US paediatric medical errors kill 4500 children a year

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Study finds US paediatric medical errors kill 4500 children a year

BMJ 2004;328:1458 (19 June), doi:10.1136/bmj.328.7454.1458-b

 

http://bmj.bmjjournals.com/cgi/content/full/328/7454/1458-b

 

New Jersey - Anne Harding

 

 

Medical errors in hospital are responsible for the deaths of nearly 4500

children in the United States every year, says a study examining the effect

of lapses in patient safety on children in hospitals throughout the nation

(Pediatrics 2004;113:1741-6).

 

" The bottom line is that none of these events should have happened, " said

Dr Marlene R Miller, the study’s lead author and director of quality and

safety initiatives at the Johns Hopkins Children’s Center in Baltimore.

 

Children less than 1 year old and those covered by Medicaid, the

government’s insurance programme for poor people, were most likely to

experience medical errors, Dr Miller and Dr Chunliu Zhan report (Pediatrics

2004;113:1741-6).

 

The study, which was funded by the Agency for Healthcare Research and

Quality, looked at 5.7 million hospital discharge records for people under

19 years in 27 states in 2000. On the basis of their findings, the

researchers estimate that paediatric patient safety errors cost the United

States more than $1bn (£551m, €828m) annually.

 

The researchers used patient safety indicators recently created by the

agency. These are based on administrative data, and the authors emphasise

that they are " indicators, " not definitive measures. Medication errors were

not included.

 

While several experts in paediatric patient safety have praised Drs Miller

and Zhan for taking a national look at this issue, one specialist said the

study grossly overstated the impact of medical errors in children’s care

because the numbers included deaths that could not unequivocally be

attributed to mistakes.

 

Dr Erin Stucky, physician advisor for quality management at the Children’s

Hospital and Health Center, San Diego, and director of inpatient teaching

at the University of California San Diego’s Department of Pediatrics, said

that of the 20 patient safety indicators analysed, only a few—such as

" foreign body left after procedure " —could without exception be attributed

to error.

 

" If someone dies in a paediatric intensive care unit from shock and sepsis,

you cannot state that that’s a patient safety issue " without additional

information, Stucky added. Several other categories, including

" postoperative physiologic/metabolic derangement " and " failure to rescue, "

were also questionable, she said.

 

It was impossible to say whether the findings overestimated or

underestimated the rate of paediatric patient safety events, said Dr Rainu

Kaushal, a specialist in internal medicine and paediatrics at Brigham and

Women’s Hospital in Boston who studies patient safety and information

technology.

 

Dr Kaushal thought it would be useful to implement known principles of

patient safety to improve children’s care. Giving parents a medical

passport with complete information on their child’s medications and medical

problems would be a good first step, she said, as would more widespread use

of computerised physician decision support systems, which she estimated

were currently implemented in only 10% to 15% of US hospitals.

 

" Information technology is really lagging in our health care in the US in

general, but particularly in paediatrics, " Kaushal said.

 

While Stuckey, Kaushal, and the authors agree that the new study did not

include enough data to offer targeted solutions to paediatric patient

safety problems, Stucky calls for pulling data from patients’ charts to get

a clearer picture of problems within paediatric health care. " Electronic

systems help, but education and people are part of it, " she said.