Acute Care/Hospitalization

Patient safety problems are relatively infrequent among hospitalized children

Conditions indicating patient safety problems (patient safety indicators, PSIs), such as postoperative respiratory failure or infections due to medical care, are infrequent among hospitalized children, reveals a new study. Three types of hospital-level effects models, which accounted for hospital differences, found few and similar problems at 34 academic, freestanding children's hospitals. Anthony D. Slonim, M.D., Dr.P.H., of the George Washington University School of Medicine, and colleagues examined a database of all pediatric discharges from the hospitals in 2003. They computed PSI rates for all discharged children, and calculated the patient and hospital characteristics associated with these PSIs. The researchers used three increasingly conservative models to control for hospital-level effects: robust standard error estimation, a fixed effects model, and a random effects model.

The PSIs were relatively infrequent events in the hospitalized children, ranging from 0 per 10,000 (postoperative hip fracture) to 87 per 10,000 (postoperative respiratory failure). Significant factors associated with PSIs included neonatal age, white race, public insurance status, extreme severity of illness, and hospital size of over 300 beds. All these groups had higher rates of PSIs than their reference groups.

There were similarities in both the clinical and statistical significance of the PSIs across each of the three models. The study was supported by the Agency for Healthcare Research and Quality (HS14009 and HS13179).

More details are in "Pediatric patient safety events during hospitalization: Approaches to accounting for institution-level effects," by Dr. Slonim, James P. Marcin, M.D., M.P.H., Wendy Turenne, M.A., and others, in the December 2007 HSR: Health Services Research 42(6), pp. 2275-2293.

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