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Plint AC, Newton AS, Stang A, Cantor Z, Hayawi L, Barrowman N, Boutis K, Gouin S, Doan Q, Dixon A, Porter R, Joubert G, Sawyer S, Crawford T, Gravel J, Bhatt M, Weldon P, Millar K, Tse S, Neto G, Grewal S, Chan M, Chan K, Yung G, Kilgar J, Lynch T, Aglipay M, Dalgleish D, Farion K, Klassen TP, Johnson DW, Calder LA. How safe are paediatric emergency departments? A national prospective cohort study. BMJ Qual Saf 2022; 31:806-817. [PMID: 35853646 PMCID: PMC9606537 DOI: 10.1136/bmjqs-2021-014608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/02/2022] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Amy C Plint
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda S Newton
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Antonia Stang
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Zach Cantor
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Lamia Hayawi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathy Boutis
- Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Pediatrics and Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Serge Gouin
- Pediatric Emergency Department, CHU Sainte-Justine, Montreal, Québec, Canada
- Pediatrics, Université de Montreal, Montreal, Québec, Canada
| | - Quynh Doan
- Evidence to Innovations, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Dixon
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Porter
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada
- Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Gary Joubert
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Scott Sawyer
- Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatric Emergency, Health Sciences Centre Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada
| | - Tyrus Crawford
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jocelyn Gravel
- Pediatric Emergency Department, CHU Sainte-Justine, Montreal, Québec, Canada
- Pediatrics, Université de Montreal, Montreal, Québec, Canada
| | - Maala Bhatt
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrick Weldon
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kelly Millar
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Sandy Tse
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gina Neto
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simran Grewal
- Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
- Emergency Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Melissa Chan
- Emergency Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Kevin Chan
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada
- Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Grant Yung
- Pediatric Emergency, Health Sciences Centre Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada
| | - Jennifer Kilgar
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Tim Lynch
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Mary Aglipay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Dale Dalgleish
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ken Farion
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatrics and Child Health, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - David W Johnson
- Paediatrics, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lisa A Calder
- Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Koh D, Wee T, Fong M, Tan X, Tan R, Menon S, Goh J, Teo S, Chia J, Kristanto W, Lim GH. Improving Results Management Processes in an Acute Hospital Using a Multi-Faceted Approach. Int J Qual Health Care 2021; 34:6485219. [PMID: 34962273 DOI: 10.1093/intqhc/mzab158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/25/2021] [Accepted: 12/16/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Radiological examinations and laboratory tests are routinely ordered by hospital physicians as part of the care plan to diagnose and treat patients. However, the failure to actively review and follow-up on these results pose a significant problem to patient safety. A study team was formed to mitigate the clinical risks of poor results management, which was identified as a top clinical risk in our organisation, in order to make improvements to the results management process and to ensure the timely review, acknowledgement, and follow-up of test results. METHODS The institutional expectations of results management were set and published as a hospital policy, which was communicated to all clinical departments for compliance. Improvements to the electronic medical records system were made to facilitate the results acknowledgement process, and physicians were engaged to educate them on the importance of results management. RESULTS The study team observed a decrease in unacknowledged results from approximately 16,000 in March 2017 to 2673 in December 2020. The compliance rate for acknowledgement results increased from a monthly average of 83.7% (from March to December 2017) to a monthly average of 99.3% (in 2020). The risk score for results management decreased from 16 to 6.5, and was excluded from the organisation's top clinical risks. CONCLUSION This study showed the importance of both system improvements and culture changes that are required to improve the process of results management, and provides a step forward for the hospital to safeguard patient safety and mitigate clinical risk.
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Affiliation(s)
- Darrel Koh
- Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, A member of National University Health System, Singapore
| | - Tracy Wee
- Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, A member of National University Health System, Singapore
| | - Michelle Fong
- Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, A member of National University Health System, Singapore
| | - Xiaohui Tan
- Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, A member of National University Health System, Singapore
| | - Rudyanna Tan
- Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, A member of National University Health System, Singapore
| | - Shalini Menon
- Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, A member of National University Health System, Singapore
| | - Joey Goh
- Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, A member of National University Health System, Singapore
| | - Stephanie Teo
- Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, A member of National University Health System, Singapore
| | - Joanna Chia
- Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, A member of National University Health System, Singapore
| | - William Kristanto
- Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, A member of National University Health System, Singapore
| | - Ghee Hian Lim
- Department of Medical Affairs, Ng Teng Fong General Hospital, JurongHealth Campus, A member of National University Health System, Singapore
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