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Preventable harm occurring to critically ill children.

Gitte Y Larsen1, Amy E Donaldson, Howard B Parker

  • 1Primary Children's Medical Center, Salt Lake City, UT, USA. gitte.larsen@hsc.utah.edu

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|April 10, 2007
PubMed
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Preventable adverse events are common in pediatric intensive care units (PICUs), though serious harm is rare. Younger patients, longer stays, and higher illness burdens increase risk. Focusing on high-risk conditions improves patient safety.

Area of Science:

  • Pediatric Critical Care Medicine
  • Patient Safety Research
  • Healthcare Quality Improvement

Background:

  • Adverse events (AEs) in pediatric intensive care units (PICUs) pose significant risks to critically ill children.
  • Identifying and characterizing AEs and preventable AEs (PAEs) is crucial for improving patient outcomes.
  • Understanding patient factors associated with PAEs can inform targeted prevention strategies.

Purpose of the Study:

  • To develop a trigger tool for identifying AEs in critically ill pediatric patients.
  • To identify and characterize AEs and PAEs in this population.
  • To characterize patients who experience PAEs.

Main Methods:

  • Retrospective chart review utilizing a developed trigger tool.
  • Systematic sampling of 259 patients from a tertiary, university-affiliated pediatric hospital's PICU over one year.

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  • Data collection focused on AE occurrence, severity, type, and patient characteristics.

    • Main Results:

    • The frequency of PAEs was 0.19 per patient-day, with 78% minor, 19% moderate, and 3% serious harm.
    • Common AE types included sedation (22%), skin (16%), medical device complications (14%), pulmonary (13%), and cardiovascular (11%).
    • PAEs were more frequent in younger patients with longer lengths of stay, higher illness burdens, and among surgical patients.

    Conclusions:

    • PAEs occur frequently in the PICU, but severe harm is uncommon.
    • Increased risk for PAEs is associated with the need for sedation, immobility, and vascular/ventilatory devices.
    • Targeted prevention strategies focusing on monitoring high-risk conditions and early intervention are more effective than general error prevention.