Pediatric Hospitals Make Errors, Too

Postop blood infections and other mistakes aren't adult only, and they are preventable.

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Having just shepherded the 2008 "America's Best Children's Hospitals" rankings to completion, I've still got young patients on my mind, and a study in the latest issue of Pediatrics caught my attention. It is a poignant reminder that while adults comprise the vast majority of inpatients and consequently suffer from a greater number of mistakes and instances of shoddy care, young patients, too, are accidentally punctured, develop infections, have surgical sponges left in their bodies, and are otherwise victimized by mishaps that are almost always preventable.

The study identified more than 6,600 such significant slipups at 38 stand-alone children's hospitals during 2006 out of a total of about 430,000 children treated. It is not too much of an oversimplification to conclude that 1 child out of every 65 admitted to these hospitals—arguably the crème de la crème source of pediatric care—had something go seriously wrong.

When mistakes happened, correcting them took time, often quite a lot. A child who developed a blood infection following surgery—about 1 in 36, so this wasn't terribly rare—remained in the hospital almost 3½

weeks longer than usual, racking up an average of more than $260,000 in additional expenses. Infections caused by sloppy medical care rather than stemming from a particular procedure added more than 22 days to a routine stay and more than $170,000 in charges.

The researchers were the first to tot up the number (and the economic consequence) of pediatric mistakes in a dozen categories defined in September 2006 by the Agency for Healthcare Research and Quality. Until the federal body devised these categories, called pediatric quality indicators, anyone looking into hospital errors involving kids had to rely on patient safety indicators intended for adults. If you'll excuse the expression, that got old. Postoperative hip fracture, one of these PSIs, is a meaningful measure for an 85-year-old. But for a 5-year-old? Hence the list of indicators aimed at children. Besides those previously mentioned a few others are bedsores, postsurgical respiratory failure, and transfusion reaction because of a typing or matching mistake or deliverty to the wrong patient.

This study set out the rough dimensions of the consequences of bad hospital care for the youngest patients. How much attention will the numbers receive?