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Original Investigation |

Parent-Reported Errors and Adverse Events in Hospitalized Children Online Only

Alisa Khan, MD, MPH1,2; Stephannie L. Furtak, BA1; Patrice Melvin, MPH3; Jayne E. Rogers, RN, MSN4; Mark A. Schuster, MD, PhD1,2; Christopher P. Landrigan, MD, MPH1,2,5
[+] Author Affiliations
1Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
2Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
3Center for Patient Safety and Quality Research, Boston Children’s Hospital, Boston, Massachusetts
4Department of Nursing, Boston Children’s Hospital, Boston, Massachusetts
5Division of Sleep Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Pediatr. 2016;170(4):e154608. doi:10.1001/jamapediatrics.2015.4608.
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Importance  Limited data exist regarding the incidence and nature of patient- and family-reported medical errors, particularly in pediatrics.

Objective  To determine the frequency with which parents experience patient safety incidents and the proportion of reported incidents that meet standard definitions of medical errors and preventable adverse events (AEs).

Design, Setting, and Participants  We conducted a prospective cohort study from May 2013 to October 2014 within 2 general pediatric units at a children’s hospital. Included in the study were English-speaking parents (N = 471) of randomly selected inpatients (ages 0-17 years) prior to discharge. Parents reported via written survey whether their child experienced any safety incidents during hospitalization. Two physician reviewers classified incidents as medical errors, other quality issues, or exclusions (κ = 0.64; agreement = 78%). They then categorized medical errors as harmful (ie, preventable AEs) or nonharmful (κ = 0.77; agreement = 89%). We analyzed errors/AEs using descriptive statistics and explored predictors of parent-reported errors using bivariate statistics. We subsequently reviewed patient medical records to determine the number of parent-reported errors that were present in the medical record. We obtained demographic/clinical data from hospital administrative records.

Main Outcomes and Measures  Medical errors and preventable AEs.

Results  The mean (SD) age of the 383 parents surveyed was 36.6 (8.9) years; most respondents (n = 266) were female. Of 383 parents surveyed (81% response rate), 34 parents (8.9%) reported 37 safety incidents. Among these, 62% (n = 23, 6.0 per 100 admissions) were determined to be medical errors on physician review, 24% (n = 9) were determined to be other quality problems, and 14% (n = 5) were determined to be neither. Thirty percent (n = 7, 1.8 per 100 admissions) of medical errors caused harm (ie, were preventable AEs). On bivariate analysis, children with medical errors appeared to have longer lengths of stay (median [interquartile range], 2.9 days [2.2-6.9] vs 2.5 days [1.9-4.1]; P = .04), more often had a metabolic (14.3% vs 3.0%; P = .04) or neuromuscular (14.3% vs 3.6%; P = .05) condition, and more often had an annual household income greater than $100 000 (38.1% vs 30.1%; P = .06) than those without errors. Fifty-seven percent (n = 13) of parent-reported medical errors were also identified on subsequent medical record review.

Conclusions and Relevance  Parents frequently reported errors and preventable AEs, many of which were not otherwise documented in the medical record. Families are an underused source of data about errors, particularly preventable AEs. Hospitals may wish to consider incorporating family reports into routine safety surveillance systems.

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Classification of Parent-Reported Safety Concerns

Thirty-four parents reported 37 safety concerns that occurred during their child’s hospitalization. Physician reviewers classified these concerns as errors, including harmful errors (ie, preventable adverse events [AEs]) and nonharmful errors/near-misses, as nonsafety-related quality issues, or as exclusions.

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