Article Text
Abstract
Background Understanding adverse events among children treated in the emergency department (ED) offers an opportunity to improve patient safety by providing evidence of where to focus efforts in a resource-restricted environment.
Objective To estimate the risk of adverse events, their type, preventability and severity, for children seen in a paediatric ED.
Methods This prospective cohort study examined outcomes of patients presenting to a paediatric ED over a 1-year period. The primary outcome was the proportion of patients with an adverse event (harm to patient related to healthcare received) related to ED care within 3 weeks of their visit. We conducted structured telephone interviews with all patients and families over a 3-week period following their visit to identify flagged outcomes (such as repeat ED visits, worsening symptoms) and screened admitted patients’ health records with a validated trigger tool. For patients with flagged outcomes or triggers, three ED physicians independently determined whether an adverse event occurred.
Results Of 1567 eligible patients, 1367 (87.2%) were enrolled and 1319 (96.5%) reached in follow-up. Median patient age was 4.34 years (IQR 1.5 to 10.57 years) and most (n=1281; 93.7%) were discharged. Among those with follow-up, 33 (2.5%, 95% CI 1.8% to 3.5%) suffered an adverse event related to ED care. None experienced more than one event. Twenty-nine adverse events (87.9%, 95% CI 72.7% to 95.2%) were deemed preventable. The most common types of adverse events (not mutually exclusive) were management issues (51.5%), diagnostic issues (45.5%) and suboptimal follow-up (15.2%).
Conclusion One in 40 children suffered adverse events related to ED care. A high proportion of events were preventable. Management and diagnostic issues warrant further study.
- adverse events, epidemiology and detection
- emergency department
- paediatrics
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Footnotes
Contributors ACP was responsible for study conception, overseeing research staff in administering the study, data interpretation, and drafting the manuscript. LAC assisted with study design, study implementation, data interpretation and drafting of the manuscript. ASN and AS assisted with study design and study implementation. KF, WDC, DWJ and TPK assisted with study design. MA and NB were responsible for data analysis and assisted with study design. DD assisted in study implementation and data acquisition. ST and GN assisted in data acquisition. All authors have reviewed the manuscript, provided critical input and agreed to the publication of the manuscript.
Funding This study were supported by a grant from the Ontario Academic Health Science Centres Alternate Funding Plan (AFP) Innovation Fund. ACP is supported in part by a Tier II University of Ottawa Research Chair.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The CHEO Research Ethics Board approved this study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.