From: Subject: Study finds US paediatric medical errors kill 4500 children a year -- Harding 328 (7454): 1458 -- BMJ Date: Sun, 15 Aug 2004 16:40:24 +0200 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0017_01C482E6.90045AF0"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1441 This is a multi-part message in MIME format. ------=_NextPart_000_0017_01C482E6.90045AF0 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://bmj.bmjjournals.com/cgi/content/full/328/7454/1458-b?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=medical+errors&andorexactfulltext=and&searchid=1092580488755_3611&stored_search=&FIRSTINDEX=0&sortspec=relevance&fdate=5/1/2004&resourcetype=1,2,3,4 Study finds US paediatric medical errors kill 4500 = children a year -- Harding 328 (7454): 1458 -- BMJ
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BMJ  2004;328:1458 (19 June),=20 doi:10.1136/bmj.328.7454.1458-b
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Study finds US paediatric medical errors kill 4500 children a = year

New Jersey Anne Harding=20

Medical errors in hospital are responsible = for the=20 deaths of nearly 4500 children in the United States every year, = says a=20 study examining the effect of lapses in patient safety on children = in=20 hospitals throughout the nation (Pediatrics = 2004;113:1741-6).=20

"The bottom line is that none of these events should have = happened,"=20 said Dr Marlene R Miller, the study=92s lead author and director = of quality=20 and safety initiatives at the Johns Hopkins Children=92s Center in = Baltimore.=20

Children less than 1 year old and those covered by Medicaid, = the=20 government=92s insurance programme for poor people, were most = likely to=20 experience medical errors, Dr Miller and Dr Chunliu = Zhan report=20 (Pediatrics 2004;113:1741-6).=20

The study, which was funded by the Agency for Healthcare = Research and=20 Quality, looked at 5.7 million hospital discharge records for = people under=20 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=20 (=A3551m, =80828m) annually.=20

The researchers used patient safety indicators recently created = by the=20 agency. These are based on administrative data, and the authors = emphasise=20 that they are "indicators," not definitive measures. Medication=20 errors were not included.=20

While several experts in paediatric patient safety have praised = Drs=20 Miller and Zhan for taking a national look at this issue, one = specialist=20 said the study grossly overstated the impact of medical errors in children=92s care = because the=20 numbers included deaths that could not unequivocally be attributed = to=20 mistakes.=20

Dr Erin Stucky, physician advisor for quality management at the = Children=92s Hospital and Health Center, San Diego, and director = of=20 inpatient teaching at the University of California San Diego=92s = Department=20 of  Pediatrics, said that of the 20 patient safety indicators = analysed, only a few=97such as "foreign body left after = procedure"=97could=20 without exception be attributed to error.=20

"If someone dies in a paediatric intensive care unit from shock = and=20 sepsis, you cannot state that that=92s a patient safety issue" = without=20 additional information, Stucky added. Several other categories, = including=20 "postoperative physiologic/metabolic derangement" and "failure to = rescue,"=20 were also questionable, she said.=20

It was impossible to say whether the findings overestimated or=20 underestimated the rate of paediatric patient safety events, said = Dr Rainu=20 Kaushal, a specialist in internal medicine and paediatrics at = Brigham and=20 Women=92s Hospital in Boston who studies patient safety and = information=20 technology.=20

Dr Kaushal thought it would be useful to implement known = principles of=20 patient safety to improve children=92s care. Giving parents a = medical passport with complete = information=20 on their child=92s medications and medical problems would be a good = first step,=20 she said, as would more widespread use of computerised physician = decision=20 support systems, which she estimated were currently implemented in = only=20 10% to 15% of US hospitals.=20

"Information technology is really lagging in our health care in = the US=20 in general, but particularly in paediatrics," Kaushal said.=20

While Stuckey, Kaushal, and the authors agree that the new = study did=20 not include enough data to offer targeted solutions to paediatric = patient=20 safety problems, Stucky calls for pulling data from patients=92 = charts to=20 get a clearer picture of problems within paediatric health care.=20 "Electronic systems help, but education and people are part of = it," she=20 said.
 


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