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Development of an Electronic Pediatric All-Cause Harm Measurement Tool Using a Modified Delphi Method
David Christopher Stockwell1, Hema Bisarya, David C Classen
1From the *Division of Critical Care Medicine, Department of Pediatrics, School of Medicine, The George Washington University, Washington, DC; †Center for Quality and Improvement Science, Children's National Medical Center, Washington, DC; ‡Children's Hospital Association, Overland Park, KS; §Department of Infectious Disease, School of Medicine, University of Utah, Salt Lake City, UT; ∥Pascal Metrics, Washington, DC; ¶Division of Biomedical Informatics, Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH; #James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; **Medical Directors Office, Quality and Safety, Great Ormond Street Hospital NHS Foundation Trust, London, England; ††Departments of Paediatrics and Medicine and Centre for Patient Safety, University of Toronto, Toronto, ON; ‡‡Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO; §§Research Institute, and ∥∥Department of Quality and Patient Safety, Children's Hospital Colorado, Aurora, CO; ¶¶Department of Anesthesia and Critical Care Medicine, and ##Department of Quality, Children's Hospital Central California, Madera, CA; ***Division of General Pediatrics, Department of Pediatrics, School of Medicine, Stanford University palo Alto, CA; and †††Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, CA.
Developing a pediatric all-cause harm measurement tool requires efficient harm detection. Experts created a list of 51 pediatric triggers to identify patient harm in hospitals, aiding safety improvements.
Area of Science:
- Pediatric patient safety
- Health informatics
- Medical error detection
Background:
- Reducing harm in pediatric inpatients necessitates reliable harm detection processes.
- Existing tools may not comprehensively capture all-cause harm in this population.
Purpose of the Study:
- To develop a pediatric all-cause harm measurement tool.
- To establish a reliable process for harm detection in pediatric inpatients.
Main Methods:
- Modified Delphi technique employed by international experts in pediatric patient safety and informatics.
- Process involved literature review, trigger-to-harm translation, expert reviews focusing on harm severity, frequency, and trigger detectability, and trigger logic development.
Main Results:
- Initial list of 108 triggers and associated harms was refined through expert consensus.
- The process resulted in a final list of 51 pediatric triggers for potential inclusion in a measurement tool.
Conclusions:
- A modified Delphi method effectively reduced a comprehensive list of triggers to 51 key pediatric triggers.
- Pilot testing of the finalized trigger list is the crucial next step for validating its use in a global pediatric safety measurement tool.
