Families detect errors hospital incident reports miss

Rates of medical errors yielded by solicited family reporting were 5 times higher than the rates provided by hospital incident reports and the rates of adverse events (AEs) were 3 times higher, a study in 4 pediatric hospitals found. Most hospitals primarily use incident reports to conduct patient safety surveillance.

Investigators developed a family safety interview (FSI) that they administered to parents/caregivers of 989 hospitalized children every 7 days during their child’s hospitalization and before discharge. To determine AEs, the FSI asked parents to indicate whether the child’s illness worsened or almost worsened because something was done that should not have been or because something was not done and should have been. The FSI also asked about mistakes that caused no harm and if anything else happened that upset the child or could have harmed him or her. In addition to hospital incident reports, investigators used clinician surveys, medical records, and clinician reports to record clinician event reporting.

Of 717 parent participants, who had varied racial/ethnic and socioeconomic backgrounds, 25.8% reported a total of 255 incidents, about half of which were safety concerns. These included 22 preventable AEs, 17 nonharmful medical errors, and 11 nonpreventable AEs. These family reports included 8 otherwise unidentified AEs, including 7 that were preventable. Among the unique family-reported AEs were multiple needlesticks, inadequate suctioning, and adverse effects from medication. Family-reported AEs most commonly related to temporary patient harm requiring intervention or prolonging hospitalization.

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Of 33 validated family-reported AEs and 39 errors, 25 of the AEs and 20 of the errors also were detected through medical record review. Nurse reports, resident reports, and hospital incident reports also detected a few of the validated family-reported AEs and errors. Overall, family reporting increased error detection by 16% and AE detection by 21%. In addition, investigators found that 49% of family-reported errors and 24% of family-reported AEs were not in the medical record (Khan A, et al. JAMA Pediatr. 2017;171[4]:372-381).

Thoughts from Dr Burke

I like the way that the model proposed here empowers parents, deputizing them to be advocates and protectors for their child. Many parents would do this anyway, but this arrangement makes it clear that family members and hospital staff are on the same side. We want family members to be on the defensive against bad outcomes while we defend that same ground.