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. 2018 May-Jun;22(3):290-299.
doi: 10.1080/10903127.2017.1371261. Epub 2017 Oct 12.

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

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

Garth Meckler et al. Prehosp Emerg Care. 2018 May-Jun.

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.

Keywords: emergency medical services; medical errors; pediatrics; safety.

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Conflict of interest statement

Disclosure Statement

The authors have no financial disclosures or conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Types of UNSEMs observed in 378 code-3 ambulance transports of pediatric patients.
Figure 2.
Figure 2.
Preventability of UNSEMs observed in 378 code-3 ambulance transports of pediatric patients.
See this image and copyright information in PMC

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