title: Families as Partners in Hospital Error and Adverse Event Surveillance.
abstract: Medical errors and adverse events (AEs) are common among hospitalized children. While clinician reports are the foundation of operational hospital safety surveillance and a key component of multifaceted research surveillance, patient and family reports are not routinely gathered. We hypothesized that a novel family-reporting mechanism would improve incident detection.
  
  
  
  To compare error and AE rates (1) gathered systematically with vs without family reporting, (2) reported by families vs clinicians, and (3) reported by families vs hospital incident reports.
  
  
  
  We conducted a prospective cohort study including the parents/caregivers of 989 hospitalized patients 17 years and younger (total 3902 patient-days) and their clinicians from December 2014 to July 2015 in 4 US pediatric centers. Clinician abstractors identified potential errors and AEs by reviewing medical records, hospital incident reports, and clinician reports as well as weekly and discharge Family Safety Interviews (FSIs). Two physicians reviewed and independently categorized all incidents, rating severity and preventability (agreement, 68%-90%; κ, 0.50-0.68). Discordant categorizations were reconciled. Rates were generated using Poisson regression estimated via generalized estimating equations to account for repeated measures on the same patient.
  
  
  
  Error and AE rates.
  
  
  
  Overall, 746 parents/caregivers consented for the study. Of these, 717 completed FSIs. Their median (interquartile range) age was 32.5 (26-40) years; 380 (53.0%) were nonwhite, 566 (78.9%) were female, 603 (84.1%) were English speaking, and 380 (53.0%) had attended college. Of 717 parents/caregivers completing FSIs, 185 (25.8%) reported a total of 255 incidents, which were classified as 132 safety concerns (51.8%), 102 nonsafety-related quality concerns (40.0%), and 21 other concerns (8.2%). These included 22 preventable AEs (8.6%), 17 nonharmful medical errors (6.7%), and 11 nonpreventable AEs (4.3%) on the study unit. In total, 179 errors and 113 AEs were identified from all sources. Family reports included 8 otherwise unidentified AEs, including 7 preventable AEs. Error rates with family reporting (45.9 per 1000 patient-days) were 1.2-fold (95% CI, 1.1-1.2) higher than rates without family reporting (39.7 per 1000 patient-days). Adverse event rates with family reporting (28.7 per 1000 patient-days) were 1.1-fold (95% CI, 1.0-1.2; P = .006) higher than rates without (26.1 per 1000 patient-days). Families and clinicians reported similar rates of errors (10.0 vs 12.8 per 1000 patient-days; relative rate, 0.8; 95% CI, .5-1.2) and AEs (8.5 vs 6.2 per 1000 patient-days; relative rate, 1.4; 95% CI, 0.8-2.2). Family-reported error rates were 5.0-fold (95% CI, 1.9-13.0) higher and AE rates 2.9-fold (95% CI, 1.2-6.7) higher than hospital incident report rates.
  
  
  
