Preventable Adverse Events Research Articles

Models of teaching medical errors.

Medical errors are relatively common causes of preventable iatrogenic adverse events. We have focused on teaching models in certain courses of study that have been reported to have significant positive impacts on the outcomes of teaching about medical errors. All healthcare organizations must establish suitable models of teaching about patient safety and medical errors as a preventive measure and as an early intervention strategy. Teaching undergraduate medical students and physicians in training how to manage and disclose medical errors helps them develop lifelong skills that can effectively reduce such errors.The literature search was conducted in international databases such as PubMed/MEDLINE and Google Scholar search engine using English equivalent keywords, from 1998 up to April, 2020. The search strategy used the following subject headings terms: “Medical error(s)” AND “Teaching”. Out of 40 Studies included, 6 studies were selected to have evaluated models of health care training and simulation based teaching of medical errors and patient safety in undergraduate and postgraduate medical education.

Patient satisfaction with a pharmacist-led best possible medication discharge plan via tele-robot in a remote and rural community hospital.

Medication reconciliation (MedRec) reduces the risk of preventable medication-related adverse events (ADEs). A best possible medication discharge plan (BPMDP) is a revised list of medications a patient will take when discharged from hospital; a pharmacist review ensures accuracy. For many hospitals, on-site pharmacists are non-existent. Extension of a visual presence via a mobile robotic platform with real-time audiovisual communication by pharmacists to conduct MedRec remains unstudied. This study explored patient perceptions of a pharmacist-led BPMDP using a telepresence robot. Time requirements, unintentional discharge medication discrepancies (UMD), programme inefficiencies/barriers and facilitators involved in pharmacist review of the discharge medication list and patient interviews were also described. This prospective cohort study enrolled adult patients admitted to a 12-bed community hospital at high risk of an ADE. Remote pharmacists reviewed the discharge prescription list, identified/resolved UMDs, and interviewed/counselled patients using a telepresence robot. Thereafter, patients completed an anonymous satisfaction questionnaire. Prescriber discharge UMDs were classified, and barriers/inefficiencies and facilitators were documented. Nine patients completed an interview, with a 75% interview agreement rate. All patients were comfortable with the robot and 76% felt their care was better. With a median of 11 discharge medications/patient, the UMD rate was 78%; 71% had omitted medications, 43% involved a cardiovascular medication, 88% were due to a hospital system cause, and 43% were specifically due to an inaccurate best possible admission medication history. Median times for interview preparation, interview and UMD/drug therapy problem resolution were 45, 15 and 10 min, respectively. Using a telepresence robot to provide pharmacist-led BPMDPs is acceptable to patients and an innovative, effective solution to identify/resolve UMDs.

The Burden of Preventable Adverse Drug Events on Hospital Stay and Healthcare Costs in Japanese Pediatric Inpatients: The JADE Study.

Background:Adverse drug events (ADEs) are a burden to the healthcare system. Preventable ADEs, which was ADEs due to medication errors, could be reduced if medication errors can be prevent or ameliorate.Objective:We investigated the burden of preventable ADEs on the length of hospital stay (LOS) and costs, and estimated the national burden of preventable ADEs in pediatric inpatients in Japan.Methods:We analyzed data from the Japan Adverse Drug Events (JADE) study on pediatric patients and estimated the incidence of preventable ADEs and associated extended LOS. Costs attributable to extended LOS by preventable ADEs were calculated using a national statistics database and we calculated the effect of preventable ADEs on national cost excess.Results:We included 907 patients with 7377 patient-days. Among them, 31 patients (3.4%) experienced preventable ADEs during hospitalization. Preventable ADEs significantly increased the LOS by 14.1 days, adjusting for gender, age, ward, resident physician, surgery during hospitalization, cancer, and severe malformation at birth. The individual cost due to the extended LOS of 14.1 days was estimated as USD 8258. We calculated the annual extra expense for preventable ADEs in Japan as USD 329 676 760. Sensitivity analyses, considering the incidence of preventable ADEs and the length of hospital stay, showed that the expected range of annual extra expense for preventable ADEs in Japan is between USD 141 468 968 and 588 450 708.Conclusion:Preventable ADEs caused longer hospitalization and considerable extra healthcare costs in pediatric inpatients. Our results would encourage further efforts to prevent and ameliorate preventable ADEs.

