Family-reported errors may go undocumented on hospital records

(AP)

Parents may notice medical errors and bad reactions to treatment that aren't documented in their children's hospital records, a U.S. study suggests.

Researchers surveyed parents of hospitalized children, asking them about mistakes and adverse events. They also conducted daily surveys of the doctors and nurses who cared for the children. Finally, they looked at medical records and formal hospital incident reports.

Overall error rates were nearly 16 percent higher with family reporting than without. And overall rates of adverse events were nearly 10 percent higher with family reporting, researchers report in JAMA Pediatrics.

Similar rates of errors and adverse events were reported by parents and by the doctors and nurses in the daily surveys. But 49 percent of family-reported errors and 24 percent of family-reported adverse events were not documented in the medical record.

Hospital incident reports were also unreliable. Family-reported error rates were five-fold higher than hospital incident report rates, and adverse event rates reported by families were nearly three-fold higher.

"Our results suggest that whether we are talking about safety surveillance research or operational hospital quality improvement and safety tracking efforts, families should be included in safety reporting," said lead study author Dr. Alisa Khan, a researcher at Harvard Medical School and Boston Children's Hospital.

While health care providers are ultimately responsible, families can help identify events that might be missed by traditional safety surveillance methods, Khan added by email.

The researchers examined survey data from 717 parents and caregivers of children and teens hospitalized in 2014 or 2015.

During interviews with researchers, participants detailed any safety incidents that occurred during those hospital stays.

Then, researchers reviewed and classified incidents as medical errors, bad reactions to treatment, other quality issues, or situations that weren't safety problems.

Overall, 185 families, or 26 percent, reported a total of 255 incidents. Researchers classified 132 incidents as safety concerns, 102 as quality issues unrelated to safety, and 21 involving other problems.

Family reports included eight otherwise unidentified adverse events, including multiple needle sticks, inadequate suctioning and medication side effects.

Only one of these was preventable, however.

Families also reported a number of safety concerns that didn't occur on the unit where their child received care, such as the emergency department or surgery department, and researchers excluded these cases from their analysis.

"We cannot draw large conclusions about overall hospital safety from this study since the primary research question was how to improve error detection, reporting and formal cataloging and the authors do not draw conclusions on overall hospital safety from their results," said Dr. Irini Kolaitis, a researcher at the Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine.

"The key finding from this study is that both clinicians and parents accurately recognize medical errors and adverse events, but the use of hospital reporting systems lags behind," Kolaitis, who wasn't involved in the study, added by email.