Study analyzes prevalence of pediatric patient-safety events at hospitals

Hospital-acquired infections are the leading cause of potentially preventable mortality among pediatric patients, according to a study of pediatric patient-safety incidents issued today by HealthGrades, the leading independent health care ratings organization.

The study utilized eight patient-safety indicators developed by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services, to analyze the prevalence of patient-safety events at hospitals as well as to identify hospitals that performed above average.

Examining all hospitals in the 19 states that make data publicly available, the first annual HealthGrades Pediatric Patient Safety in American Hospitals Study analyzed five million pediatric patient records over the years 2006, 2007 and 2008 and identified 25,367 patient-safety events and 1,465 potentially preventable inhospital deaths. Of the deaths, 70.44% were associated with hospital-acquired infections (postoperative sepsis and central venous catheter-related infections).

Pediatric patient-safety incidents in the following eight categories were studied:

•Accidental puncture or laceration
•Pressure ulcer
•Avoidance of collapsed lung
•Postoperative hemorrhage or hematoma
•Postoperative respiratory failure
•Postoperative sepsis
•Postoperative wound dehiscence (wound-site breakdown)
•Central venous catheter-related infections

The study found that one in 208 pediatric patients experienced a potentially avoidable patient-safety event in a hospital during the three years studied.

Of the 2,080 hospitals studied, 97 had pediatric patient-safety event rates that were statistically lower than other hospitals. These hospitals are identified on www.healthgrades.com as recipients of the HealthGrades Pediatric Patient Safety Excellence Award™. Pediatric patients at these hospitals had, on average, a 29.48% lower risk of experiencing one or more of the eight patient-safety events compared with all other hospitals. If all hospitals performed at this level, approximately 6,532 pediatric patient-safety events could potentially have been avoided over the three years studied.

"After a decade of work in examining the quality of care at the nation's hospitals, HealthGrades is now evaluating the state of pediatric patient safety," said Rick May, MD, vice president of clinical quality improvement services at HealthGrades and a co-author of the study. "And while the data show both improvements and regression, there is a subset of hospitals that are consistently avoiding patient-safety incidents, setting benchmarks for other hospitals to follow."

The four pediatric patient-safety incidents showing the highest rates per 1,000 patients were postoperative sepsis (24.05), postoperative respiratory failure (18.62), pressure ulcers (3.72) and central venous catheter-related infections (2.41).

Of the eight pediatric patient-safety incidents examined, four indicators showed improvement over the three years studied, while four worsened. Those showing improvement were central venous catheter-related infections, postoperative hemorrhage or hematoma, postoperative respiratory failure, and postoperative wound dehiscence. The other four incidents showed a rise in incidence levels.

The 19 state governments that make pediatric patient records available for analysis are: Arizona, California, Colorado, Florida, Iowa, Maine, Maryland, Massachusetts, New Jersey, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Washington and Wisconsin.