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Hospital-reported medical errors in children
Anthony D Slonim1, Bonnie J LaFleur, Wendy Ahmed
1Center for Health Services and Clinical Research, Children's Research Institute, Children's National Medical Center, Washington, DC 20010, USA. aslonim@cnmc.org
Insights
Medical errors in hospitalized children were studied from 1988-1997. Higher rates were linked to higher income, special medical needs, and urban teaching hospitals.
Area of Science:
- Pediatric Healthcare Research
- Patient Safety
- Medical Error Analysis
Background:
- Medical errors are a significant concern in adult hospitalizations.
- Pediatric medical errors are understudied with limited published research.
- Understanding pediatric medical error rates is crucial for improving child healthcare.
Purpose of the Study:
- To determine national rates of hospital-reported medical errors in pediatric inpatients from 1988 to 1997.
- To identify patient and hospital characteristics associated with these medical errors.
- To provide data for targeted interventions to reduce pediatric medical errors.
Main Methods:
- A nonconcurrent cohort study design was employed.
- Data from the Healthcare Cost and Utilization Project (HCUP) for 1988, 1991, 1994, and 1997 were analyzed.
- Included were hospitalized nonnewborn pediatric patients (<=18 years) in the United States.
Main Results:
- National rates of hospital-reported medical errors in children ranged from 1.81 to 2.96 per 100 discharges.
- Rates were lower in 1988, with no significant changes in subsequent years.
- Higher median household income, special medical needs, and dependence on medical technology were associated with increased error rates.
- Private for-profit hospitals reported lower rates, while urban teaching hospitals reported higher rates.
Conclusions:
- Administrative data offer insights but have limitations for studying medical errors.
- Children with special medical needs represent a key area for further detailed investigation.
- Findings suggest specific hospital types and patient demographics warrant focused safety initiatives.
Context:
Medical errors are an important problem for hospitalized adult inpatients. However, medical errors in children remain comparatively understudied, and published research has been relatively limited.
Objectives:
To investigate the national rates of hospital-reported medical errors in pediatric inpatients over the period 1988-1997; and to determine the association of patient and hospital characteristics with the occurrence of hospital-reported medical errors in children.
Design, Setting, And Patients:
A nonconcurrent cohort study of hospitalized nonnewborn pediatric patients in the United States
Main Outcome Measure:
The occurrence of hospital-reported medical errors.
Results:
The national rate of hospital-reported medical errors in hospitalized children ranged from 1.81 to 2.96 per 100 discharges. These medical error rates were statistically lower in 1988, with the years 1991, 1994, and 1997 not being statistically different from each other. There were no consistent differences in the rates of medical errors when stratified by gender, race, payor status, or median household income of the patient's zip code across years. There was, however, a statistically significant relationship between higher median household income and increasing medical error rates; this trend was consistent across all 4 years. Similarly, children with special medical needs or dependence on a medical technology also had significantly higher rates of hospital-reported medical errors. Although hospital size did not seem to be related to the rate of medical errors, private for-profit hospitals consistently reported lower rates, whereas urban teaching hospitals in all years but 1997 reported higher rates of medical errors.
Conclusions:
These data highlight both the strengths and limitations of administrative data in the investigation of medical errors. Substantively, they suggest fruitful areas for additional and more detailed study, notably children with special medical needs.
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