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Prevalence and severity of patient harm in a sample of UK-hospitalised children detected by the Paediatric Trigger Tool.

ABSTRACT: The measurement and examination of adverse events (AEs) that occur in children during hospital admissions is essential if we are to prevent, reduce or ameliorate the harm experienced. The UK Paediatric Trigger Tool (UKPTT) is a method of retrospective case note review that measures harm in hospitalised children.To examine the harm resulting from the processes of healthcare in hospitalised children from centres providing data to the National Health Service (NHS) Institute UKPTT data portal, to understand the positive predictive values of triggers and to make recommendations for the further development of the trigger tool.25 hospitals across the UK, including secondary, tertiary and quaternary paediatric centres.Randomly selected children who were admitted to hospital for longer than 24?h.The primary outcome measure was the rate of harm (the percentage of children experiencing one or more AEs during a hospital admission). Secondary measures were the severity of harm and performance of triggers.Data from 3992 patient admissions were reviewed across the hospitals and submitted to the trigger tool portal from February 2008 to November 2011. At least one AE was reported for 567 (14.2%) patients, with 211 (5.3%) experiencing more than one event. There were 1001 AEs identified. Where harm occurred, it was considered temporary for 923 (92.2%) AEs; however, 43 (4.3%) AEs resulted in the need for life-sustaining interventions, 18 (1.8%) AEs led to permanent harm and for 17 children (1.7% of AEs) the AE was believed to have contributed to death.There is a significant, measurable level of harm experienced by children admitted to hospitals in the UK. While most of this harm is temporary, some of it is serious. The UKPTT offers organisations the means to measure and examine the AEs occurring in their hospital in order to reduce harm.

SUBMITTER: Chapman SM

PROVIDER: S-EPMC4091511 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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Prevalence and severity of patient harm in a sample of UK-hospitalised children detected by the Paediatric Trigger Tool.

Chapman Susan M SM Fitzsimons John J Davey Nicola N Lachman Peter P

BMJ open 20140703 7

<h4>Unlabelled</h4>The measurement and examination of adverse events (AEs) that occur in children during hospital admissions is essential if we are to prevent, reduce or ameliorate the harm experienced. The UK Paediatric Trigger Tool (UKPTT) is a method of retrospective case note review that measures harm in hospitalised children.<h4>Objectives</h4>To examine the harm resulting from the processes of healthcare in hospitalised children from centres providing data to the National Health Service (N ...[more]

PMID: 24993759

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Project description:Background and aimsE-cigarettes (EC) and nicotine replacement therapy (NRT) are less harmful than smoking, but misperceptions of relative harm are common. Aims were to (1) assess nicotine knowledge and perceptions of: harm of EC and NRT relative to smoking, addictiveness of EC relative to smoking, and change in harm to user if smoking replaced with EC; (2) define associations of these perceptions with respondent characteristics including nicotine knowledge; and (3) explore perceived main harms of EC and whether these differ by vaping status.DesignAnalyses were: (1) frequencies; (2) logistic regressions of perceptions of relative harm, addictiveness and change in harm onto demographics, smoking and vaping status and nicotine knowledge (attributing cancer or health risks of smoking to nicotine); and (3) frequencies and χ2 statistics.Setting and participantsParticipants were smokers and recent ex-smokers from one wave (September 2017) of a longitudinal online survey in the United Kingdom (n = 1720).MeasurementsDemographics included gender, age, smoking status, vaping status and income. Survey questions collected data on nicotine knowledge and harm perceptions of different products; the relative harm perceptions of NRT, EC and tobacco cigarettes; and perceived main harms of EC.FindingsRelative to smoking, 57.3% perceived EC and 63.4% NRT to be less harmful; 25.4% perceived EC to be less addictive; and 32.2% thought replacing smoking with EC reduced health harms a great deal. Participants were less likely to endorse these beliefs if they had never vaped, and participants who had inaccurate nicotine knowledge were less likely to endorse all these beliefs apart from the addictiveness of EC. The main concerns about EC were a lack of research (48.3%), regulation or quality control (37.8%) and harmfulness of chemicals (41.6%).ConclusionsLarge proportions of UK smokers and ex-smokers overestimate the relative harmfulness of e-cigarettes and nicotine replacement therapy compared with smoking; misattributing smoking harms to nicotine is associated with increased misperceptions.

