Out-of-Hospital Pediatric Patient Safety Events: Results of the CSI Chart Review

Garth Meckler, Matthew Hansen, William Lambert, Kerth O'Brien, Caitlin Dickinson, Kathryn Dickinson, Joshua Van Otterloo, Jeanne Marie Guise

Research output: Research - peer-reviewArticle

Abstract

Objective: Studies of adult hospital patients have identified medical errors as a significant cause of morbidity and mortality. Little is known about the frequency and nature of pediatric patient safety events in the out-of-hospital setting. We sought to quantify pediatric patient safety events in EMS and identify patient, call, and care characteristics associated with potentially severe events. Methods: As part of the Children's Safety Initiative -EMS, expert panels independently reviewed charts of pediatric critical ambulance transports in a metropolitan area over a three-year period. Regression models were used to identify factors associated with increased risk of potentially severe safety events. Patient safety events were categorized as: Unintended injury; Near miss; Suboptimal action; Error; or Management complication (“UNSEMs”) and their severity and potential preventability were assessed. Results: Overall, 265 of 378 (70.1%) unique charts contained at least one UNSEM, including 146 (32.8%) errors and 199 (44.7%) suboptimal actions. Sixty-one UNSEMs were categorized as potentially severe (23.3% of UNSEMs) and nearly half (45.3%) were rated entirely preventable. Two factors were associated with heightened risk for a severe UNSEM: (1) age 29 days to 11 months (OR 3.3, 95% CI 1.25-8.68); (2) cases requiring resuscitation (OR 3.1, 95% CI 1.16-8.28). Severe UNSEMs were disproportionately higher among cardiopulmonary arrests (8.5% of cases, 34.4% of severe UNSEMs). Conclusions: During high-risk out-of-hospital care of pediatric patients, safety events are common, potentially severe, and largely preventable. Infants and those requiring resuscitation are important areas of focus to reduce out-of-hospital pediatric patient safety events.

LanguageEnglish (US)
Pages1-10
Number of pages10
JournalPrehospital Emergency Care
DOIs
StateAccepted/In press - Oct 12 2017

Fingerprint

Pediatric Hospitals
Patient Safety
Pediatrics
Resuscitation
Safety
Medical Errors
Ambulances
Heart Arrest
Patient Care
Morbidity
Mortality
Wounds and Injuries

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Out-of-Hospital Pediatric Patient Safety Events : Results of the CSI Chart Review. / Meckler, Garth; Hansen, Matthew; Lambert, William; O'Brien, Kerth; Dickinson, Caitlin; Dickinson, Kathryn; Van Otterloo, Joshua; Guise, Jeanne Marie.

In: Prehospital Emergency Care, 12.10.2017, p. 1-10.

Research output: Research - peer-reviewArticle

Meckler, Garth ; Hansen, Matthew ; Lambert, William ; O'Brien, Kerth ; Dickinson, Caitlin ; Dickinson, Kathryn ; Van Otterloo, Joshua ; Guise, Jeanne Marie. / Out-of-Hospital Pediatric Patient Safety Events : Results of the CSI Chart Review. In: Prehospital Emergency Care. 2017 ; pp. 1-10
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