ADVERSE EVENTS RELATED TO MECHANICAL VENTILATION IN A PEDIATRIC INTENSIVE CARE UNIT.

ABSTRACTObjective: To identify the prevalence and factors associated with adverse events (AE) related to invasive mechanical ventilation in patients admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary public hospital.Methods: This is a cross-sectional study from July 2016 to June 2018, with data collected throughout patients’ routine care in the unit by the care team. Demographic, clinical and ventilatory characteristics and adverse events were analysed. The logistic regression model was used for multivariate analysis regarding the factors associated with AE.Results: Three hundred and six patients were included, with a total ventilation time of 2,155 days. Adverse events occurred in 66 patients (21.6%), and in 11 of those (16.7%) two AE occurred, totalling 77 events (36 AE per 1000 days of ventilation). The most common AE was post-extubation stridor (25.9%), followed by unplanned extubation (16.9%). Episodes occurred predominantly in the afternoon shift (49.3%) and associated with mild damage (54.6%). Multivariate analysis showed a higher occurrence of AE associated with length of stay of 7 days or more (Odds Ratio [OR]=2.6; 95% confidence interval [95%CI] 1.49-4.66; p=0.001).Conclusions: The results of the present study show a significant number of preventable adverse events, especially stridor after extubation and accidental extubation. The higher frequency of these events is associated with longer hospitalization.

Cardio-Pulmonary Sequelae in Recovered COVID-19 Patients: Considerations for Primary Care.

Background:Current literature lacks characterization of the post-recovery sequelae among COVID-19 patients. This review characterizes the course of clinical, laboratory, radiological findings during the primary infection period, and the complications post-recovery. Primary care findings are presented for long-COVID care.Methods:Adhering to PRISMA guidelines, 4 databases were searched (PubMed, Embase, CINAHL Plus, Scopus) through December 5, 2020, using the keywords “COVID-19 and/or recovered and/or cardiovascular and/or long-term and/or sequelae and/or sub-acute and/or complication.” We included published peer-reviewed case reports, case series, and cross-sectional studies providing the clinical course of COVID-19 infection, and cardiopulmonary complications of patients who recovered from COVID-19, while making healthcare considerations for primary care workers.Results:We identified 29 studies across 9 countries including 37.9% Chinese and 24.1% U.S. studies, comprising 655 patients (Mean Age = 45) with various ethnical backgrounds including Asian and European. Based on the WHO COVID-19 severity classification scale, initial disease severity was mild for 377 patients and severe for 52 patients. Treatments during primary infection included corticosteroids, oxygen support, and antivirals. The mean value (in days) for complication onset after acute recovery was 28 days. Complete blood counts and RT-PCR tests were the most common laboratory results described. In 22 of the studies, patients showed signs of clinical improvement and were prescribed medications such as anticoagulants or corticosteroids.Conclusion:Post-recovery infectious complications are common in long-COVID-19 patients ranging from mild infections to life-threatening conditions. International thoracic and cardiovascular societies need to develop guidelines for patients recovering from COVID-19 pneumonia, while focused patient care by the primary care physician is crucial to curb preventable adverse events. Recommendations for real-time and lab-quality diagnostic tests are warranted to establish point-of-care testing, detect early complications, and provide timely treatment.

