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Incidence of medical error and adverse outcomes on a pediatric general surgery service
Monja L Proctor1, Jennifer Pastore, Justin T Gerstle
1Hospital for Sick Children, Toronto, Ontario, Canada.
Background/Purpose:
The Institute of Medicine has identified medical error as a leading cause of death and injury, with deaths resulting from medical error exceeding those caused by motor vehicle collisions, breast cancer, or AIDS. The authors examined the incidence and sources of medical error in relation to adverse events on a pediatric general surgery service.
Methods:
All intensive care unit (ICU) and ward admissions to 2 staff pediatric general surgeons during a 1-month period were identified prospectively and in-patient care was reviewed daily by a 3-person panel consisting of a staff surgeon, a surgical fellow, and a nonmedical observer. Medical errors, identified through daily patient encounters, nursing rounds, medical rounds, and chart examinations, were evaluated based on type, hospital setting, personnel involved, and outcome. Adverse outcomes were evaluated based on type and contributing factors.
Results:
Our study group included 64 patients. A total of 108 errors were identified; 28% of these errors resulted in adverse outcomes. One or more medical errors were identified in the care of two thirds of patients (43 of 64), with medical error contributing to adverse outcomes in one third of patients (21 of 64). Errors occurred most frequently in communication, postoperative monitoring and care, and diagnosis, with errors in postoperative care and diagnosis having the highest likelihood of resulting in an adverse outcome. Seventy-four adverse outcomes were identified in 31 patients; 35 (47%) of these outcomes, occurring in 21 patients, were attributable to medical error. The most common adverse outcomes identified were additional nonoperative procedures, of which, 92% resulted from medical error. There were no deaths.
Conclusions:
Medical error occurs in more than one half of hospital admissions on a general pediatric surgery service and contributes to a substantial number of adverse outcomes.
Insights
Medical errors are frequent in pediatric surgery, affecting two-thirds of patients and contributing to adverse outcomes. Communication and postoperative care were key error areas, highlighting the need for improved patient safety protocols.
Area of Science:
- Pediatric Surgery
- Patient Safety
- Medical Error Analysis
Background:
- Medical error is a significant cause of death and injury, surpassing major diseases.
- Previous research highlights the critical need to understand medical error in surgical settings.
Purpose of the Study:
- To investigate the incidence and sources of medical error in pediatric general surgery.
- To determine the relationship between medical errors and adverse events in this patient population.
Main Methods:
- Prospective daily review of pediatric general surgery admissions by a multidisciplinary panel.
- Identification and evaluation of medical errors and adverse outcomes based on type, setting, personnel, and contributing factors.
Main Results:
- Medical errors occurred in two-thirds of 64 patients, contributing to adverse outcomes in one-third.
- Communication, postoperative monitoring, and diagnosis were frequent error sources.
- 47% of 74 adverse outcomes were attributable to medical error, most commonly leading to additional nonoperative procedures.
Conclusions:
- Medical error is prevalent in pediatric general surgery admissions.
- Medical errors significantly contribute to adverse patient outcomes, underscoring patient safety concerns.