Evaluating Family Safety Reporting Through an Operational and Research Taxonomy

Integrating family-reported safety data into hospitals' operational safety reporting systems could enrich them, but requires understanding how reports would be classified. We sought to evaluate how family safety reports would be classified in an operational system and compare classifications with a newer research taxonomy.

We prospectively collected safety reports from English and Spanish-speaking families of children hospitalized in a pediatric quaternary hospital's complex care service. Three physicians scored reports using research (modified Bates and colleagues and NCC-MERP) and operational taxonomies. In total, 10% of reports were reviewed independently to determine interrater reliability [kappa (κ)].

In total, 132 families provided 289 reports. Research κ (% agreement) was 0.40 (52.0%) for safety classification and 0.58 (68.0%) for NCC-MERP category. Operational κ was 0.46 (62.5%) for severity. κ for preventability, a shared category across operational and research taxonomies, was 0.53 (76.9%). Using operational taxonomy, reports were commonly classified as medications and fluids (29.8%, n=86), severity level 1 (no harm; 34.6%, n=100), with 34.9% (n=101) deemed unclassifiable. Using research taxonomy, reports were most commonly medicine/IV fluids (36.3%, n=105), nonharmful errors (38.4%, n=111), non-safety-related quality (30.8%, n=89), and NCC-MERP C (29.8%, n=86). 63% (n=182) were possibly preventable/preventable.

Operational and research taxonomies classify family-reported safety events similarly, though many are nonclassifiable in the operational taxonomy. Research taxonomy characterized family-reported concerns, including quality and environmental hazards, highlighting important aspects that operational systems do not capture. Hospitals and researchers should include family-reported data, and operational systems could add research categories to better capture safety and quality information from families.