Families as Partners in Hospital Error and Adverse Event Surveillance.

Khan A1,2, Coffey M3, Litterer KP4, Baird JD5, Furtak SL1, Garcia BM1, Ashland MA6, Calaman S7, Kuzma NC8, O'Toole JK9, Patel A9, Rosenbluth G10, Destino LA11, Everhart JL11, Good BP12, Hepps JH13, Dalal AK14,15, Lipsitz SR14,15, Yoon CS15, Zigmont KR15, Srivastava R12,16, Starmer AJ1,2, Sectish TC1,2, Spector ND17, West DC10, Landrigan CP1,2,18; and the Patient and Family Centered I-PASS Study Group, Allair BK19, Alminde C20, Alvarado-Little W21, Atsatt M22, Aylor ME23, Bale JF Jr24, Balmer D25, Barton KT26, Beck C27, Bismilla Z27, Blankenburg RL28, Chandler D29, Choudhary A30, Christensen E30, Coghlan-McDonald S31, Cole FS26, Corless E30, Cray S20, Da Silva R32, Dahale D29, Dreyer B33, Growdon AS34, Gubler L30, Guiot A35, Harris R36, Haskell H37, Kocolas I24, Kruvand E36, Lane MM36, Langrish K27, Ledford CJW38, Lewis K39, Lopreiato JO38, Maloney CG24, Mangan A31, Markle P32, Mendoza F28, Micalizzi DA40, Mittal V41, Obermeyer M29, O'Donnell KA34, Ottolini M42, Patel SJ43, Pickler R44, Rogers JE19, Sanders LM28, Sauder K36, Shah SS35, Sharma M19, Simpkin A45, Subramony A46, Thompson ED Jr39, Trueman L29, Trujillo T30, Turmelle MP26, Warnick C30, Welch C30, White AJ26, Wien MF47, Winn AS34, Wintch S22, Wolf M48, Yin HS33, Yu CE38.

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Abstract

IMPORTANCE:

Medical errors and adverse events (AEs) are common among hospitalized children. While clinician reports are the foundation of operational hospital safety surveillance and a key component of multifaceted research surveillance, patient and family reports are not routinely gathered. We hypothesized that a novel family-reporting mechanism would improve incident detection.

OBJECTIVE:

To compare error and AE rates (1) gathered systematically with vs without family reporting, (2) reported by families vs clinicians, and (3) reported by families vs hospital incident reports.

DESIGN, SETTING, AND PARTICIPANTS:

We conducted a prospective cohort study including the parents/caregivers of 989 hospitalized patients 17 years and younger (total 3902 patient-days) and their clinicians from December 2014 to July 2015 in 4 US pediatric centers. Clinician abstractors identified potential errors and AEs by reviewing medical records, hospital incident reports, and clinician reports as well as weekly and discharge Family Safety Interviews (FSIs). Two physicians reviewed and independently categorized all incidents, rating severity and preventability (agreement, 68%-90%; κ, 0.50-0.68). Discordant categorizations were reconciled. Rates were generated using Poisson regression estimated via generalized estimating equations to account for repeated measures on the same patient.

MAIN OUTCOMES AND MEASURES:

Error and AE rates.

RESULTS:

Overall, 746 parents/caregivers consented for the study. Of these, 717 completed FSIs. Their median (interquartile range) age was 32.5 (26-40) years; 380 (53.0%) were nonwhite, 566 (78.9%) were female, 603 (84.1%) were English speaking, and 380 (53.0%) had attended college. Of 717 parents/caregivers completing FSIs, 185 (25.8%) reported a total of 255 incidents, which were classified as 132 safety concerns (51.8%), 102 nonsafety-related quality concerns (40.0%), and 21 other concerns (8.2%). These included 22 preventable AEs (8.6%), 17 nonharmful medical errors (6.7%), and 11 nonpreventable AEs (4.3%) on the study unit. In total, 179 errors and 113 AEs were identified from all sources. Family reports included 8 otherwise unidentified AEs, including 7 preventable AEs. Error rates with family reporting (45.9 per 1000 patient-days) were 1.2-fold (95% CI, 1.1-1.2) higher than rates without family reporting (39.7 per 1000 patient-days). Adverse event rates with family reporting (28.7 per 1000 patient-days) were 1.1-fold (95% CI, 1.0-1.2; P = .006) higher than rates without (26.1 per 1000 patient-days). Families and clinicians reported similar rates of errors (10.0 vs 12.8 per 1000 patient-days; relative rate, 0.8; 95% CI, .5-1.2) and AEs (8.5 vs 6.2 per 1000 patient-days; relative rate, 1.4; 95% CI, 0.8-2.2). Family-reported error rates were 5.0-fold (95% CI, 1.9-13.0) higher and AE rates 2.9-fold (95% CI, 1.2-6.7) higher than hospital incident report rates.

CONCLUSIONS AND RELEVANCE:

Families provide unique information about hospital safety and should be included in hospital safety surveillance in order to facilitate better design and assessment of interventions to improve safety.