Project description:BackgroundPneumonia is the leading infectious cause of under-5 mortality in sub-Saharan Africa. Clinical prediction tools may aide case classification, triage, and allocation of hospital resources. We performed an external validation of two published prediction tools and compared this to a locally developed tool to identify children admitted with pneumonia at increased risk for in-hospital mortality in Malawi.MethodsWe retrospectively analyzed the performance of the Respiratory Index of Severity in Children (RISC) and modified RISC (mRISC) scores in a child pneumonia dataset prospectively collected during routine care at seven hospitals in Malawi between 2011-2014. RISC has both an HIV-infected and HIV-uninfected tool. A local score (RISC-Malawi) was developed using multivariable logistic regression with missing data multiply imputed using chained equations. Score performances were assessed using c-statistics, sensitivity, specificity, positive predictive value, negative predictive value, and likelihood statistics.Results16,475 in-patient pneumonia episodes were recorded (case-fatality rate (CFR): 3.2%), 9,533 with complete data (CFR: 2.0%). The c-statistic for the RISC (HIV-uninfected) score, used to assess its ability to differentiate between children who survived to discharge and those that died, was 0.72. The RISC-Malawi score, using mid-upper arm circumference as an indicator of malnutrition severity, had a c-statistic of 0.79. We were unable to perform a comprehensive external validation of RISC (HIV-infected) and mRISC as both scores include parameters that were not routinely documented variables in our dataset.ConclusionIn our population of Malawian children with WHO-defined pneumonia, the RISC (HIV-uninfected) score identified those at high risk for in-hospital mortality. However the refinement of parameters and resultant creation of RISC-Malawi improved performance. Next steps include prospectively studying both scores to determine if incorporation into routine care delivery can have a meaningful impact on in-hospital CFRs of children with WHO-defined pneumonia.

Project description:ObjectiveTo assess (1) how well validated existing paediatric track and trigger tools (PTTT) are for predicting adverse outcomes in hospitalised children, and (2) how effective broader paediatric early warning systems are at reducing adverse outcomes in hospitalised children.DesignSystematic review.Data sourcesBritish Nursing Index, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effectiveness, EMBASE, Health Management Information Centre, Medline, Medline in Process, Scopus and Web of Knowledge searched through May 2018.Eligibility criteriaWe included (1) papers reporting on the development or validation of a PTTT or (2) the implementation of a broader early warning system in paediatric units (age 0-18 years), where adverse outcome metrics were reported. Several study designs were considered.Data extraction and synthesisData extraction was conducted by two independent reviewers using template forms. Studies were quality assessed using a modified Downs and Black rating scale.Results36 validation studies and 30 effectiveness studies were included, with 27 unique PTTT identified. Validation studies were largely retrospective case-control studies or chart reviews, while effectiveness studies were predominantly uncontrolled before-after studies. Metrics of adverse outcomes varied considerably. Some PTTT demonstrated good diagnostic accuracy in retrospective case-control studies (primarily for predicting paediatric intensive care unit transfers), but positive predictive value was consistently low, suggesting potential for alarm fatigue. A small number of effectiveness studies reported significant decreases in mortality, arrests or code calls, but were limited by methodological concerns. Overall, there was limited evidence of paediatric early warning system interventions leading to reductions in deterioration.ConclusionThere are several fundamental methodological limitations in the PTTT literature, and the predominance of single-site studies carried out in specialist centres greatly limits generalisability. With limited evidence of effectiveness, calls to make PTTT mandatory across all paediatric units are not supported by the evidence base.Prospero registration numberCRD42015015326.

Project description:ObjectiveTo systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.DesignSystematic review and meta-analysis.Data sourcesMedline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.Review methodsObservational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I2 statistic, and publication bias was evaluated.ResultsOf the 7313 records identified, 70 studies involving 337?025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10).ConclusionsAround one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.

Dataset Information

Prevalence and severity of patient harm in a sample of UK-hospitalised children detected by the Paediatric Trigger Tool.

Publications

Prevalence and severity of patient harm in a sample of UK-hospitalised children detected by the Paediatric Trigger Tool.

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