Adherence of the nursing team to patient safety actions in neonatal units.

to describe the nursing team's adherence to patient safety actions in neonatal units using a validated instrument. a cross-sectional study, carried out through direct observation of the nursing team and descriptive analysis of 182 records of the "Checklist for patient safety in nursing care during hospitalization in Neonatal Intensive Care Units" in a hospital in the municipality of Belo Horizonte. there was evidence of adherence greater than 90.0% in the units concerning the use of the identification wristband and guidance of the companions. It was identified 79.0% of absence on the checking of wristband identification and 59.0% of the absence of an evaluation of the crib wheels' locks. Three of the 21 items included in the checklist did not show non-conformities. partial adherence to patient safety actions was observed, especially regarding the target of patient identification and prevention of falls, which exposes newborns to preventable adverse events.

Medication errors safety signals COVID-19-related Moroccan Pv database

On March 23, 2020, the Moroccan Ministry of Health issued a circular authorizing the off label use of hydroxychloroquine or chloroquine in combination with azythromycin as first-line treatment for all COVID-19 patients. The aim of this study is to detect, assess and manage safety signals from individual cardiovascular adverse events (AE) reported. Methods: During the COVID19 pandemic, pharmacovigilance surveillance was based on spontaneous targeted notification in all health facilities. Newsletters with a suitable reporting form were sent and reporting of AEs was mandatory. The AEs collected were analyzed for causality assessment using the WHO method and the Preventavility method was used to detect any preventable ADR. Safety signals were detected and analyzed using a qualitative pharmacovigilance method. Results: As of December 31, 2020, a total of 527 adverse events have been reported to the NPC related to Hydroxychloroquine or Chloroquine among the Covid 19 patients. We received 09 cases of preventable AEs related to medication error including one drug interaction for 3 cases, dose errors for 5 cases and one case with both errors, these cases have been validated ad managed as safety signals. Discussion and conclusion: The detected signal concerned the QT prolongation, hypokalaemia and arrythmias, due to high dose of azithromycin and to drug interactions with hypokalaemic drugs. The signal was analyzed and validated during the technical committee, and recommendations were established to avoid the occurrence of similar cases.

925. Adverse Events Due to Inappropriate Prescribing in Older Adults Living with HIV

BackgroundPeople living with HIV (PLWH) are aging and experience age-related comorbidities as well as physiological changes leading to a higher risk for polypharmacy, drug-drug interactions, inappropriate prescribing and related adverse events (AE). Prior studies have highlighted a growing concern for inappropriate prescribing in older PLWH. The objective of this study was to examine the prevalence of AEs resulting from inappropriate prescribing in PLWH > 65 years of age.MethodsThis was a retrospective chart review. PLWH followed-up at the outpatient HIV clinic at the University Hospital in New Mexico between 01/01/2015 and 08/21/ 2018 were eligible if they were > 65 years of age and had >1 potentially inappropriate prescriptions (PIP). PIP were identified using the Beers and STOPP/START criteria for inappropriate mediations in elderly, as well as drugs incorrectly dosed, and potentially deleterious drug-drug interactions (DDI). The University of Liverpool’s HIV interaction checker and Lexicomp’s interaction checker were used to screen for DDI between HIV and non-HIV drugs, and between non-HIV drugs. AEs related to PIPs were collected and their severity was classified using the WHO scale for grading of AEs.ResultsA total of 104 PLWH >65 years of age fulfilled the eligibility criteria. Most patients were male (88.5%) with an average age of 69 years. The majority of patients were virologically suppressed (89%), with an average CD4 cell count of 650 cells/µL. Polypharmacy (>5 non-HIV medications) was identified in all 104 patients; average number of non-HIV medications was 9.4 + 4.8. 30 (28.8%) patients experienced >1 AE, with a total of 53 AEs identified. Of those, 20 (67%) presented with a serious AE. 14 patients (47%) had to seek treatment at an emergency department and 2 patients (7%) had to be hospitalized. The most common AEs included falls (27/53 events; 51%), bleeds (7/53 events; 13%), fractures (4/53 events; 8%). Risk for an AE was significantly associated with increasing number of medications (OR 1.16; 95% CI 1.05-1.29).ConclusionPIP and related AEs are common in older PLWH. Interventions to prevent harm including medication reconciliation, medication review, and medication prioritization according to the risks/benefits of individual patients are warranted.DisclosuresKeenan L. Ryan, PharmD, PhC, Theravance (Advisor or Review Panel member)

National and Institutional Trends in Adverse Events Over Time: A Systematic Review and Meta-analysis of Longitudinal Retrospective Patient Record Review Studies.

