1% [10] and 9.2% [9] of the admissions Another pediatric trigger tool was launched in the United Kingdom in 2010 and a recently published study reported that at least one AE occurred in 14.2% of the patients [18]. The findings still point to a need for further development of the this methodology [18] and if the aim is to promote learning from AEs, continuous development of triggers, trigger definitions and the framework for categorizing AEs is needed
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