Know differences between kids and adults: Cut errors
Study points out key areas for safety improvement
Kids really are different from adults, and recognizing those differences can help lower the rate of errors for the youngest patients, advises Donna Woods, PhD, a postdoctoral fellow at the Institute for Health Services Research and Policy Studies in the Feinberg School of Medicine at Northwestern University in Chicago. Woods is the lead author of a study recently published in the journal Pediatrics.1
Woods and her colleagues used data from the Colorado and Utah Medical Practice Study to analyze the incidence and types of adverse events in children. The analysis included some 3,700 hospital patients up to 20 years of age and, for comparison purposes, about 7,500 adult patients between the ages of 21 and 65.
Overall, one of every 100 patients in the study suffered an adverse event, and 60% of these were preventable.
Preventable adverse event rates were 0.53% among infants, compared with 0.22% in children 1 to 12 years of age and 0.95% among adolescents 13 to 20. The figure was 1.5% for adults.
In terms of the greatest number of preventable adverse events, they ranked as follows:
- birth-related, 32.2%;
- diagnostic-related, 30.4%;
- system-related, 27.3%.
The team defined an adverse event as an injury caused by medical management rather than disease that led to prolonged hospitalization or disability that persisted at the time the patient left the hospital. They defined a preventable adverse event as an injury that was avoidable using currently accepted practices.
"This study really provides us with an estimate of the magnitude of the problem of adverse and preventable adverse events in this population," notes Woods. "It is equivalent to the estimates that were produced by the IOM [Institute of Medicine] several years ago, and gives us a sense of where we should we focus."
Customize care for kids
One of the most important things that came out of this study is that patient safety activity for children’s medical care must be customized for the child, she asserts. "Children are different from adults, so our hypothesis was that the areas of greatest risk would be different — and they were. Whereas medications and surgeries are the highest risk areas for adults, the areas that need the most patient safety focus for kids are birth and diagnostics."
Using a panel of medical experts, the team determined which "currently accepted practices" could have prevented an injury.
In terms of diagnostics, the errors were not necessarily related to a particular diagnosis, but to the interpretation of diagnostics findings and in the ordering, Woods explains.
"So, for example, a prolonged hospital stay might result if the patient had to remain in the hospital for an extra week or month because of an inappropriate diagnostic test," she offers.
In terms of preventable adverse events, the location most frequently identified was labor and delivery, Woods adds.
Why the emphasis on system-related errors? "This just indicates that many of these things were not skill-related but related to the way information flows and the way procedures move through the medical system," notes Woods. "It’s not that [the health care professionals] did not have the skills or knowledge, but rather the systems around them [broke down]."
In summarizing take-home issues for quality managers, she observes:
"One in 100 children experiences an adverse event, and 60 of those are preventable — this is a lot for the population and for hospitals," Woods asserts.
"The direction of our attention must be focused in certain areas — for example, diagnostics is a big and difficult area that no one gets their hands around — and the processes involved in caring for children may be different, so the actual intervention may need to be customized to provide safe medical care for children," she adds.
Finally, there’s a paucity of pediatric data available, and more attention must be placed on safety risks for children, Woods says.
"We really need to dig down — to exactly which diagnoses, for example, are the sources of the most errors. We need a much bigger [study] population for that — but those kinds of questions are important questions."
Reference
1. Woods D, Thomas E, Holl J, et al. Adverse events and preventable adverse events in children. Pediatrics 2005; 115:155-160.
Need More Information?
For more information, contact:
• Donna Woods, PhD, Institute for Health Services Research and Policy Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL. Phone: (847) 832-9650. E-mail: [email protected].
Kids really are different from adults, and recognizing those differences can help lower the rate of errors for the youngest patients, advises Donna Woods, PhD, a postdoctoral fellow at the Institute for Health Services Research and Policy Studies in the Feinberg School of Medicine at Northwestern University in Chicago.
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