Study identifies most costly adverse events in children's hospitals

A large study of health records from 38 American children's hospitals has measured adverse events that most increase length of stay and overall cost. The researchers say their findings provide useful targets for hospital programs aimed at preventing harm to young patients.

"Our study offers a framework for physicians, researchers and administrators to think about pediatric-specific adverse events that are potentially preventable," said study leader Samir S. Shah, M.D., an infectious diseases specialist at The Children's Hospital of Philadelphia. "Among the areas in which children's hospitals can address quality improvement, it is important to set priorities. This study provides some guidance."

In a study in the June issue of Pediatrics, the researchers analyzed information from more than 430,000 discharges from 38 pediatric hospitals in the United States that participated in the Pediatric Health Information Systems database in 2006. They searched the database for 12 different adverse patient safety events, designated pediatric-specific quality indicators (PDIs) by the federal Agency for Healthcare Research and Quality (AHRQ). The adverse events included infections and other complications that occurred as unintended consequences of treatment and hospitalization.

"Our study was the first to use this pediatric-specific tool to screen for adverse events," said co-author Matthew Kronman, M.D., a hospital-based specialist in infectious diseases at Children's Hospital. "AHRQ had previously developed patient-safety indicators for adult patients, but some of those adverse events in adults, such as hip fractures after a fall in the hospital, were uncommon in children. Our findings suggest that the pediatric safety indicators reflect a better understanding of the situation of children."

The total number of adverse events was 6,656, or approximately 1.5 percent of the sample. Overall, the most frequent adverse events in hospitalized children were infection due to medical care, respiratory failure following surgery and postoperative sepsis (an infection in the bloodstream).

The excess length of hospital stay from PDI events ranged from 2.8 days for accidental puncture and laceration to 23.5 days for postoperative sepsis. Excess overall charges ranged from $34,884 for accidental puncture and laceration to $337,226 for in-hospital mortality after pediatric heart surgery. Among excess charges, the largest were for laboratory, room and nursing charges. The researchers adjusted charges to reflect geographical differences in prices and wages.

"Our findings may help guide physicians and hospital administrators toward changes in practices where even modest improvements could have a high impact in patient safety and in more efficient, less costly health care," said Shah. "For instance, focusing quality improvement efforts on reducing postoperative sepsis and infection due to medical care could create large cost savings and reduction in length of hospitalization. Additional studies should focus on determining specific safety measures and practices that pediatric hospitals can implement in the most appropriate areas."

Shah added that such quality improvement programs are all the more important in light of a recent decision by the federal Centers for Medicare and Medicaid Services to begin denying payments to hospitals for patients who develop preventable complications during hospitalization.