title: Critical incidents in a French department of paediatric anaesthesia.
abstract: BACKGROUND
  Several studies have highlighted the importance of critical incident (CI) reporting in order to enhance patient safety. We have implemented an anonymous procedure for CI reporting in our department of paediatric anaesthesia. This study aims at analysing those CIs so as to improve patient care and risk management.
  
  
  METHODS
  CIs were reported by the anaesthetic team using the World Health Organization classification and analysed using the ORION methodology. CIs were classified according to type, surgery and complications. Risk factors and consequences for patients and for the institution were analysed. Risk factors with high degree of harm for the patient were identified using a univariate analysis and odds ratios (OR).
  
  
  RESULTS
  Over an 18-month period, 114 CIs were reported for 103 patients (median age: 7.0 years [95% CI: 3.6-9.8]). We found that 29.9% of reported CIs had consequences for the patients and 76.3% were considered preventable. The two main types of CI were "respiratory" (28.8%) and "drug-related" (22.8%) incidents. The main risk factor was 'human error' (42.3%). Several consequences for the patient and the hospital were identified. An ASA score≥3 (OR: 2.52; [95% CI: 1.10-5.78]) was an independent risk factor for a high degree of patient harm.
  
  
  CONCLUSIONS
  Improving quality of care must be a priority for paediatric anaesthesiologists as most of the CIs observed are preventable and have consequences for the patient and the institution.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Hôpital Universitaire Necker-Enfants-Malades, AP-HP, University Paris Descartes, 149, rue de Sèvres, 75743 Paris, France.
authors.forename: Elisa
authors.initials: E
authors.lastname: Kupersztych-Hagege
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Hôpital Universitaire Necker-Enfants-Malades, AP-HP, University Paris Descartes, 149, rue de Sèvres, 75743 Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Duracher-Gout
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Hôpital Universitaire Necker-Enfants-Malades, AP-HP, University Paris Descartes, 149, rue de Sèvres, 75743 Paris, France.
authors.forename: Rocio
authors.initials: R
authors.lastname: Ortego
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Hôpital Universitaire Necker-Enfants-Malades, AP-HP, University Paris Descartes, 149, rue de Sèvres, 75743 Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Carli
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Hôpital Universitaire Necker-Enfants-Malades, AP-HP, University Paris Descartes, 149, rue de Sèvres, 75743 Paris, France. Electronic address: gilles.orliaguet@aphp.fr.
authors.forename: Gilles
authors.initials: G
authors.lastname: Orliaguet
mesh_terms: D000758:Anesthesia; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France; D006748:Hospital Departments; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D005791:Patient Care; D061214:Patient Safety; D010372:Pediatrics; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012308:Risk Management
keywords: Critical incidents; ORION methodology; Paediatric; Quality improvement; Risk management; WHO classification