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A recent Canadian study (Plint 2022) sought to understand how often pediatric patients suffered adverse events (AEís)† related to emergency department visits.
The researchers found that 3.0% of over 6000 children studied had at least one adverse event. Moreover, 76.5% of these adverse events were deemed preventable. Management issues (52.4%) and diagnostic issues (19.3%) were the most common types of adverse events. 42.2% of events resulted in a return emergency department visit, 12.8% resulted in hospital admission, and 1.6% resulted in transfer to a critical care unit.
The authors note that characteristics of both EDís and children likely contribute to the occurrence of adverse events. They note that high-acuity patient presentations, increasing
patient volumes, and frequent interruptions make EDís a challenging environment for providing pediatric care. But developmental and physical characteristics of children affect communication, treatment strategies, procedures, and medication regimens.
Examples of AEís include delay in diagnosis and treatment of osteomyelitis; lack of documented reassessments for patients in respiratory distress who returned requiring escalated care; missed diagnoses of pneumonia or fractures on X-ray that required further treatment; and adverse effects of medications.
Increasing age, triage category, and treatment in the acute care area of the ED were factors associated with being a patient with an AE. Increasing age, having a chronic condition, increasing time to physician assessment, and treatment in the acute care area of the ED were significantly associated with a preventable AE.
The authors cite the need for quality improvement programs targeting the high-risk groups they identified and addressing the system issues that contribute to AEís.
In an accompanying editorial, Michelson and Griffey (Michelson 2022) discuss some of the methodological challenges in determining pediatric AE rates. They also point out that the study was on true pediatric EDís, whereas in the US, about 90% of childrenís ED visits are to general EDís, with only 10% taking place in dedicated pediatric EDís. That makes generalizability difficult.
Plint AC, Newton AS, Stang A, et al. How safe are paediatric emergency departments? A national prospective cohort study. BMJ Quality & Safety 2022; Published Online First: 19 July 2022
Michelson KA, Griffey RT. Why identifying adverse events in paediatric emergency care matters. BMJ Quality & Safety 2022; Published Online First: 21 July 2022
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