This study aimed to determine if the implementation of large-scale patient safety initiatives have been successful in reducing overall and preventable adverse event rates in hospital inpatients. The design used in this study was systematic review and meta-analysis. We followed our published protocol (PROSPERO [CRD42019140058]) and searched the following databases: PubMed, CINAHL, PsycINFO, Cochrane Library, and Embase from inception to February 2020. The reference lists of eligible studies were also searched. All longitudinal retrospective record review studies that examined adverse event rates before and after the introduction of patient safety initiatives in hospital inpatients were included. Data extraction, quality, and risk of bias assessment were carried out by 2 independent reviewers. Information on study design, setting, demographics, interventions, and safety outcome measures was extracted. A total of 3894 articles were screened, and 7 articles met the eligibility criteria for our systematic review with 5 of these providing sufficient information for inclusion in the meta-analysis. The degree of heterogeneity was high among studies. The meta-analysis demonstrated a minimal risk reduction in overall adverse event rates of 0.017 (95% confidence interval, 0.002-0.032) when the lower-quality studies were excluded, with one adverse event being prevented for every 59 hospital admissions. These findings are significant when the large numbers of admissions to a hospital every year are considered. Given the low numbers of large-scale implementation studies, there is a need for more research on the effectiveness of patient safety initiatives to further assess the impact of such initiatives on adverse events.

Ophthalmology Self-medication Practices: A Questionnaire-based Study

ABSTRACT Purpose: The aim of the study was to identify patterns of self-medication practices in ophthalmology. Methods: We conducted an electronic cross-sectional descriptive survey of the Riyadh regional population in Saudi Arabia. Results: The study included 1354 subjects; 662 were males (49%), and 692 were females (51%). The rate of self-medication with prescription drugs (topical antibiotics and steroid-containing eye drops) in our sample was 37.2%. The number of respondents who reported using eye drops, whether it was an over-the-counter drug or a prescription drug, was 733 (54.1%). The most frequently used ophthalmic medications after lubrication drops were steroid-containing eye drops (32.6%), followed by topical decongestants (11%) and antibiotics (4.6%). The majority of steroid users (86.6%) were not aware of any steroid-related ocular complications. Conclusion: Our study showed a high rate of self-medication practices along with a low level of awareness of topical medication-related side effects. If left unaddressed, this combination may result in high rates of preventable and avoidable adverse events.

Perioperative changes in body temperature in patients undergoing cesarean section: a comparison between spinal and general anesthesia

Background: Perioperative decrease of body temperature is one of the most common preventable adverse events in patients undergoing a cesarean section. The aim of this study was to compare general anesthesia (GA) and spinal anesthesia (SA) in terms of perioperative changes in body temperature and related perioperative adverse events. Methods: In this prospective study, temperature was obtained 5 minutes before induction, 30 minutes after induction, and 5 minutes after arrival to Post anesthesia care unit (PACU) for patients undergoing GA and SA. In the PACU, patients were evaluated for shivering and pain. Neonatal temperature and Apgar score at 1,5, and 10 minutes were recorded, as well as neonatal intensive care unit (NICU) admissions. Results: 115 patients were included in this study, of which 65 underwent SA, while 50 patients underwent GA. Body temperature of patients undergoing SA was significantly less than that of GA group 30 minutes after induction (p= 0.038). There was no significant difference in the decrease of mean body temperature at different timeframes perioperatively between the groups. There was an increase in the incidence of shivering in SA patients (30.8%), compared to the GA patients (8%; p= 0.003). No significant differences were found between the two groups in newborn Apgar score (at 1,5,10 minutes), newborn body temperature, and NICU admission. Conclusion: We did not find a significant decrease in temperature in both groups. We thus demonstrated that interventions used for prevention of hypothermia are of great importance for maternal and fetal well‐being, by decreasing the risk of developing hypothermia in both GA and SA.

