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Safety incidents in pediatric emergency departments: Incidence, characteristics, and variability between centers. A
Dolores Beteta Fernández1, Carlos Pérez Cánovas1, Rosa Belén Martínez Egea1
1Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
Insights
Patient safety incidents are common in pediatric emergency departments, with 8.5% of children experiencing them. Many incidents were preventable and linked to organizational or communication issues, highlighting the need for improved safety strategies.
Area of Science:
- Healthcare Management
- Patient Safety
- Pediatric Emergency Medicine
Background:
- Pediatric emergency departments (PEDs) face high patient safety risks due to workload and patient vulnerability.
- Limited evidence exists on the prevalence and factors associated with safety incidents in PEDs.
- Understanding these incidents is crucial for developing effective improvement strategies.
Purpose of the Study:
- To determine the incidence of patient safety incidents in PEDs.
- To describe the characteristics of these incidents.
- To identify factors associated with their occurrence.
Main Methods:
- A multicenter, observational, descriptive study was conducted.
- Retrospective chart review and structured incident reporting were used.
- Data were collected on 1056 pediatric patients across nine Spanish hospitals.
Main Results:
- 8.5% of pediatric patients experienced at least one safety incident.
- Most incidents caused no or mild/moderate harm; 13% were preventable.
- Incidents were linked to organizational, communication, or human factors, with significant hospital-to-hospital variation.
Conclusions:
- Patient safety incidents are frequent and partly preventable in PEDs.
- Variability between centers suggests institutional structural and cultural factors are influential.
- Context-adapted strategies are needed to enhance safety culture and risk management.
Introduction:
Pediatric emergency departments are high-risk environments for patient safety due to the workload, time pressure and clinical vulnerability of the population. However, there is limited evidence regarding the prevalence, characteristics and associated factors of safety incidents in this setting. Understanding these events is essential to design effective improvement strategies.
Objective:
To estimate the incidence of patient safety incidents in pediatric emergency departments, describe their characteristics and identify associated factors. Multicenter, observational and descriptive study based on retrospective chart review and structured incident reporting.
Methods:
We identified a total of 1102 pediatric patients treated in the emergency departments of nine Spanish hospitals during the second quarter of 2021 were identified. After excluding 49 patients who could not be reached for follow-up, the final sample included 1056 cases. Of these, 90 children experienced incidents related to healthcare, with a total of 94 incidents, as four patients experienced two incidents each. A previously validated tool was used to collect demographic, clinical and organizational data, as well as information on safety incidents.
Results:
The overall proportion of patients with at least one safety incident was 8.5% (95%CI: 6.0-9.0). Most incidents caused no harm (39%) or mild to moderate harm (46%), and 13% were deemed clearly preventable. Incidents mainly occurred during emergency care and were attributed to organizational, communication or human factors. There were significant differences between hospitals (P < .01), but we found no associations with shift, triage level, or mode of arrival. The hospital continued to be a significant predictor in the multivariate analysis.
Conclusions:
Patient safety incidents in pediatric emergency departments are frequent and partly preventable. The variability observed between centers, which persisted after adjusting for the catchment pediatric population and staffing characteristics, suggests the influence of structural and cultural factors specific to each institution. Context-adapted institutional strategies need to be implemented to foster a proactive safety culture and effective risk management.
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