How Safe Are Our Pediatric Emergency Departments?

Children's Hospital of Eastern Ontario6,385 enrolled

Overview

Patient safety is an internationally recognized health care priority. Canadian data suggests that about 8% of adults admitted to hospital experience unintended harm (or 'adverse events') from the health care provided during their hospital stay. On a national level, this represents almost 25,000 preventable deaths among hospitalized adults each year. The emergency department is recognized as a high-risk environment for adverse events but most patient safety research is not specific to the emergency department. As well, the vast majority of people treated in the emergency department are sent home after their visit; yet safety research focuses primarily on people who are admitted to hospital. Finally, although children have also been identified as particularly high risk for suffering adverse events, very little research has been done on how often these events occur among children who visit the emergency department. Our study will address this gap in our knowledge about patient safety and provide important information on the frequency, severity and preventability of adverse events occurring among children in the emergency department. This information will help us to improve the safety of emergency department care for all Canadian children.

Study Type

OBSERVATIONAL

Enrollment

6,385

Conditions

Adverse Effects Adverse Drug Event

Eligibility

Sex: ALLMin age: 1 DayMax age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age less than 18 years * Patients from all pediatric Canadian Triage Acuity Scale categories (pedsCTAS; 1:resuscitation; 2:emergent, 3:urgent, 4:semi-urgent, 5:non-urgent). Exclusion Criteria: * Insurmountable language barrier that prevents informed consent and follow-up by telephone. * Children and families that will be unavailable for telephone follow-up in the three weeks after their emergency department visit (e.g., no telephone in the home, travelling out of the country, etc.).

Locations (10)

Alberta Children's Hospital

Calgary, Alberta, Canada

Stollery Children's Hospital

Edmonton, Alberta, Canada

BC Children's Hospital

Vancouver, British Columbia, Canada

Manitoba Institute of Child Health

Winnipeg, Manitoba, Canada

Winnipeg Children's Hospital

Winnipeg, Manitoba, Canada

Janeway Children's Health and Rehabilitation Centre

St. John's, Newfoundland and Labrador, Canada

Children's Hospital at London Health Sciences Centre

London, Ontario, Canada

Children's Hospital for Eastern Ontario

Ottawa, Ontario, Canada

The Hospital for Sick Children

Toronto, Ontario, Canada

CHU Sainte-Justine

Montreal, Quebec, Canada

Outcomes

Primary Outcomes

Proportion of patients who experience an adverse event related to emergency department care within 3 weeks of an emergency department visit

An adverse event will be defined as an event that results in unintended harm to the patient, and is related to the health care and/or services provided to the patient rather than to the patient's underlying medical condition. Emergency department care will be defined as any care provided in the emergency department and will explicitly include care provided by emergency department specific staff (i.e., staff physicians, nurses, and allied health care providers) and care provided by consultants in the emergency department.

Time frame: 3 weeks

Secondary Outcomes

Proportion of patients experiencing a preventable adverse event

Time frame: 3 weeks

Clinical severity of adverse events

For all patients, we will report the clinical severity as: (a) an abnormality on laboratory testing, (b) ≤1 day of symptoms, (c) \>1 day of symptoms, (d) nonpermanent disability (e) permanent disability, or (f) death. For admitted patients, we will also report clinical severity according to The Institute for Health Care Improvement trigger tool categories: (a) temporary harm to the patient requiring intervention, (b) temporary harm to the patient requiring initial or prolonged hospitalization, (c) permanent patient harm, (d) intervention required to sustain life, or (e) death.

Time frame: 3 weeks

Types of adverse events

Adverse Events will be classified as (a) diagnostic issue, (b) management issue, (c) unsafe disposition decision, (d) suboptimal follow-up, (e) medication adverse effect, (f) procedural complication, and (g) nosocomial infection

Time frame: 3 weeks

System response required for adverse events

The response will be classified as: (a) no treatment (symptoms only), (b) required medical/surgical intervention, (c) visit to MD office, (d) Emergency Department visit, (e) admission to hospital. These previously published broad categories were chosen in order to address the effect of the Adverse Events at both the patient and health care system level.These categories are not exclusive.

Time frame: 3 weeks

Proportion of patients for whom an adverse event is related to emergency department specific care

Versus consulting specialty service care provided in the emergency department or care provided after the child's emergency department visit

Time frame: 3 weeks

Adverse events related to care provided in the emergency department by consulting service

Time frame: 3 weeks

Patient and system level characteristics associated with adverse events and preventable adverse events

Time frame: 3 weeks

Adverse events that occur within the 3-week time frame but are not related to care received in the emergency department

Including those related to in-hospital care and primary care

Time frame: 3 weeks