March 6, 2017

Study: Hospital surveillance systems might miss family-reported medical errors, adverse events

Daily Briefing

    Families or caregivers of pediatric patients detect medical errors and adverse events that sometimes go unreported in hospital surveillance systems, according to a study published Monday in JAMA Pediatrics.

    Study details

    The researchers noted that provider reported medical errors and adverse events are a primary component to pediatric hospitals' operational safety surveillance. However, they said family- or caregiver-reported medical errors and adverse events "are not routinely gathered" and hypothesized that including such data could improve incident detection.

    To test their hypothesis, the researchers surveyed 746 parents or caregivers of 989 pediatric patients who were hospitalized at four pediatric centers between December 2014 and July 2015. The researchers compared those family-safety interview responses with daily surveys of the providers who cared for the children, as well as medical records and formal hospital incident reports from that time period.

    Findings

    The researchers found medical error and adverse event detection rates increased by 16 percent and 10 percent, respectively, when family-safety interview responses were included.

    According to the study, 185 families reported a total of 255 incidents, including:

    • 132 safety concerns;
    • 102 nonsafety-related quality concerns; and
    • 21 other concerns.

    The researchers said family reports included eight adverse events that were not reported by providers.  Of those, seven were preventable.

    Further, according to Reuters, the researchers found 49 percent of parent- or caregiver-reported errors and 24 percent of parent- or caregiver-reported adverse events were not included in the patient's medical record.

    Medical errors study: Was it overblown?

    Hospital incident reports also did not accurately reflect parent- or caregiver-reported errors, according to the study. Medical error rates by parents or caregivers were five-fold higher than hospital incident report rates, and parent- or caregiver-reported adverse event rates were nearly three-fold higher than hospital incident reports.

    Discussion

    The researchers wrote that "families provide unique information about hospital safety and should be included in hospital safety surveillance in order to facilitate better design and assessment of interventions to improve safety."

    Alisa Khan, a researcher at Harvard Medical School and Boston Children's Hospital who lead the study, said the "results suggest that whether we are talking about safety surveillance research or operational hospital quality improvement and safety tracking efforts, families should be included in safety reporting." She added that while health care providers ultimately are responsible for reporting errors and adverse events, families can help detect events that traditional surveillance methods might miss.

    Separately, Irini Kolaitis, a researcher at the Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine who was not involved in the study, said, "The key finding from this study is that both clinicians and parents accurately recognize medical errors and adverse events, but the use of hospital reporting systems lags behind" (Rapaport, Reuters, 2/27; Khan et al., JAMA Pediatrics, 2/27; Zimmerman, Becker's Infection Control & Clinical Quality, 2/28).

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