A Trigger Tool to Detect Harm in Pediatric Inpatient Settings

Author:

Stockwell David C.12,Bisarya Hema3,Classen David C.45,Kirkendall Eric S.67,Landrigan Christopher P.8910,Lemon Valere11,Tham Eric1213,Hyman Daniel1214,Lehman Samuel M.15,Searles Elizabeth16,Hall Matt17,Muething Stephen E.7,Schuster Mark A.810,Sharek Paul J.1819

Affiliation:

1. Division of Critical Care Medicine, Department of Pediatrics, School of Medicine, The George Washington University, Washington, District of Columbia;

2. Center for Quality and Improvement Science, Children’s National Medical Center, Washington, District of Columbia;

3. Children’s Hospital Association and

4. Department of Infectious Disease, School of Medicine, University of Utah, Salt Lake City, Utah;

5. Chief Medical Information Officer, Pascal Metrics, Washington, District of Columbia;

6. Division of Biomedical Informatics, Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio;

7. James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;

8. Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts;

9. Division of Sleep Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts;

10. Harvard Medical School, Boston, Massachusetts;

11. Departments of Performance Improvement, Children’s National Health System, Washington, District of Columbia;

12. Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado;

13. Research Institute and

14. Department of Quality and Patient Safety, Children’s Hospital Colorado, Aurora, Colorado;

15. Department of Anesthesia and Critical Care Medicine and

16. Department of Quality, Children’s Hospital Central California, Madera, California;

17. Division of Analytics, Children’s Hospital Association, Overland Park, Kansas;

18. Division of Hospitalist Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; and

19. Center for Quality and Clinical Effectiveness, Lucile Packard Children’s Hospital, Palo Alto, California

Abstract

OBJECTIVES: An efficient and reliable process for measuring harm due to medical care is needed to advance pediatric patient safety. Several pediatric studies have assessed the use of trigger tools in varying inpatient environments. Using the Institute for Healthcare Improvement’s adult-focused Global Trigger Tool as a model, we developed and pilot tested a trigger tool that would identify the most common causes of harm in pediatric inpatient environments. METHODS: After formal training, 6 academic children’s hospitals used this novel pediatric trigger tool to review 100 randomly selected inpatient records per site from patients discharged during the month of February 2012. RESULTS: From the 600 patient charts evaluated, 240 harmful events (“harms”) were identified, resulting in a rate of 40 harms per 100 patients admitted and 54.9 harms per 1000 patient days across the 6 hospitals. At least 1 harm was identified in 146 patients (24.3% of patients). Of the 240 total events, 108 (45.0%) were assessed to have been potentially or definitely preventable. The most common patient harms were intravenous catheter infiltrations/burns, respiratory distress, constipation, pain, and surgical complications. CONCLUSIONS: Consistent with earlier rates of all-cause harm in adult hospitals, harm occurs at high rates in hospitalized children. Availability and use of an all-cause harm identification tool will establish the epidemiology of harm and will provide a consistent approach to assessing the effect of interventions on harms in hospitalized children.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference23 articles.

1. Temporal trends in rates of patient harm resulting from medical care.;Landrigan;N Engl J Med,2010

2. A new, evidence-based estimate of patient harms associated with hospital care.;James;J Patient Saf,2013

3. Center for Disease Control and Prevention. FASTSTATs—Leading Causes of Death. Available at: http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. Accessed January 5, 2015

4. Quality and safety in the intensive care unit.;Stockwell;J Intensive Care Med,2006

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