Highlights
- •Merging databases is an effective practice to identify AE and patient safety risks in trauma populations for evidence-based practice.
- •Found a PICU AE rate of 1.23 events/patient, decubitus ulcers most common (15%), with TBI severity the most important factor to increase odds of AE.
- •First study to report higher median costs for PICU AE patients ($121,234 vs. $53,341 no AE; p=0.031) in this high acuity pediatric sTBI population.
- •Regular AE monitoring demonstrates the Trauma Registry supports the performance improvement process for ACS verification.
- •It promotes performance improvement by implementing targeted, evidence-based prevention strategies to optimize patient outcomes and safety.
Abstract
Introduction
Trauma centres are required to continuously measure, evaluate and improve care. Severe
traumatic brain injury (sTBI) patients are highly susceptible to adverse events (AE;
unintended, potentially harmful events resulting from health care) due to their unstable
condition requiring high risk interventions, multiple medications and invasive monitoring.
Objectives were to describe: (1) a process for identifying AE in pediatric sTBI patients
to identify safety risks, target and implement evidence-based prevention strategies;
and (2) a tertiary care PICU's sTBI AE experience.
Methods
Merging databases, Trauma Registry with Adverse Events Management System, identified
AE in patients. Details on the event location, type and severity of harm were combined
with patient demographics, injury data, costs and outcomes in a cohort of 193 PICU
sTBI patients (2000-15). Descriptive statistics and multivariate logistic regression
were undertaken to describe AE, and their association with risk factors and outcomes.
Results
103/193 sTBI patients (53%) suffered at least one AE. 238 AE occurred (1.23 AE/patient),
with 30% of patients having 2+ AE. Most resulted in no harm (54%) with decubitus ulcers
(15%) the most common AE. AE patients were more likely to be monitored for elevated
ICP (p<0.001), with fewer ventilator-free days (p=0.015), longer LOS for PICU (11 vs. 3.5 days; p<0.001) and in-hospital (31 vs. 11 days; p<0.001) with higher median costs ($121,234 vs. $53,341; p=0.031). AE patients required a higher level of care on discharge (p=0.035).
Conclusions
Merging databases is an effective practice to identify AE and safety risks in trauma
populations. Utilizing this method, a PICU AE rate of 1.23 events per patient was
found with TBI severity the most important factor to increase the odds of AE. AE represent
performance improvement events, opportunities to optimize care, decrease costs, as
well as improve outcomes, to ultimately improve patient safety in this vulnerable
population.
Keywords
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Article info
Publication history
Published online: May 21, 2020
Accepted:
April 25,
2020
Footnotes
Presented: 6th Annual Meeting of the Pediatric Trauma Society, San Diego, CA, November 14th, 2019
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
