Perhaps no one is more worried than a parent with a sick child in the hospital. But families are doing more than just venting their fears and frustrations when they complain about the care their child is receiving, a new Canadian study suggests.
It found that relatives were much more likely to officially report problems than hospital staff, and that their complaints often had merit. Almost half of parents' complaints were legitimate patient-safety concerns, "not merely reports of dissatisfaction," the study found. The study was published Monday in the Canadian Medical Association Journal.
British Columbia researchers tested whether having a system for family members to report "adverse events" — incidents that negatively affected the recovery or health of their child — while in hospital would affect the rate at which health-care providers reported the incidents. The findings revealed just 2.5 per cent of the adverse events reported by families were also reported by health-care providers.
"Parents are often much more aware of things that go wrong because they're there at the bedside with one patient all the time," said Dr. Mark Ansermino, senior author of the study. "Whereas the health-care provider has multiple patients to look after and may not have the same vested interested in looking after that patient. . . . Parents are much better observers of that individual subject than multiple health-care providers will be."
Many hospitals in Canada have set up systems for health-care providers to report errors in a patient's care to help prevent similar mistakes from happening again.
However, for a variety of reasons, including time pressures and heavy patient loads, health-care providers don't always take advantage of those reporting systems. Accepting that mistakes happen, the researchers set out with a goal of finding a way to reduce their frequency.
"We really felt that finding ways to engage patients as champions of safety would be a great way to move this forward," explained Ansermino. "(The findings confirm that) the more we can engage families and children in their own care, I think we can do a much better job."
In the study, the researchers followed 544 families whose children were admitted to B.C. Children's Hospital in Vancouver between Nov. 1, 2008, and Nov. 30, 2009. When their child was discharged from the hospital, participating families were given a questionnaire asking them about different types of adverse events during the hospital stay.
These instances included problems with medication, such as a bad reaction or incorrect dosage, complications during treatment, equipment problems and miscommunication between staff, or staff and family members. Of the 544 families that submitted questionnaires, 37 per cent, or 201, reported one or more problems during their child's hospital stay.
Miscommunication between staff or between family and staff was the most commonly reported problem. A total of 321 errors in care were found, of which almost half were deemed legitimate patient-safety concerns that had the potential to cause some degree of harm to the patient, the researchers reported. No deaths were reported by the families.
Two independent clinical experts analyzed the questionnaire results to determine how harmful the errors in care could have been to the patient's health. Harm was defined as either a near miss — in which a patient's health was nearly harmed but fortunately avoided through a doctor or nurse catching the mistake at the last minute — or minor, moderate or severe harm— where an error resulted in some degree of harm that was either temporary or resulted in the patient staying in hospital for longer and requiring additional medical treatment.
Health-care providers reported only 2.5 per cent of the same errors reported by families, a marginal increase from the baseline of adverse event reporting before the study began, the authors found. In 139 cases, families received apologies for these incidents.
Ansermino said there are many reasons for the discrepancy, one of which is the grey area surrounding what is considered an adverse event from one health-care provider to another. "One of the things we found out is that communication is one of the big things that could be considered a safety event, and that's obviously very difficult to judge from someone else's perspective," he said.
Another barrier to reporting adverse events is a culture of "blame and shame," in which health-care providers are concerned about liability, said Ansermino. Some health-care providers also don't see a benefit of reporting adverse events, as they believe the report "goes into some black hole somewhere," said Ansermino, filed away and rarely looked at again.
"These are not bad people," said Ansermino. "(The study was not about) 'We're going to find out what people did wrong.' These are learning opportunities to find out what we did wrong, and how to actually make our system safer."
Ansermino said the creation of reporting systems for health-care providers is helping to improve the situation. "The concerns about liability and blame are significant barriers, but . . . I think the culture has really changed in the last five years," he said.
The authors acknowledged that the study's results could have been skewed by selection bias — if families looking to "vent their frustration with the system were inclined to participate."
Ansermino said they hope to expand the questionnaire to other hospitals in B.C. to see if similar results are reported. The goal now is finding a way to prevent the same hospital-care errors from reoccurring, said Ansermino.
In pediatrics, previous studies have estimated that one per cent of children in hospital experience an adverse event and 60 per cent of these are preventable. "It's all very well identifying these events, but you need to actually do something about them," he said. "I think we are learning how to do that, but I think we've got a long way to go."