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Children in hospitals frequently experience medical injuries

Children in hospitals often experience adverse patient safety events—such as medical injuries or errors—in the course of their care. Those in vulnerable populations, including children under 1 year old are at highest risk for medical injuries related to hospitalization, according to a new study conducted by researchers at the Agency for Healthcare Research and Quality.

The study, which uses the recently developed Patient Safety Indicators (PSIs) to focus on children in hospitals, examined 5.7 million hospital discharge records for children under age 19 from 27 States. The data were drawn from the 2000 Healthcare Cost and Utilization Project State Inpatient Database. This is one of the first studies to quantify the impact of patient safety events on children in terms of excess hospital stays and charges, as well as the increased risk of death among children due to medical errors.

In total, the PSIs identified 51,615 patient safety events involving children in hospitals during 2000. Children up to 1 year old were consistently and significantly more likely to experience many of the events identified by the PSIs than older children. Children whose primary insurance was Medicaid also were more likely to experience several of the PSI events.

The prevalence of patient safety events resulting in injuries among children also had an impact on the length of stay, charges, and the rate of in-hospital deaths. For example, infections resulting from medical care caused a 30-day increase in the average length of stay and resulted in increased charges of more than $121,000, on average, per discharge. In total, the combined excess charges for all PSI events are estimated to have exceeded $1 billion. Postoperative respiratory failure increased the rate of deaths in hospitals by as much as 76 percent. The researchers estimate that if all deaths among pediatric patients who experience a medical injury are attributed to those injuries, then the records in their analysis alone account for 4,483 deaths among hospitalized children in the year 2000 alone.

The study was conducted by Marlene R. Miller, M.D., formerly acting director of AHRQ's Center for Quality Improvement and Patient Safety and now with Johns Hopkins Children's Center, and Chunliu Zhan, M.D., Ph.D., also of AHRQ. They found that the likelihood of a child experiencing a patient safety event varied greatly depending on the type of event. Some types of events were very uncommon, like postoperative hip fractures and transfusion reactions, both of which occurred less than once for every 10,000 discharges. Others types of events, however, were very prevalent. The leading patient safety events were obstetric trauma among adolescent mothers, with or without forceps, vacuums, or other instruments, with rates of 2,152 and 1,072 events per 10,000 discharges, respectively.

For more information, see "Pediatric patient safety in hospitals: A national picture in 2000," by Drs. Miller and Zhan, in the June 2004 Pediatrics 113(6), pp. 1741-1746.

Reprints (AHRQ Publication No. 04-R047) are available from the AHRQ Publications Clearinghouse.

Editor's Note: Another AHRQ-supported study (AHRQ grant HS11583) on a related topic appears in the same issue of Pediatrics. See "Voluntary anonymous reporting of medical errors for neonatal intensive care," by Gautham Suresh, M.D., Jeffrey D. Horbar, M.D., Paul Plsek, M.S., and others, of the University of Vermont's Center for Patient Safety in Neonatal Intensive Care. They found that when a specialty-based, voluntary, anonymous Internet reporting system for identifying medical errors in neonatal intensive care was implemented, a significant number of medical errors were identified. The researchers successfully implemented the reporting system in 54 neonatal intensive care units in the Vermont Oxford Network. This study demonstrated that health care providers will voluntarily report significant medical errors and adverse events to an external organization using a system like the one these researchers designed, when there is trust in that organization.

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