title: A trigger tool to detect harm in pediatric inpatient settings.
abstract: OBJECTIVE
  An efficient and reliable process for measuring harm due to medical care is needed to advance pediatric patient safety. Several pediatric studies have assessed the use of trigger tools in varying inpatient environments. Using the Institute for Healthcare Improvement's adult-focused Global Trigger Tool as a model, we developed and pilot tested a trigger tool that would identify the most common causes of harm in pediatric inpatient environments.
  
  
  METHODS
  After formal training, 6 academic children's hospitals used this novel pediatric trigger tool to review 100 randomly selected inpatient records per site from patients discharged during the month of February 2012.
  
  
  RESULTS
  From the 600 patient charts evaluated, 240 harmful events ("harms") were identified, resulting in a rate of 40 harms per 100 patients admitted and 54.9 harms per 1000 patient days across the 6 hospitals. At least 1 harm was identified in 146 patients (24.3% of patients). Of the 240 total events, 108 (45.0%) were assessed to have been potentially or definitely preventable. The most common patient harms were intravenous catheter infiltrations/burns, respiratory distress, constipation, pain, and surgical complications.
  
  
  CONCLUSIONS
  Consistent with earlier rates of all-cause harm in adult hospitals, harm occurs at high rates in hospitalized children. Availability and use of an all-cause harm identification tool will establish the epidemiology of harm and will provide a consistent approach to assessing the effect of interventions on harms in hospitalized children.
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, School of Medicine, The George Washington University, Washington, District of Columbia; Center for Quality and Improvement Science, Children's National Medical Center, Washington, District of Columbia; dstockwell@childrensnational.org.
authors.forename: David C
authors.initials: DC
authors.lastname: Stockwell
authors.affiliation: Children's Hospital Association and.
authors.forename: Hema
authors.initials: H
authors.lastname: Bisarya
authors.affiliation: Department of Infectious Disease, School of Medicine, University of Utah, Salt Lake City, Utah; Chief Medical Information Officer, Pascal Metrics, Washington, District of Columbia;
authors.forename: David C
authors.initials: DC
authors.lastname: Classen
authors.affiliation: Division of Biomedical Informatics, Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Eric S
authors.initials: ES
authors.lastname: Kirkendall
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts;
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Landrigan
authors.affiliation: Departments of Performance Improvement, Children's National Health System, Washington, District of Columbia;
authors.forename: Valere
authors.initials: V
authors.lastname: Lemon
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Research Institute and.
authors.forename: Eric
authors.initials: E
authors.lastname: Tham
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Department of Quality and Patient Safety, Children's Hospital Colorado, Aurora, Colorado;
authors.forename: Daniel
authors.initials: D
authors.lastname: Hyman
authors.affiliation: Department of Anesthesia and Critical Care Medicine and.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Lehman
authors.affiliation: Department of Quality, Children's Hospital Central California, Madera, California;
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Searles
authors.affiliation: Division of Analytics, Children's Hospital Association, Overland Park, Kansas;
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Muething
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts;
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
authors.affiliation: Division of Hospitalist Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; and Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
mesh_terms: D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007297:Inpatients; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D061214:Patient Safety