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How safe are paediatric emergency departments? A national prospective cohort study
BACKGROUND: Despite the high number of children treated in emergency departments, patient safety risks in this setting are not well quantified. Our objective was to estimate the risk and type of adverse events, as well as their preventability and severity, for children treated in a paediatric emerge...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9606537/ https://www.ncbi.nlm.nih.gov/pubmed/35853646 http://dx.doi.org/10.1136/bmjqs-2021-014608 |
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author | Plint, Amy C Newton, Amanda S Stang, Antonia Cantor, Zach Hayawi, Lamia Barrowman, Nick Boutis, Kathy Gouin, Serge Doan, Quynh Dixon, Andrew Porter, Robert Joubert, Gary Sawyer, Scott Crawford, Tyrus Gravel, Jocelyn Bhatt, Maala Weldon, Patrick Millar, Kelly Tse, Sandy Neto, Gina Grewal, Simran Chan, Melissa Chan, Kevin Yung, Grant Kilgar, Jennifer Lynch, Tim Aglipay, Mary Dalgleish, Dale Farion, Ken Klassen, Terry P Johnson, David W Calder, Lisa A |
author_facet | Plint, Amy C Newton, Amanda S Stang, Antonia Cantor, Zach Hayawi, Lamia Barrowman, Nick Boutis, Kathy Gouin, Serge Doan, Quynh Dixon, Andrew Porter, Robert Joubert, Gary Sawyer, Scott Crawford, Tyrus Gravel, Jocelyn Bhatt, Maala Weldon, Patrick Millar, Kelly Tse, Sandy Neto, Gina Grewal, Simran Chan, Melissa Chan, Kevin Yung, Grant Kilgar, Jennifer Lynch, Tim Aglipay, Mary Dalgleish, Dale Farion, Ken Klassen, Terry P Johnson, David W Calder, Lisa A |
author_sort | Plint, Amy C |
collection | PubMed |
description | BACKGROUND: Despite the high number of children treated in emergency departments, patient safety risks in this setting are not well quantified. Our objective was to estimate the risk and type of adverse events, as well as their preventability and severity, for children treated in a paediatric emergency department. METHODS: Our prospective, multicentre cohort study enrolled children presenting for care during one of 168 8-hour study shifts across nine paediatric emergency departments. Our primary outcome was an adverse event within 21 days of enrolment which was related to care provided at the enrolment visit. We identified ‘flagged outcomes’ (such as hospital visits, worsening symptoms) through structured telephone interviews with patients and families over the 21 days following enrolment. We screened admitted patients’ health records with a validated trigger tool. For patients with flags or triggers, three reviewers independently determined whether an adverse event occurred. RESULTS: We enrolled 6376 children; 6015 (94%) had follow-up data. Enrolled children had a median age of 4.3 years (IQR 1.6–9.8 years). One hundred and seventy-nine children (3.0%, 95% CI 2.6% to 3.5%) had at least one adverse event. There were 187 adverse events in total; 143 (76.5%, 95% CI 68.9% to 82.7%) were deemed preventable. Management (n=98, 52.4%) and diagnostic issues (n=36, 19.3%) were the most common types of adverse events. Seventy-nine (42.2%) events resulted in a return emergency department visit; 24 (12.8%) resulted in hospital admission; and 3 (1.6%) resulted in transfer to a critical care unit. CONCLUSION: In this large-scale study, 1 in 33 children treated in a paediatric emergency department experienced an adverse event related to the care they received there. The majority of events were preventable; most were related to management and diagnostic issues. Specific patient populations were at higher risk of adverse events. We identify opportunities for improvement in care. |
format | Online Article Text |
id | pubmed-9606537 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-96065372022-10-28 How safe are paediatric emergency departments? A national prospective cohort study Plint, Amy C Newton, Amanda S Stang, Antonia Cantor, Zach Hayawi, Lamia Barrowman, Nick Boutis, Kathy Gouin, Serge Doan, Quynh Dixon, Andrew Porter, Robert Joubert, Gary Sawyer, Scott Crawford, Tyrus Gravel, Jocelyn Bhatt, Maala Weldon, Patrick Millar, Kelly Tse, Sandy Neto, Gina Grewal, Simran Chan, Melissa Chan, Kevin Yung, Grant Kilgar, Jennifer Lynch, Tim Aglipay, Mary Dalgleish, Dale Farion, Ken Klassen, Terry P Johnson, David W Calder, Lisa A BMJ Qual Saf Original Research BACKGROUND: Despite the high number of children treated in emergency departments, patient safety risks in this setting are not well quantified. Our objective was to estimate the risk and type of adverse events, as well as their preventability and severity, for children treated in a paediatric emergency department. METHODS: Our prospective, multicentre cohort study enrolled children presenting for care during one of 168 8-hour study shifts across nine paediatric emergency departments. Our primary outcome was an adverse event within 21 days of enrolment which was related to care provided at the enrolment visit. We identified ‘flagged outcomes’ (such as hospital visits, worsening symptoms) through structured telephone interviews with patients and families over the 21 days following enrolment. We screened admitted patients’ health records with a validated trigger tool. For patients with flags or triggers, three reviewers independently determined whether an adverse event occurred. RESULTS: We enrolled 6376 children; 6015 (94%) had follow-up data. Enrolled children had a median age of 4.3 years (IQR 1.6–9.8 years). One hundred and seventy-nine children (3.0%, 95% CI 2.6% to 3.5%) had at least one adverse event. There were 187 adverse events in total; 143 (76.5%, 95% CI 68.9% to 82.7%) were deemed preventable. Management (n=98, 52.4%) and diagnostic issues (n=36, 19.3%) were the most common types of adverse events. Seventy-nine (42.2%) events resulted in a return emergency department visit; 24 (12.8%) resulted in hospital admission; and 3 (1.6%) resulted in transfer to a critical care unit. CONCLUSION: In this large-scale study, 1 in 33 children treated in a paediatric emergency department experienced an adverse event related to the care they received there. The majority of events were preventable; most were related to management and diagnostic issues. Specific patient populations were at higher risk of adverse events. We identify opportunities for improvement in care. BMJ Publishing Group 2022-11 2022-07-19 /pmc/articles/PMC9606537/ /pubmed/35853646 http://dx.doi.org/10.1136/bmjqs-2021-014608 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Original Research Plint, Amy C Newton, Amanda S Stang, Antonia Cantor, Zach Hayawi, Lamia Barrowman, Nick Boutis, Kathy Gouin, Serge Doan, Quynh Dixon, Andrew Porter, Robert Joubert, Gary Sawyer, Scott Crawford, Tyrus Gravel, Jocelyn Bhatt, Maala Weldon, Patrick Millar, Kelly Tse, Sandy Neto, Gina Grewal, Simran Chan, Melissa Chan, Kevin Yung, Grant Kilgar, Jennifer Lynch, Tim Aglipay, Mary Dalgleish, Dale Farion, Ken Klassen, Terry P Johnson, David W Calder, Lisa A How safe are paediatric emergency departments? A national prospective cohort study |
title | How safe are paediatric emergency departments? A national prospective cohort study |
title_full | How safe are paediatric emergency departments? A national prospective cohort study |
title_fullStr | How safe are paediatric emergency departments? A national prospective cohort study |
title_full_unstemmed | How safe are paediatric emergency departments? A national prospective cohort study |
title_short | How safe are paediatric emergency departments? A national prospective cohort study |
title_sort | how safe are paediatric emergency departments? a national prospective cohort study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9606537/ https://www.ncbi.nlm.nih.gov/pubmed/35853646 http://dx.doi.org/10.1136/bmjqs-2021-014608 |
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