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LO25: How safe are our pediatric emergency departments? A multicentre, prospective cohort study

Published online by Cambridge University Press:  15 May 2017

A. Plint
Affiliation:
University of Ottawa, Ottawa, ON
L. Calder
Affiliation:
University of Ottawa, Ottawa, ON
Z. Cantor
Affiliation:
University of Ottawa, Ottawa, ON
M. Aglipay
Affiliation:
University of Ottawa, Ottawa, ON
A.S. Stang
Affiliation:
University of Ottawa, Ottawa, ON
A.S. Newton
Affiliation:
University of Ottawa, Ottawa, ON
S. Gouin
Affiliation:
University of Ottawa, Ottawa, ON
K. Boutis
Affiliation:
University of Ottawa, Ottawa, ON
G. Joubert
Affiliation:
University of Ottawa, Ottawa, ON
Q. Doan
Affiliation:
University of Ottawa, Ottawa, ON
A. Dixon
Affiliation:
University of Ottawa, Ottawa, ON
R. Porter
Affiliation:
University of Ottawa, Ottawa, ON
S. Sawyer
Affiliation:
University of Ottawa, Ottawa, ON
M. Bhatt
Affiliation:
University of Ottawa, Ottawa, ON
K. Farion
Affiliation:
University of Ottawa, Ottawa, ON
T. Crawford
Affiliation:
University of Ottawa, Ottawa, ON
D. Dalgleish
Affiliation:
University of Ottawa, Ottawa, ON
D.W. Johnson
Affiliation:
University of Ottawa, Ottawa, ON
T. Klassen
Affiliation:
University of Ottawa, Ottawa, ON
N. Barrowman
Affiliation:
University of Ottawa, Ottawa, ON

Abstract

Introduction: Data regarding adverse events (AEs) (unintended harm to the patient from health care provided) among children seen in the emergency department (ED) are scarce despite the high risk setting and population. The objective of our study was to estimate the risk and type of AEs, and their preventability and severity, among children treated in pediatric EDs. Methods: Our prospective cohort study enrolled children <18 years of age presenting for care during 21 randomized 8 hr-shifts at 9 pediatric EDs from Nov 2014 to October 2015. Exclusion criteria included unavailability for follow-up or insurmountable language barrier. RAs collected demographic, medical history, ED course, and systems level data. At day 7, 14, and 21 a RA administered a structured telephone interview to all patients to identify flagged outcomes (e.g. repeat ED visits, worsening/new symptoms, etc). A validated trigger tool was used to screen admitted patients’ health records. For any patients with a flagged outcome or trigger, 3 ED physicians independently determined if an AE occurred. Primary outcome was the proportion of patients with an AE related to ED care within 3 weeks of their ED visit. Results: We enrolled 6377 (72.0%) of 8855 eligible patients; 545 (8.5%) were lost to follow-up. Median age was 4.4 years (range 3 months to 17.9 yrs). Eight hundred and seventy seven (13.8%) were triaged as CTAS 1 or 2, 2638 (41.4%) as CTAS 3, and 2839 (44.7%) as CTAS 4 or 5. Top entrance complaints were fever (11.2%) and cough (8.8%). Flagged outcomes/triggers were identified for 2047 (32.1%) patients. While 252 (4.0%) patients suffered at least one AE within 3 weeks of ED visit, 163 (2.6%) suffered an AE related to ED care. In total, patients suffered 286 AEs, most (67.9%) being preventable. The most common AE types were management issues (32.5%) and procedural complications (21.9%). The need for a medical intervention (33.9%) and another ED visit (33.9%) were the most frequent clinical consequences. In univariate analysis, older age, chronic conditions, hospital admission, initial location in high acuity area of the ED, having >1 ED MD or a consultant involved in care, (all p<0.001) and longer length of stay (p<0.01) were associated with AEs. Conclusion: While our multicentre study found a lower risk of AEs among pediatric ED patients than reported among pediatric inpatients and adult ED patients, a high proportion of these AEs were preventable.

Type
Oral Presentations
Copyright
Copyright © Canadian Association of Emergency Physicians 2017 

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