Factors Related to Serious Safety Events in a Children's Hospital Patient Safety Collaborative.

BACKGROUND AND OBJECTIVES: Serious safety events (SSEs) occur infrequently at individual hospitals, making it difficult to establish trends to improve patient care. Patient safety organizations, such as the Child Health Patient Safety Organization (CHILDPSO), can identify trends and support learning across children's hospitals. We aim to describe longitudinal trends in SSE rates among CHILDPSO member hospitals and describe their sources of harm. METHODS: SSEs from 44 children's hospitals were assigned severity and reported to CHILDPSO from January 1, 2015, to December 31, 2018. SSEs were classified into groups and subgroups based on analysis. Events were then tagged with up to 3 contributing factors. Subgroups with <5 events were excluded. RESULTS: There were 22.5 million adjusted patient days included. The 12-month rolling average SSE rate per 10 000 adjusted patient days decreased from 0.71 to 0.41 (P < .001). There were 830 SSEs reported to CHILDPSO. The median hospital volume of SSEs was 12 events (interquartile range: 6-23), or ∼3 SSEs per year. Of the 830 events, 21.0% were high severity (SSE 1-3) and approximately two-thirds (67.0%, n = 610) were patient care management events, including subgroups of missed, delayed, or wrong diagnosis or treatment; medication errors; and suboptimal care coordination. The most common contributing factor was lack of situational awareness (17.9%, n = 382), which contributed to 1 in 5 (20%) high-severity SSEs. CONCLUSIONS: Hospitals sharing SSE data through CHILDPSO have seen a decrease in SSEs. Patient care management was the most frequently seen. Future work should focus on investigation of contributing factors and risk mitigation strategies.

Implementation of a General Pediatric Clinical Rounding Checklist.

BACKGROUND: Checklists have been found to improve patient outcomes in a variety of health care settings, but use is rare during general pediatric rounds. We aimed to decrease length of stay (LOS) by 10% within 12 months through the standardized delivery of 8 aspects of hospital care for the general pediatric unit. METHODS: For the general pediatrics unit at our freestanding children's hospital, a clinical rounding checklist was developed through a consensus of teaching faculty. Iterative plan-do-study-act cycles were conducted in a targeted medical unit over a 12-month period. We assessed change using control charts. RESULTS: Checklist use increased from 61% to 96% early in the implementation phase. LOS (72 hours) was relatively unchanged. Cardiorespiratory monitor (CRM) duration was reduced by 28% (17.3 hours) within 4 months and was sustained for more than 12 months. A similar CRM reduction of 29% (22.5 hours) was seen in our medically complex patient subgroup. No clinically significant change was appreciated in central line, peripheral intravenous (IV) catheter, IV fluid, or IV medication duration. Thirty-day readmissions, code blue events, and rapid response team activations were not impacted. CONCLUSIONS: The use of a clinical rounding checklist on the general pediatric floor improved care in only 1 of 8 targeted domains. LOS did not change significantly over the project's duration. CRM duration was significantly reduced in both routine patients and medically complex children, and these improvements were sustained without impacting patient safety. More study is needed to determine which checklist components, if any, may prove beneficial to patient outcomes.

Childhood obesity and in-hospital asthma resource utilization.

OBJECTIVE: To examine the relationship between pediatric obesity and inpatient length of stay (LOS), resource utilization, readmission rates, and total billed charges for in-hospital status asthmaticus. DESIGN/METHODS: We conducted a cross-sectional study of patients 5 to 17 years old hospitalized with status asthmaticus to 1 free-standing children's hospital system over 12 months. Only hospitalized patients initially treated in the hospital's emergency department were included to ensure all therapies/charges were examined. Patients with complex chronic conditions, pneumonia, or lacking recorded body mass index (BMI) were excluded. The primary exposure was BMI percentile for age. The primary outcome was LOS (in hours). Secondary outcomes were 90-day readmission rate, billed charges, and resource utilization: number of albuterol treatments, chest radiographs, intravenous fluids, intravenous or intramuscular steroids, and intensive care unit admission. Bivariate, adjusted Poisson and logistic regression model analyses were performed. RESULTS: Five hundred eighteen patients met inclusion criteria. Most had a normal BMI (59.7%); 36.7% were overweight or obese. LOS, readmissions, and resource utilization outcomes were not associated with BMI category on bivariate analyses. After adjustment for demographic/clinical characteristics, LOS decreased by 2% for each decile increase in BMI percentile for age. BMI percentile for age was not associated with billed charges, readmissions, or other measures of resource utilization. CONCLUSIONS: Although BMI decile for age is inversely associated with LOS for in-hospital pediatric status asthmaticus, the effect likely is not clinically meaningful.