. 2022 Oct 19;31(11):806-817.

doi: 10.1136/bmjqs-2021-014608.

How safe are paediatric emergency departments? A national prospective cohort study

Amy C Plint^{1

2}, Amanda S Newton³, Antonia Stang^{4

5}, Zach Cantor⁶, Lamia Hayawi⁶, Nick Barrowman^{6

7}, Kathy Boutis^{8

9}, Serge Gouin^{10

11}, Quynh Doan^{12

13}, Andrew Dixon^{14

15}, Robert Porter^{16

17}, Gary Joubert^{18

19}, Scott Sawyer^{20

21}, Tyrus Crawford⁶, Jocelyn Gravel^{10

11}, Maala Bhatt^{22

2}, Patrick Weldon^{22

7}, Kelly Millar^{5

23}, Sandy Tse^{22

2}, Gina Neto^{22

2}, Simran Grewal^{13

24}, Melissa Chan²⁵, Kevin Chan^{16

17}, Grant Yung²¹, Jennifer Kilgar^{18

19}, Tim Lynch^{18

19}, Mary Aglipay⁶, Dale Dalgleish⁶, Ken Farion^{22

2}, Terry P Klassen^{26

27}, David W Johnson²⁸, Lisa A Calder²⁹; for Pediatric Emergency Research Canada (PERC)

Collaborators, Affiliations

Collaborators

for Pediatric Emergency Research Canada (PERC):
Marie-Christine Auclair, Gregory Georgio, Nadia Shular, Jennifer Crotts, Laura Ebenspanger, Cindy Langford, Debbie Harnum, Muzna Ahmad

Affiliations

¹ Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada plint@cheo.on.ca.
² Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³ Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada.
⁴ Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
⁵ Pediatrics, University of Calgary, Calgary, Alberta, Canada.
⁶ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
⁷ Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
⁸ Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁹ Pediatrics and Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Pediatric Emergency Department, CHU Sainte-Justine, Montreal, Québec, Canada.
¹¹ Pediatrics, Université de Montreal, Montreal, Québec, Canada.
¹² Evidence to Innovations, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
¹³ Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.
¹⁴ Stollery Children's Hospital, Edmonton, Alberta, Canada.
¹⁵ Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
¹⁶ Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada.
¹⁷ Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
¹⁸ Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.
¹⁹ Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada.
²⁰ Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.
²¹ Pediatric Emergency, Health Sciences Centre Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada.
²² Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
²³ Alberta Children's Hospital, Calgary, Alberta, Canada.
²⁴ Emergency Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada.
²⁵ Emergency Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada.
²⁶ Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
²⁷ Pediatrics and Child Health, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada.
²⁸ Paediatrics, Alberta Health Services, Edmonton, Alberta, Canada.
²⁹ Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.

PMID: 35853646
PMCID: PMC9606537
DOI: 10.1136/bmjqs-2021-014608

How safe are paediatric emergency departments? A national prospective cohort study

Amy C Plint et al. BMJ Qual Saf. 2022.

. 2022 Oct 19;31(11):806-817.

doi: 10.1136/bmjqs-2021-014608.

Authors

Collaborators

for Pediatric Emergency Research Canada (PERC):
Marie-Christine Auclair, Gregory Georgio, Nadia Shular, Jennifer Crotts, Laura Ebenspanger, Cindy Langford, Debbie Harnum, Muzna Ahmad

Affiliations

¹ Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada plint@cheo.on.ca.
² Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³ Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada.
⁴ Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
⁵ Pediatrics, University of Calgary, Calgary, Alberta, Canada.
⁶ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
⁷ Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
⁸ Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁹ Pediatrics and Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Pediatric Emergency Department, CHU Sainte-Justine, Montreal, Québec, Canada.
¹¹ Pediatrics, Université de Montreal, Montreal, Québec, Canada.
¹² Evidence to Innovations, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
¹³ Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.
¹⁴ Stollery Children's Hospital, Edmonton, Alberta, Canada.
¹⁵ Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
¹⁶ Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada.
¹⁷ Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
¹⁸ Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.
¹⁹ Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada.
²⁰ Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.
²¹ Pediatric Emergency, Health Sciences Centre Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada.
²² Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
²³ Alberta Children's Hospital, Calgary, Alberta, Canada.
²⁴ Emergency Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada.
²⁵ Emergency Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada.
²⁶ Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
²⁷ Pediatrics and Child Health, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada.
²⁸ Paediatrics, Alberta Health Services, Edmonton, Alberta, Canada.
²⁹ Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.

PMID: 35853646
PMCID: PMC9606537
DOI: 10.1136/bmjqs-2021-014608

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.

Keywords: adverse events, epidemiology and detection; emergency department; paediatrics.

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Conflict of interest statement

Competing interests: LAC is the CEO of the Canadian Medical Protective Association and chair of the Saegis Board of Directors (paid positions). KC is the chair of Acute Care Committee, Canadian Paediatric Society, and the past president of the Section for Emergency Medicine, Canadian Paediatric Society (unpaid positions). GY is a voting member of the Royal College Committee for Pediatric Emergency Medicine (Canada) (unpaid). ASN is the secretary-treasurer for the Mental Health Executive, Canadian Paediatric Society (unpaid).

Figures

**Figure 1**
Flow diagram of patient enrolment and follow-up. ED, emergency department; ICU, intensive care unit; RA, research assistant.

See this image and copyright information in PMC

Comment in

Why identifying adverse events in paediatric emergency care matters.
Michelson KA, Griffey RT. Michelson KA, et al. BMJ Qual Saf. 2022 Oct 19;31(11):776-778. doi: 10.1136/bmjqs-2022-014939. BMJ Qual Saf. 2022. PMID: 35863876 Free PMC article. No abstract available.

References

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1. Doan Q, Wong H, Meckler G, et al. The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study. Can Med Assoc J 2019;191:E627–35. 10.1503/cmaj.181426 - DOI - PMC - PubMed
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1. Doan Q, Wong H, Meckler G, et al. The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study. CMAJ 2019;191:E627–35. 10.1503/cmaj.181426 - DOI - PMC - PubMed

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How safe are paediatric emergency departments? A national prospective cohort study

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How safe are paediatric emergency departments? A national prospective cohort study

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