The Effects of a Multifaceted Intervention to Improve Care Transitions Within an Accountable Care Organization: Results of a Stepped-Wedge Cluster-Randomized Trial.

Transitions from hospital to the ambulatory setting are high risk for patients in terms of adverse events, poor clinical outcomes, and readmission. To develop, implement, and refine a multifaceted care transitions intervention and evaluate its effects on postdischarge adverse events. Two-arm, single-blind (blinded outcomes assessor), stepped-wedge, cluster-randomized clinical trial. Participants were 1,679 adult patients who belonged to one of 17 primary care practices and were admitted to a medical or surgical service at either of two participating hospitals within a pioneer accountable care organization (ACO). Multicomponent intervention in the 30 days following hospitalization, including inpatient pharmacist-led medication reconciliation, coordination of care between an inpatient "discharge advocate" and a primary care "responsible outpatient clinician," postdischarge phone calls, and postdischarge primary care visit. The primary outcome was rate of postdischarge adverse events, as assessed by a 30-day postdischarge phone call and medical record review and adjudicated by two blinded physician reviewers. Secondary outcomes included preventable adverse events, new or worsening symptoms after discharge, and 30-day nonelective hospital readmission. Among patients included in the study, 692 were assigned to usual care and 987 to the intervention. Patients in the intervention arm had a 45% relative reduction in postdischarge adverse events (18 vs 23 events per 100 patients; adjusted incidence rate ratio, 0.55; 95% CI, 0.35-0.84). Significant reductions were also seen in preventable adverse events and in new or worsening symptoms, but there was no difference in readmission rates. A multifaceted intervention was associated with a significant reduction in postdischarge adverse events but no difference in 30-day readmission rates.

Poisoning Exposures in People with Dementia (2014‒2019): A Retrospective Study

ObjectiveTo describe the most common types of poisoning exposures, implicated substances and underlying sources of medication error in people with dementia. DesignRetrospective analysis of call records from the New South Wales (NSW) Poisons Information Center (PIC). Setting and ParticipantsPeople with dementia who had a poisoning exposure reported to the NSW PIC (Australia's largest PIC). MethodsA retrospective study was conducted using data from the NSW PIC from July 2014 to July 2019. All calls pertaining to individuals with a reported diagnosis of dementia (Alzheimer's disease or other) or who were taking an antidementia drug were included. Descriptive analysis was performed to characterize poisoning exposures, substances involved, and sources of error. ResultsA total of 2726 cases involving individuals with dementia [mean age = 79.5 (standard deviation 11.0) years; 56.2% female] were reported to the NSW PIC after intentional or unintentional poisoning. Therapeutic errors comprised 1692 (62.1%) of all reported cases followed by accidental exposures which contributed 711 (26.1%). The most common therapeutic substances responsible for therapeutic errors were donepezil (137 cases, 8.1%) and paracetamol (87 cases, 5.1%). The greatest proportion of all accidental exposures was attributed to hand sanitizer (46 cases, 6.5%). Over one-half of therapeutic errors (n = 1021, 60.3%) were linked to double dosing or mistiming of medications, and nursing home or carer errors were implicated in 385 cases (22.8%). Calls were most commonly made by family (n = 1187, 43.5%) and handled at home (n =1444, 53.0%). Conclusions and ImplicationsTherapeutic errors and accidental poisonings are of concern in people with dementia. Strategies to reduce these potentially preventable adverse events should be further explored.