  Families provide unique information about hospital safety and should be included in hospital safety surveillance in order to facilitate better design and assessment of interventions to improve safety.
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.|Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Alisa
authors.initials: A
authors.lastname: Khan
authors.affiliation: Centre for Quality Improvement and Patient Safety, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Maitreya
authors.initials: M
authors.lastname: Coffey
authors.affiliation: Center for Families, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Litterer
authors.affiliation: Department of Nursing, Cardiovascular, and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Baird
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Stephannie L
authors.initials: SL
authors.lastname: Furtak
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Briana M
authors.initials: BM
authors.lastname: Garcia
authors.affiliation: Family-Centered Care, Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Michele A
authors.initials: MA
authors.lastname: Ashland
authors.affiliation: Section of Critical Care, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Sharon
authors.initials: S
authors.lastname: Calaman
authors.affiliation: Section of Hospital Medicine, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Kuzma
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: O'Toole
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Aarti
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Pediatrics, Benioff Children's Hospital, University of California-San Francisco School of Medicine, San Francisco.
authors.forename: Glenn
authors.initials: G
authors.lastname: Rosenbluth
authors.affiliation: Division of Pediatric Hospital Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Destino
authors.affiliation: Division of Pediatric Hospital Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Everhart
authors.affiliation: Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Good
authors.affiliation: Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Hepps
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, Massachusetts.|The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Anuj K
authors.initials: AK
authors.lastname: Dalal
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, Massachusetts.|The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.affiliation: The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Yoon
authors.affiliation: The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Zigmont
authors.affiliation: Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City.|Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.|Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Starmer
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.|Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Sectish
authors.affiliation: Section of General Pediatrics, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Spector
authors.affiliation: Department of Pediatrics, Benioff Children's Hospital, University of California-San Francisco School of Medicine, San Francisco.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: West
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.|Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.|Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Landrigan
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Brenda K
authors.initials: BK
authors.lastname: Allair
authors.affiliation: St Christopher's Hospital for Children, Philadelphia, Pennsylvania.
authors.forename: Claire
authors.initials: C
authors.lastname: Alminde
authors.affiliation: Alvarado-Little Consulting LLC, Albany, New York.
authors.forename: Wilma
authors.initials: W
authors.lastname: Alvarado-Little
authors.affiliation: Lucile Packard Children's Hospital, Stanford, California.
authors.forename: Marisa
authors.initials: M
authors.lastname: Atsatt
authors.affiliation: Doernbecher Children's Hospital, Oregon Health and Science University, Portland.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Aylor
authors.affiliation: Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City.
authors.forename: James F
authors.initials: JF
authors.lastname: Bale
authors.affiliation: Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia.
authors.forename: Dorene
authors.initials: D
authors.lastname: Balmer
authors.affiliation: St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Barton
authors.affiliation: Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Beck
authors.affiliation: Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Zia
authors.initials: Z
authors.lastname: Bismilla
authors.affiliation: Lucile Packard Children's Hospital, Stanford University, Stanford, California.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Blankenburg
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Debra
authors.initials: D
authors.lastname: Chandler
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Amanda
authors.initials: A
authors.lastname: Choudhary
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Eileen
authors.initials: E
authors.lastname: Christensen
authors.affiliation: Benioff Children's Hospital, San Francisco, California.
authors.forename: Sally
authors.initials: S
authors.lastname: Coghlan-McDonald
authors.affiliation: St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri.
authors.forename: F Sessions
authors.initials: FS
authors.lastname: Cole
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Corless
authors.affiliation: St Christopher's Hospital for Children, Philadelphia, Pennsylvania.
authors.forename: Sharon
authors.initials: S
authors.lastname: Cray
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Roxi
authors.initials: R
authors.lastname: Da Silva
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Devesh
authors.initials: D
authors.lastname: Dahale
authors.affiliation: New York University Langone Medical Center, New York University School of Medicine, New York.
authors.forename: Benard
authors.initials: B
authors.lastname: Dreyer
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Growdon
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: LeAnn
authors.initials: L
authors.lastname: Gubler
authors.affiliation: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Amy
authors.initials: A
authors.lastname: Guiot
authors.affiliation: St Louis Children's Hospital, St Louis, Missouri.
authors.forename: Roben
authors.initials: R
authors.lastname: Harris
authors.affiliation: Mothers Against Medical Error, Columbia, South Carolina.
authors.forename: Helen
authors.initials: H
authors.lastname: Haskell
authors.affiliation: Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City.
authors.forename: Irene
authors.initials: I
authors.lastname: Kocolas
authors.affiliation: St Louis Children's Hospital, St Louis, Missouri.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kruvand
authors.affiliation: St Louis Children's Hospital, St Louis, Missouri.
authors.forename: Michele Marie
authors.initials: MM
authors.lastname: Lane
authors.affiliation: Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Langrish
authors.affiliation: Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Christy J W
authors.initials: CJW
authors.lastname: Ledford
authors.affiliation: St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Kheyandra
authors.initials: K
authors.lastname: Lewis
authors.affiliation: Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Lopreiato
authors.affiliation: Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maloney
authors.affiliation: Benioff Children's Hospital, San Francisco, California.
authors.forename: Amanda
authors.initials: A
authors.lastname: Mangan
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Peggy
authors.initials: P
authors.lastname: Markle
authors.affiliation: Lucile Packard Children's Hospital, Stanford University, Stanford, California.
authors.forename: Fernando
authors.initials: F
authors.lastname: Mendoza
authors.affiliation: Justin's HOPE Project, Task Force for Global Health, Decatur, Georgia.
authors.forename: Dale Ann
authors.initials: DA
authors.lastname: Micalizzi
authors.affiliation: Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas.
authors.forename: Vineeta
authors.initials: V
authors.lastname: Mittal
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Maria
authors.initials: M
authors.lastname: Obermeyer
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: O'Donnell
authors.affiliation: Children's National Health System, George Washington University School of Medicine, Washington, DC.
authors.forename: Mary
authors.initials: M
authors.lastname: Ottolini
authors.affiliation: Kapi'olani Medical Center for Women and Children, University of Hawai'i John A. Burns School of Medicine, Honolulu.
authors.forename: Shilpa J
authors.initials: SJ
authors.lastname: Patel
authors.affiliation: Ohio State University, Columbus.
authors.forename: Rita
authors.initials: R
authors.lastname: Pickler
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Jayne Elizabeth
authors.initials: JE
authors.lastname: Rogers
authors.affiliation: Lucile Packard Children's Hospital, Stanford University, Stanford, California.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Sanders
authors.affiliation: St Louis Children's Hospital, St Louis, Missouri.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Sauder
authors.affiliation: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Meesha
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Arabella
authors.initials: A
authors.lastname: Simpkin
authors.affiliation: Cohen Children's Medical Center, Hofstra Northwell School of Medicine, East Garden City, New York.
authors.forename: Anupama
authors.initials: A
authors.lastname: Subramony
authors.affiliation: St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: E Douglas
authors.initials: ED
authors.lastname: Thompson
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Laura
authors.initials: L
authors.lastname: Trueman
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Tanner
authors.initials: T
authors.lastname: Trujillo
authors.affiliation: St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Turmelle
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Cindy
authors.initials: C
authors.lastname: Warnick
authors.affiliation: Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Welch
authors.affiliation: St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: White
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Wien
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ariel S
authors.initials: AS
authors.lastname: Winn
authors.affiliation: Lucile Packard Children's Hospital, Stanford, California.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wintch
authors.affiliation: Northwestern University Feinberg School of Medicine, Evanston, Illinois.
authors.forename: Michael
authors.initials: M
authors.lastname: Wolf
authors.affiliation: New York University Langone Medical Center, New York University School of Medicine, New York.
authors.forename: H Shonna
authors.initials: HS
authors.lastname: Yin
authors.affiliation: Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Clifton E
authors.initials: CE
authors.lastname: Yu
mesh_terms: D000328:Adult; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005190:Family; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014481:United States