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

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Patient
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News extra

Study finds US paediatric medical errors kill 4500 children a year

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.

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A.

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Collections under which this article
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