RT Journal Article SR Electronic T1 How safe are paediatric emergency departments? A national prospective cohort study JF BMJ Quality & Safety JO BMJ Qual Saf FD BMJ Publishing Group Ltd SP 806 OP 817 DO 10.1136/bmjqs-2021-014608 VO 31 IS 11 A1 Amy C Plint A1 Amanda S Newton A1 Antonia Stang A1 Zach Cantor A1 Lamia Hayawi A1 Nick Barrowman A1 Kathy Boutis A1 Serge Gouin A1 Quynh Doan A1 Andrew Dixon A1 Robert Porter A1 Gary Joubert A1 Scott Sawyer A1 Tyrus Crawford A1 Jocelyn Gravel A1 Maala Bhatt A1 Patrick Weldon A1 Kelly Millar A1 Sandy Tse A1 Gina Neto A1 Simran Grewal A1 Melissa Chan A1 Kevin Chan A1 Grant Yung A1 Jennifer Kilgar A1 Tim Lynch A1 Mary Aglipay A1 Dale Dalgleish A1 Ken Farion A1 Terry P Klassen A1 David W Johnson A1 Lisa A Calder A1 , YR 2022 UL http://qualitysafety.bmj.com/content/31/11/806.abstract AB 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.All data relevant to the study are included in the article or uploaded as supplementary information.