A study on surveillance of vaccine preventable disease and adverse events following immunization

Introduction: The surveillance of public health problem is an important task in public health. It is essential to include Vaccine Preventable Diseases (VPD) surveillance in Universal Immunisation Programme (UIP) in order to know its impact. Aims: The present study was an attempt to examine the various aspects of existing surveillance system for vaccine preventable diseases and adverse event following immunization in Ghaziabad district of UP state in India. Materials and Methods: This study was descriptive and observational in nature, and was carried out in Ghaziabad district of Uttar Pradesh, India for a period of four months from1st November 2008 to 28th February 2009. Dasna block in the district was selected through simple random sampling and all the Primary Health Centres and Sub-centres were studied. Results: Study findings revealed that surveillance data on VPDs and AEFI is obtained mainly through routine reporting. More than 50% children immunized by 70% ANM reported back with complication. Once a VPD case and death is reported the preventive, therapeutic, anti epidemic measures and health camps are organised. Conclusions: Sincere and sustained efforts are needed for implementation of surveillance programme for VPDs and AEFI as current picture is not very encouraging. Keywords: Epidemiology, Surveillance, Vaccine Preventable Diseases (VPD), Adverse Events Following Immunization (AEFI) Key messages: The manpower and infrastructure are usually in place, despite that the implementation of the surveillance of VPDs and AFEIs is lacking in different healthcare facilities. More stress should be laid on the training of the healthcare personnel in surveillance of VPDs and AEFIs, supervision and monitoring.

Medical Error, Adverse Events, and Complications in Interventional Radiology: Liability or Opportunity?

This review suggests that there is a critical need to renew understanding of adverse events and complications within interventional radiology and to redefine a robust commitment to patient safety a...

What is the role of technology in improving patient safety? A French, German and UK healthcare professional perspective

Patient safety in hospitals can be compromised by preventable adverse events (AE). Among the preventable AEs, hospital-acquired infections (HAIs) are one of the most burdensome, contributing to not only poorer patient outcomes but institutional burden through direct financial losses and increased patient length of stay. Technological innovations can enhance patient safety by automating tasks, introducing medication alerts, clinical reminders, improved diagnostic and consultation reports, facilitating information sharing, improving clinical decision-making, intercepting potential errors, reducing variation in practice, and managing workforce shortages as well as making complete patient data available. A multidisciplinary working group from three European countries was convened to discuss how to optimise the use of technology to reduce preventable AEs in acute care hospitals. The working group identified examples where they felt there were opportunities to streamline patient pathways, including antimicrobial stewardship, point of care testing, microbiology test reporting to streamline time from sample-taking to clinical decision and mobile automated dispensing systems, which can reduce the burden on overworked staff. The working group also discussed key factors that were critical to ensuring different stakeholders, both within and outside the hospital, could meaningfully contribute to improving patient safety. They agreed that technological approaches and advances would have limited impact without meaningful cultural changes at all levels of healthcare infrastructure to implement the benefits offered by current or future technologies.

Interventions to Improve Interprofessional Bedside Rounds in a Paediatric Critical Care Unit

Communication errors are the leading root cause of preventable adverse events in hospitals. Patient care rounds provide the most important opportunity for interprofessional communication; however, rounds involve many interprofessional team members, and it can be challenging to achieve optimal communication and team functioning. While rounding best practices have been identified, implementations of best practices have produced mixed results, and little emphasis has been placed on explicitly aligning interventions to user needs. The goal of this study was to elucidate health care providers’ (HCPs) rounding needs and to align intervention design to those needs to improve interprofessional communication within a paediatric critical care unit (CCU). Interview and survey data were collected to identify needs and a participatory design approach was taken to transform needs into intervention(s). The main needs identified led to specific changes included in the intervention design such as changes in the structure, content and timing of morning rounds.

