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Preventable adverse events in infants hospitalized with bronchiolitis
Sarah C McBride1, Vincent W Chiang, Donald A Goldmann
1Department of Medicine, Children's Hospital Boston, Boston, MA 02115, USA. sarah.mcbride@childrens.harvard.edu
Insights
Preventable adverse events (AEs) and near misses (NMs) are common in infants hospitalized for bronchiolitis, particularly those critically ill. These errors significantly increase hospital length of stay (LOS) for critically ill patients.
Area of Science:
- Pediatric Hospital Medicine
- Patient Safety Research
- Infectious Diseases
Background:
- Bronchiolitis is a common cause of infant hospitalization.
- Adverse events (AEs) and near misses (NMs) can impact patient outcomes and healthcare costs.
- Identifying error rates is crucial for improving pediatric care quality.
Purpose of the Study:
- To determine the incidence of preventable AEs and NMs in infants hospitalized with bronchiolitis.
- To assess the impact of these errors on hospital length of stay (LOS).
Main Methods:
- Prospective chart review and staff reports were used to identify and classify AEs and NMs.
- 143 infants (0-12 months) hospitalized for bronchiolitis were studied.
- Events were categorized into preventable AEs, nonpreventable AEs, intercepted NMs, nonintercepted NMs, or errors with minimal harm potential.
Main Results:
- 10% of patients experienced an AE or NM, with a 10% incidence of preventable AEs per 100 admissions.
- Critically ill patients (CIPs) had a 14-fold higher risk of AEs/NMs compared to non-CIPs (68 vs. 5 per 100 admissions).
- CIPs with AEs had significantly longer LOS (9.1 days) than those without (2.9 days).
Conclusions:
- Preventable AEs are frequent in hospitalized infants with bronchiolitis, especially among critically ill patients.
- AEs in critically ill patients are associated with prolonged hospital stays.
- Future research should focus on error prevention strategies for severely ill pediatric patients.
Objective:
To determine the incidence of preventable adverse events (AEs) and near misses (NMs) among infants hospitalized for bronchiolitis at a pediatric tertiary care hospital and the impact of these errors on hospital length of stay (LOS).
Methods:
We studied 143 infants with bronchiolitis, ages 0 to 12 months, admitted from December 2002 to April 2003. Using prospective chart review and staff reports, we captured medical errors and AEs. Each event was classified as a (1) preventable AE, (2) nonpreventable AE, (3) intercepted NM, (4) nonintercepted NM, or (5) error with little or no potential for harm.
Results:
Of 143 patients, 15 (10%) suffered an AE or NM. The incidence of preventable AEs was 10 per 100 admissions. We found a higher incidence of preventable AEs and NMs among critically ill patients (CIPs) compared with non-CIPs (68 vs 5 per 100 admissions, respectively), making the absolute risk of an AE or NM 14 times more likely in CIPs. Mean LOS was significantly longer for CIPs with at least 1 AE (9.1 +/- 8.8 days) than for CIPs without AEs (2.9 +/- 1.5 days). Mean LOS was not significantly different between non-CIPs who did (3.8 +/- 2.6 days) and did not (4.2 +/- 5.0 days) experience an AE.
Conclusions:
Preventable AEs occur frequently among patients admitted for bronchiolitis, especially those who are critically ill. CIPs who suffer AEs during their hospitalization have longer hospital LOSs. Future studies should investigate error-prevention strategies with a focus on those patients with severe disease.
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