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Family Safety Reporting in Hospitalized Children With Medical Complexity
Alexandra N Mercer1, Sangeeta Mauskar1, Jennifer Baird2
1Division of General Pediatrics, Department of Pediatrics.
Insights
Parents of hospitalized children with medical complexity (CMC) frequently identified medical errors. Hospitals should improve safety reporting mechanisms for families, especially those from disadvantaged backgrounds, to enhance patient-centered care.
Area of Science:
- Pediatric Healthcare
- Patient Safety
- Medical Error Analysis
Background:
- Hospitalized children with medical complexity (CMC) face significant risks of medical errors.
- Families of CMC are a valuable, yet underutilized, resource for hospital safety data.
- Understanding family-identified safety concerns is crucial for improving care.
Purpose of the Study:
- To evaluate safety concerns reported by families of hospitalized CMC.
- To identify patient and parent characteristics associated with these safety concerns.
Main Methods:
- A 12-month prospective cohort study involving parents and staff of hospitalized CMC.
- Parents completed pre-discharge safety and experience surveys.
- Mixed-effects logistic regression analyzed associations between family safety concerns and patient/parent factors.
Main Results:
- 43% of parents reported at least one safety concern, with 69% identified as medical errors.
- Higher parental education and longer length of stay were associated with increased safety concerns.
- Most parents reported concerns to bedside nurses, but only 32% recalled knowing how to report.
Conclusions:
- Families of CMC frequently identify medical errors, highlighting their role in patient safety.
- Hospitals need to establish clear reporting mechanisms for families, particularly for CMC and those from disadvantaged backgrounds.
- Engaging families in safety reporting fosters a more comprehensive, patient-centered approach to hospital safety.
Background And Objectives:
Hospitalized children with medical complexity (CMC) are at high risk of medical errors. Their families are an underutilized source of hospital safety data. We evaluated safety concerns from families of hospitalized CMC and patient/parent characteristics associated with family safety concerns.
Methods:
We conducted a 12-month prospective cohort study of English- and Spanish-speaking parents/staff of hospitalized CMC on 5 units caring for complex care patients at a tertiary care children's hospital. Parents completed safety and experience surveys predischarge. Staff completed surveys during meetings and shifts. Mixed-effects logistic regression with random intercepts controlling for clustering and other patient/parent factors evaluated associations between family safety concerns and patient/parent characteristics.
Results:
A total of 155 parents and 214 staff completed surveys (>89% response rates). 43% (n = 66) had ≥1 hospital safety concerns, totaling 115 concerns (1-6 concerns each). On physician review, 69% of concerns were medical errors and 22% nonsafety-related quality issues. Most parents (68%) reported concerns to staff, particularly bedside nurses. Only 32% of parents recalled being told how to report safety concerns. Higher education (adjusted odds ratio 2.94, 95% confidence interval [1.21-7.14], P = .02) and longer length of stay (3.08 [1.29-7.38], P = .01) were associated with family safety concerns.
Conclusions:
Although parents of CMC were infrequently advised about how to report safety concerns, they frequently identified medical errors during hospitalization. Hospitals should provide clear mechanisms for families, particularly of CMC and those from disadvantaged backgrounds, to share safety concerns. Actively engaging patients/families in reporting will allow hospitals to develop a more comprehensive, patient-centered view of safety.
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