Improved handoff quality and reduction in adverse events following implementation of a Spanish-language version of the I-PASS bundle for pediatric hospitalized patients in Argentina

Introduction communication errors between medical personnel are known to be a leading source of adverse events (AEs). The implementation of teamwork training together with the use of a standardized handoff bundle has previously shown to reduce the number of AEs. However, the applicability of this program in spanish-speaker countries remains unclear. Objective to assess whether the exploratory implementation of I-PASS bundle in an Argentine pediatric hospital is associated with a reduction in the rate of AEs. Methods Design: an exploratory, uncontrolled, pre-post study. Population and sample: medical records (MR), medical prescriptions, and physician reports were reviewed in two clinical wards of the "Hospital General de Niños Pedro de Elizalde". Intervention: I-PASS Spanish version, an standardized handoff bundle consists in: a mnemonics, an introductory workshop, a written handoff tool, simulation sessions, and structured observations with feedback. Results we reviewed 264 MR. Preventable AEs decreased by 62.8% between pre-intervention and post-intervention period (12.1 vs 4.5 AEs/100 admissions; IC95: 0.010; 0.142; [p = 0.025]). Adherence to the use of quality handoff key elements increased significantly, from 25% to 61% in post-intervention period (p = 0.0001). Handoff duration did not change significantly (5.5 ± 0.2 vs 5.3 ± 0.3 minutes per patient [p = 0.59]). Conclusion Implementation of an I-PASS Spanish version was associated with a significant reduction in the rate of AEs and with improvements in handoff quality; without changes in duration.

Preventable Morbidity and Mortality Among Non-trauma Emergency Surgery Patients: The Role of Personal Performance and System Flaws in Adverse Events.

Preventable morbidity and mortality among emergency surgery patients is not adequately analyzed. We aim to describe and classify preventable complications and deaths in this population. The medical records and quality control documents of patients with emergency, non-trauma, surgical disease admitted between September 1, 2006, and August 31, 2018, and recorded to have a preventable or potentially preventable morbidity and mortality were reviewed. The primary outcome was a classification of the complications and deaths by a panel of experts, as attributable to issues of personal performance or system deficiencies. One hundred and fifty patients were identified (127 complications and 23 deaths). The most commonly encountered preventable complications were surgical-site infection (17%), bleeding (13%), injury to adjacent structures (12%), and anastomotic leak (8%). The majority of complications seemed to stem from personal performance (97%), due to either technical or judgment issues, and only 3% were linked with system flaws, either in the form of communication or inadequate protocols. Alcohol use disorder and duration of operation were different between patients with preventable adverse events related to technical issues and patients related to judgment issues; furthermore, more patients who experienced judgment issues died during hospital stay (p <0.05). Among emergency surgery patients, who suffer preventable complications and deaths, issues related to personal performance are more frequent than system flaws. Whereas the effort to improve systems should be unwavering, the emphasis on the surgeon's personal responsibility to avoid preventable complications should not be derailed.

Subjective Toxicity Profiles of Children in Treatment for Cancer: A New Guide to Supportive Care?

ContextChildren and adolescents with cancer experience treatment-related, subjective adverse events (AEs). Identifying distinct groups of patients who predictably experience higher prevalence of AEs could guide patient care. ObjectivesStudy aims were to 1) identify groups of children and adolescents reporting AEs using the Pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (Ped-PRO-CTCAE); 2) determine whether demographic and clinical characteristics predict AE group membership; and 3) examine whether AE group membership was related to the distal outcome of psychological stress. MethodsFour hundred seventy-seven patients self-reported AEs via the Ped-PRO-CTCAE at T1 (beginning of treatment) and the PROMIS Pediatric Psychological Stress measure at T2 (7–28 days later). Latent class analysis was conducted to identify groups of patients and the relationships of the groups with demographic and clinical characteristics, and with stress. ResultsThree distinct a priori unknown AE groups were identified (high AE prevalence, moderate AE prevalence, and low AE prevalence). Females, blacks, patients with high psychological stress, and patients more recently diagnosed were more likely to be in the high AE prevalence group. Gender, age, race, and time since diagnosis were associated with psychological stress. ConclusionChildren with cancer are heterogeneous in experiencing subjective AEs. Gender, race, and time since diagnosis were significantly associated with higher subjective AE prevalence that may lead to psychological stress.