365 - Understanding Pediatric Hospital Safety Reporting from the Perspective of Parents and Staff: A Mixed Methods Study

Publication Number: 4358.365

Amanda Growdon, Boston Children's Hospital, Boston, MA, United States; Rachel K. D'Anna, Boston Children's Hospital, Boston, MA, United States; Kathryn P. Gray, Boston Children's Hospital/Harvard Medical School, Boston, MA, United States; Zia Bismilla, SickKids, Toronto, ON, Canada; Marwa Elborki, Boston Children's Hospital, Boston, MA, United States; Jennifer L. Everhart, Stanford University School of Medicine, Palo Alto, CA, United States; Angela L. Fan, Boston Children's Hospital, Waco, TX, United States; Jennifer Hepps, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Helen Haskell, Mothers Against Medical Error, COLUMBIA, SC, United States; Irene Kocolas, University of Utah School of Medicine, Salt Lake City, UT, United States; Tyler Johnson, Boston Children's Hospital, Vienna, VA, United States; Susan Matherson, Boston Children's Hospital, Boston, MA, United States; Christopher P. Landrigan, Boston Children's Hospital, Boston, MA, United States; Alisa Khan, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States

Background: Medical errors cause 250,000 deaths yearly. Traditional voluntary staff incident reporting is biased, underestimates errors, and excludes families. While families reliably report errors and adverse events (AEs), little is known about similarities and differences in what staff and families report.

Objective: Evaluate rates and types of safety and quality events reported by families, resident physicians, and nurses.

Design/Methods: We conducted a retrospective mixed methods study of safety incidents from the 2014-2017 Patient and Family Centered I-PASS Study reported by either: (1) families through solicited pre-discharge interviews, (2) resident-physicians through solicited daily post-night shift surveys, or (3) nurses through voluntary surveys. The original dataset used a two-step nurse and physician reviewer systematic safety surveillance methodology to classify incidents into AEs, nonharmful errors, and exclusions. From 2023-2025, our multidisciplinary research team further classified incidents' clinical category; subcategorized exclusions (into hazards, non-safety related quality issues, or neither); and performed a content analysis of incidents to identify themes.

Results: The analysis cohort included 422 incidents (across 333 patients): 33% family-reported (n=137), 58% resident-reported (n=240), and 16% nurse-reported (n=67). Only 29 were reported by 2 observer types; none by all 3. For all 3 groups, most incidents were errors or AEs, (69% of family-reported, 79% of resident-reported, and 81% of nurse-reported) and the most common clinical category was medications/IV fluids (57% of family-reported, 38% of resident-reported, and 56% of nurse-reported). Families reported a slightly higher rate of non-safety-related quality events (20% of family-reported, 15% of resident-reported, and 13% of nurse-reported). Four themes arose. (1) Each group had a unique vantage point to view care. (2) Providing high-quality care involved reconciliation of care needs beyond medicines alone. (3) Families noted deviations in all five "rights" of medication administration that staff did not always report. (4) Gaps in care occurred when families were not present at bedside.

Conclusion(s): Families, residents, and nurses reported distinct but similar categories of safety and quality incidents. Hospitals should proactively solicit input from both families and staff to obtain a comprehensive view of safety and quality.

Patient Demographics


Venn Diagram of Overall Incidents by Reporting Group
Number of reported incidents by reporting group.

Qualitiative Comments from Families