June 12, 2015
2 min read

Surveillance tool identifies 45% of inpatient pediatric harms as preventable

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A recently developed trigger tool applied by researchers to measure the rate of harm to pediatric patients under medical care detected that 45% of harmful events were most likely preventable, according to a study in Pediatrics.

“Rates of harm resulting in death among hospitalized patients are more than four times higher than originally reported,” researcher David C. Stockwell, MD, MBA, medical director of the pediatric intensive care unit at Children’s National Medical Center in Washington, D.C., and colleagues wrote. “These rates suggest that almost half a million people die in the United States per year as a result of hospital-associated harm. This estimate would place patient harm as the third leading overall cause of death behind heart disease and cancer.”

A trigger tool scans a patient’s medical records for a set of predetermined anomalous triggers, which initiates a more refined search to determine whether the anomaly resulted from an adverse event. Harms, defined as unintended physical injuries, included pain, respiratory distress, constipation and surgical complications.

“Although voluntary reports have been shown to capture only 2% to 8% of all harms, they remain the mainstay of harm detection in most hospitals,” the researchers wrote. “Efforts to improve harm detection have accelerated. These efforts have reinforced the perspective that the trigger tool approach is at present the most reliable and consistent harm detection method.”

While the Institute for Healthcare Improvement’s Global Trigger Tool (IHI GTT) that detects harm in adult patients has been used since 2003, a pediatric-specific trigger tool has not been widely available.

Patterned after the IHI-GTT, the researchers developed the Pediatric All-Cause Harm Measurement Tool (PACHMT) to evaluate 100 patient records from six hospital settings, for 600 patient records, including 313 for boys. The median age of evaluated patients was 4 years.

Two hundred forty harms were detected at a rate of 40 harms per 100 patients. Of those, 85% were identified by the PACHMT; the remainder were not linked to any specific trigger. The data indicated that 108 of the PACHMT-identified harms were considered preventable or probably preventable by reviewing physicians.

“Despite more than a decade of intense focus, harm continues to occur in large numbers in hospitalized children,” Stockwell and colleagues wrote. “The use of the PACHMT trigger tool will provide the foundation to capture harms in a rigorous and systematic way.” – by David Costill

Disclosure: Stockwell reports partial employment by Pascal Metrics, a federally certified Patient Safety Organization. Please see the full study for a list of all other authors’ relevant financial disclosures.