Pediatric patient safety in hospitals: a national picture in 2000.
OBJECTIVE
To describe potential patient safety events for hospitalized children, examine associated factors, and explore impacts of safety events.


METHODS
The newly released Patient Safety Indicators (PSIs), developed by researchers at the Agency for Healthcare Research and Quality to identify potential in-hospital patient safety problems using administrative data, were applied to hospital discharge data. All 5.7 million discharge records for children younger than 19 years from 27 states in the 2000 Healthcare Cost and Utilization Project were analyzed for PSI events. Prevalence of PSI events and associations with patient-level and hospital-level characteristics were examined. Multivariate regression adjusting for patient severity of illness was used to estimate impacts of safety events in terms of excess length of stay, charges, and in-hospital mortality.


RESULTS
The prevalence of pediatric patient safety events is significant. PSI events occurred more frequently in the very young and those on Medicaid insurance, some of the most vulnerable hospitalized children. Regression analysis found that almost all PSIs are associated with significant and substantial increases in length of stay, charges, and in-hospital death. Using the estimates derived here and the actual number of cases identified in the 2000 data, we estimate that patient safety events incurred >1 billion dollars in excess charges for children alone in 2000.


CONCLUSIONS
Patient safety problems for hospitalized children occur frequently and with substantial impacts to our health care industry. Unmeasurable by this study are the additional "costs" and "burdens" of safety events that our patients are forced to handle. Additional work to describe and quantify better these outcomes in addition to ones measured here can help solidify the "business case" for patient safety efforts.
Miller
Marlene R
MR
Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA. mmille21@jhmi.edu
Zhan
Chunliu
C
D000293:Adolescent; D002648:Child; D002673:Child, Hospitalized; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D007223:Infant; D007902:Length of Stay; D019300:Medical Errors / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D012449:Safety / Q000706:statistics & numerical data; D017751:Safety Management; D014481:United States / Q000453:epidemiology