http://www.hopkinsmedicine.org/press/2003/June/030603.htm

June 3, 2003

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Hospitalized Children Experience Medical Errors at the Same Rate as Adults
 

As healthcare leaders from around the country continue to examine ways to improve patient safety in hospitals nationwide, a new study from researchers at the Agency for Healthcare Research and Quality (AHRQ) finds that hospitalized children experience rates of medical errors similar to those of hospitalized adults.

Based on 3.8 million pediatric discharge records from 22 states in 1997, or approximately 70 percent of all children hospitalized in the United States during that year, the study is believed to be the first of its kind - one based on comprehensive, administrative data - to provide a national snapshot of the issue of pediatric patient safety.

"Children are subject to unique vulnerabilities that predispose them to high rates of in-patient safety failures," said lead study author Marlene Miller, M.D., M.Sc., director of Quality and Safety Initiatives at the Johns Hopkins Children's Center. Miller conducted the research while with the AHRQ.

Among the examples she cited are that "children have a near universal hospitalization for birth, are not able to directly question their own care, and, if their parents or guardians are unavailable, are unable to provide authorized consent for some types of medical care, meaning a possible delay to treatment."

The study, published in the June issue of Pediatrics, reports that the highest rate of pediatric adverse events - 1.5 per 1000 births - involves birth trauma, mostly long bone and skull fractures.

In addition to birth trauma, researchers found children often experience adverse events relating to post-operative infections and other obstetrical complications involving the mother, such as difficulties with anesthesia

"Our findings of high rates of adverse events involving birth trauma clearly indicate that attention needs to be paid to the unique event of childbirth and how health providers can prevent such incidents from occurring during this experience," said Miller.

In their study, Miller and her team analyzed pediatric discharge records using the AHRQ's established Patient Safety Indicators (PSIs), a set of administrative, data-based indicators providing information on potential in-hospital complications and adverse events following surgeries, procedures, and childbirth.

They found that discharged pediatric patients who experienced adverse events had up to a six times longer hospital stay and as many as 18 times the rates of death compared to children who did not experience such incidents. Miller says these rates are comparable to those seen for adults. Adverse events can involve everything from medication errors to accidental cuts and fractures during a procedure.

"The ability to provide the safest medical care is shifting from an emphasis on expecting perfection in individuals, to changing those systems in which they work, reducing risks by factoring in their possibility at every point of care," said Miller. "As the nation's focus on patient safety continues to increase, we need to assure that reporting systems, educational programs, and team training activities actively involve providers of children's health care."

The research was funded by the AHRQ. Additional authors on this study include Anne Elixhauser, Ph.D. and Chunliu Zhan, M.D., Ph.D. of the AHRQ.

 

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