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Adverse events and comparison of systematic and voluntary reporting from a paediatric intensive care unit
1Department of Quality and Safety, Royal Children’s Hospital, Melbourne, Australia.
Insights
Systematic enquiry in paediatric intensive care units (PICUs) detects more adverse events than voluntary reporting. Systematic methods capture serious events, while voluntary reporting identifies minor ones.
Area of Science:
- Pediatric Intensive Care
- Patient Safety
- Healthcare Quality Improvement
Background:
- Limited understanding of adverse event incidence in pediatric intensive care units (PICUs).
- Perceived incidence of adverse events may be influenced by data collection methods.
Purpose of the Study:
- To determine the incidence of adverse events in PICUs using both voluntary reporting and systematic enquiry.
- To compare the effectiveness of different data collection methods for adverse events.
Main Methods:
- Adverse events in PICU were recorded contemporaneously via systematic enquiry with bedside nurses and attending doctors.
- Data from systematic enquiry were compared with voluntarily submitted reports to the hospital's quality and safety unit.
- Events were classified by severity (insignificant to catastrophic/lethal) and origin (diagnosis, procedures, medication, miscellaneous).
Main Results:
- Out of 740 patients, 524 adverse events occurred in 193 patients (26.1%).
- Systematic enquiry identified 405 events (80%), capturing mostly moderate to major events.
- Voluntary reporting identified 166 events (32%), primarily insignificant and minor events, missing severe occurrences.
Conclusions:
- Neither voluntary reporting nor systematic enquiry alone captures all adverse events in PICUs.
- Systematic enquiry is more effective in detecting serious adverse events.
- Voluntary reporting captures a subset of events, mainly minor ones, highlighting the need for combined methods.
Background:
Little is known of the incidence of adverse events in the paediatric intensive care unit (PICU). Perceived incidence may be dependent on data-collection methods.
Objective:
To determine the incidence of adverse events by voluntary reporting and systematic enquiry.
Methods:
Adverse events in PICU were recorded contemporaneously by systematic enquiry with bedside nurses and attending doctors, and compared with data submitted voluntarily to the hospital's quality and safety unit. Events were classified as insignificant, minor, moderate, major and catastrophic or lethal, and assigned origins as medical/surgical diagnosis or management, medical/surgical procedures, medication or miscellaneous.
Results:
Among 740 patients, 524 adverse events (mean 0.71 per patient) occurred in 193 patients (26.1%). Systematic enquiry detected 405 (80%) among 165 patients and were classified by one investigator as insignificant 30 (7%); minor 100 (25%); moderate 160 (37%); major 103(25%) and catastrophic 12 (3%). The coefficient of agreement (kappa) of severity between the two investigators was 0.82 (95% CI 0.78-0.87). Voluntary reporting detected 166 (32%) adverse events among 100 patients, of which 119 were undetected by systematic reporting. Forty-nine events (9%) were detected by both methods. The number and severity of events reported by the two methods were significantly different (p<0.0001). Voluntary reporting, mainly by nurses, did not capture major, severe or catastrophic events related to medical/surgical diagnosis or management.
Conclusions:
Neither voluntary reporting nor systematic enquiry captures all adverse events. While the two methods both capture some events, systematic reporting captures serious events, while voluntary reporting captures mainly insignificant and minor events.
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