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Pediatric surgical errors: A systematic scoping review
Katherine M Marsh1, Mark A Fleming2, Florence E Turrentine3
1Department of Surgery, University of Virginia, Charlottesville, VA 22908-0709, USA; Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia 22908-0709, USA.
Background:
Medical errors were largely concealed prior to the landmark report "To Err Is Human". The purpose of this systematic scoping review was to determine the extent pediatric surgery defines and studies errors, and to explore themes among papers focused on errors in pediatric surgery.
Methods:
The methodological framework used to conduct this scoping study has been outlined by Arksey and O'Malley. In January 2020, PubMed, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. Oxford Level of Evidence was assigned to each study; only studies rated Level 3 or higher were included.
Results:
Of 3,064 initial studies, 12 were included in the final analysis: 4 cohort studies, and 8 outcome/audit studies. This data represented 5,442,000 aggregate patients and 8,893 errors. There were 6 different error definitions and 5 study methods. Common themes amongst the studies included a systems-focused approach, an increase in errors seen with increased complexity, and studies exploring the relationship between error and adverse events.
Conclusions:
This study revealed multiple error definitions, multiple error study methods, and common themes described in the pediatric surgical literature. Opportunities exist to improve the safety of surgical care of children by reducing errors. Original Scientific Research Type of Study: Systematic Scoping Review Level of Evidence Rating: 1.
Insights
Pediatric surgery uses varied definitions and methods to study medical errors. Improving patient safety requires standardizing these approaches to reduce errors in children's surgical care.
Area of Science:
- Medical error analysis
- Pediatric surgery safety
- Systematic scoping review
Background:
- Medical errors were historically underreported before the "To Err Is Human" report.
- Understanding error definition and study practices in pediatric surgery is crucial.
Purpose of the Study:
- To systematically review how pediatric surgery defines and investigates medical errors.
- To identify common themes in research on pediatric surgical errors.
Main Methods:
- A systematic scoping review following the Arksey and O'Malley framework.
- Searches conducted in PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials in January 2020.
- Inclusion of studies rated Oxford Level of Evidence 3 or higher.
Main Results:
- 12 studies were included from 3,064 initial records, analyzing 5,442,000 patients and 8,893 errors.
- Six distinct error definitions and five different study methodologies were identified.
- Key themes included a systems-based approach, increased errors with complexity, and links between errors and adverse events.
Conclusions:
- The pediatric surgical literature exhibits diverse definitions and methods for studying errors.
- Standardization of error definitions and study approaches is needed.
- Opportunities exist to enhance the safety of pediatric surgical care by reducing medical errors.
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