Families report adverse events in hospitalized children not tracked

Perhaps no one is more worried than a parent with a sick child in the hospital.


But families are doing more than just venting their fears and frustrations when they complain about the care their child is receiving, a new Canadian study suggests.


It found relatives were much more likely to officially report problems than hospital staff, and that their com-plaints often had merit. Almost half of parents' complaints were legitimate patient-safety concerns, "not merely reports of dissatisfaction," the study found.


The study was published Monday in the Canadian Medical Association Journal.


British Columbia researchers tested whether having a system for family members to report "adverse events" - incidents that negatively affected the recovery or health of their child - while in hospital would affect the rate at which health care providers reported the incidents.


The findings revealed just 2.5 per cent of the adverse events reported by families were also reported by health care providers.


"Parents are often much more aware of things that go wrong because they're there at the bedside with one patient all the time," said Dr. Mark Anser-mino, senior author of the study.


"Whereas the health care provider has multiple patients to look after and may not have the same vested interested in looking after that patient. Parents are much better observers of that individual subject than multiple health care providers will be."


Many hospitals in Canada have established systems for health care providers to report errors in a patient's care to help prevent similar mistakes from happening again.


Researchers from British Columbia conducted a study to determine whether an adverse event system involving families would result in a change in events reporting by health care providers. The researchers expected that reporting rates would increase and that families would provide useful information on patient safety.


The study included 544 families whose children were on an inpatient ward that provided general medical, general surgical, neurologic or neurosurgical care in British Columbia's Children's Hospital to babies, children and adolescents. Each family submitted a report and of these 544 participants, 201 (37%) noted at least one adverse event or near miss during hospitalization, for a total of 321 adverse events. Adverse events included medication problems such as a reaction or incorrect dosage, treatment complications, equipment problems and miscommunication. Most of these events — 313 out of 321 — were not reported by the hospital.


However, "the results of this study showed that the introduction of a family-initiated adverse event reporting system administered at the time of discharge from a pediatric inpatient surgical ward was not associated with a change in the rate of reporting of adverse events by health care providers," writes Dr. Jeremy Daniels, University of British Columbia, with coauthors.


Only 2.5% of the events noted by families were documented by health care providers, although "almost half of the adverse events reported by families represented valid safety concerns, not merely reports of dissatisfaction," states the authors. In 139 cases, families received apologies for these incidents.


"The initiation of [the] family-based patient safety reporting system provided new opportunities to learn and improve the safety of health care provision without an additional reporting burden for health care providers," write the authors. "Giving families the opportunity to report patient safety events did not remove the barriers to reporting by providers (time pressure, culture of blame, fear of reprisal and lack of belief in the value of reporting) but served to complement such reporting."


The authors conclude that "further research is needed to delineate how best to harness the potential of families to improve the safety of the health care system."