Clinical Question: Do family reports of adverse events improve incident detection, compared with clinician reports and hospital incident reports?
Background: Hospital incident reports, which are voluntary and suffer from underreporting, capture only a fraction of errors and adverse events (defined as errors resulting in harm). Systematic, prospective surveillance by researchers is the gold standard but is time consuming and expensive. The authors hypothesized that family reports would improve error and adverse event detection.
Setting: Four U.S. pediatric hospitals.
Synopsis: The authors developed a Family Safety Interview, administered weekly and on discharge, and compared reporting of errors and adverse events to clinician reports, hospital incident reports, and systematic review of records by researchers. Of 989 hospitalized pediatric patients, 746 parents/caregivers completed interviews between December 2014 and July 2015. From all sources, the authors found a total of 179 errors and 113 adverse events. Families reported a total of 39 of these 179 errors (including 19 unique errors not reported elsewhere) and 33 of 113 adverse events (8 unique).
Overall, error rates with family-reported errors were 15.5% higher (95% confidence interval, 9.0%-22.3%) than without. Adverse event rates with family reporting were 9.8% higher (95% CI, 3.1%-16.9%) than without. Family-reported error rates were 5 times higher (95% CI, 1.9-13.0) than hospital incident report rates.
The study showed that family-reported error and adverse event rates were significantly higher than voluntary, clinician-only hospital incident report rates. The study was limited to pediatric hospitals on general pediatric and subspecialty services, though findings potentially may be applicable more broadly (for example, adult and surgical services).
Bottom Line: Using a structured interview, families report significantly higher rates of errors and adverse events, compared with other sources.
Reference: Khan A, Coffey M, Litterer KP, et al. Families as partners in hospital error and adverse event surveillance. JAMA Pediatrics. Published online Feb 27, 2017. doi: 10.1001/jamapediatrics.2016.4812.