Performance of the Global Assessment of Pediatric Patient Safety (GAPPS) Tool

Landrigan, Christopher P.; Stockwell, David C.; Toomey, Sara L.; Loren, Samuel S.; Tracy, Michaela; Jang, Jisun; Quinn, Jessica; Ashrafzadeh, Sepideh; Wang, Michelle; Sharek, Paul J.; Parry, Gareth; Schuster, Mark A.

doi:10.1542/peds.2015-4076

Cited by 51 publications

(50 citation statements)

References 23 publications

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“…[8][9][10][11][12] Trigger tools are higher yield and becoming more sophisticated at identifying events but are not yet widely used. 13 Prospective systematic surveillance, in which trained research staff conduct daily reviews of patient medical records (Figure 1), is the most effective way to measure errors but is expensive and typically limited to research settings. 5,14,15 Patients and families are absent both from hospital incident reports and systematic surveillance.…”

Section: Main Outcomes and Measures-error And Ae Ratesmentioning

confidence: 99%

Families as Partners in Hospital Error and Adverse Event Surveillance

Khan¹,

Coffey²,

Litterer³

et al. 2017

JAMA Pediatr

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113

115

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Medical errors and adverse events (AEs) are common among hospitalized children. While clinician reports are the foundation of operational hospital safety surveillance and a key component of multifaceted research surveillance, patient and family reports are not routinely gathered. We hypothesized that a novel family-reporting mechanism would improve incident detection. OBJECTIVE To compare error and AE rates (1) gathered systematically with vs without family reporting, (2) reported by families vs clinicians, and (3) reported by families vs hospital incident reports. DESIGN, SETTING, AND PARTICIPANTSWe conducted a prospective cohort study including the parents/caregivers of 989 hospitalized patients 17 years and younger (total 3902 patient-days) and their clinicians from December 2014 to July 2015 in 4 US pediatric centers. Clinician abstractors identified potential errors and AEs by reviewing medical records, hospital incident reports, and clinician reports as well as weekly and discharge Family Safety Interviews (FSIs). Two physicians reviewed and independently categorized all incidents, rating severity and preventability (agreement, 68%-90%; κ, 0.50-0.68). Discordant categorizations were reconciled. Rates were generated using Poisson regression estimated via generalized estimating equations to account for repeated measures on the same patient. MAIN OUTCOMES AND MEASURES Error and AE rates.RESULTS Overall, 746 parents/caregivers consented for the study. Of these, 717 completed FSIs. Their median (interquartile range) age was 32.5 (26-40) years; 380 (53.0%) were nonwhite, 566 (78.9%) were female, 603 (84.1%) were English speaking, and 380 (53.0%) had attended college. Of 717 parents/caregivers completing FSIs, 185 (25.8%) reported a total of 255 incidents, which were classified as 132 safety concerns (51.8%), 102 nonsafety-related quality concerns (40.0%), and 21 other concerns (8.2%). These included 22 preventable AEs (8.6%), 17 nonharmful medical errors (6.7%), and 11 nonpreventable AEs (4.3%) on the study unit. In total, 179 errors and 113 AEs were identified from all sources. Family reports included 8 otherwise unidentified AEs, including 7 preventable AEs. Error rates with family reporting (45.9 per 1000 patient-days) were 1.2-fold (95% CI, 1.1-1.2) higher than rates without family reporting (39.7 per 1000 patient-days). Adverse event rates with family reporting (28.7 per 1000 patient-days) were 1.1-fold (95% CI, 1.0-1.2; P=.006) higher than rates without (26.1 per 1000 patient-days). Families and clinicians reported similar rates of errors (10.0 vs 12.8 per 1000 patient-days; relative rate, 0.8; 95% CI, .5-1.2) and AEs (8.5 vs 6.2 per 1000 patient-days; relative rate, 1.4; 95% CI, 0.8-2.2). Family-reported error rates were 5.0-fold (95% CI, 1.9-13.0) higher and AE rates 2.9-fold (95% CI, 1.2-6.7) higher than hospital incident report rates.CONCLUSIONS AND RELEVANCE Families provide unique information about hospital safety and should be included in hospital safety surveillance in order to facilitate better des...

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Section: Main Outcomes and Measures-error And Ae Ratesmentioning

confidence: 99%

Families as Partners in Hospital Error and Adverse Event Surveillance

Khan¹,

Coffey²,

Litterer³

et al. 2017

JAMA Pediatr

Self Cite

113

115

View full text Add to dashboard Cite

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“…This process has been described previously. 17 Briefly, nurse reviewers at each hospital investigated selected records, identifying AEs on the basis of GAPPS triggers. Once identified, 2 secondary physician reviewers independently adjudicated on AEs.…”

Section: Methodsmentioning

confidence: 99%

“…16 The Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool builds on previous pediatric trigger tools because it can be used to rigorously evaluate the accuracy of each trigger, measure interrater reliability, and ensure consistency across hospital contexts. 17 To our knowledge, patient safety disparities have not been previously identified in the pediatric inpatient environment by measuring rates of clinically confirmed AEs in a multisite investigation.…”

mentioning

confidence: 94%

Racial, Ethnic, and Socioeconomic Disparities in Patient Safety Events for Hospitalized Children

Stockwell

Landrigan

Toomey

et al. 2019

Hospital Pediatrics

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OBJECTIVES: Previous studies have revealed racial/ethnic and socioeconomic disparities in quality of care and patient safety. However, these disparities have not been examined in a pediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). In this study, we do so using the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool. METHODS: GAPPS was applied to medical records of randomly selected pediatric patients discharged from 16 hospitals in the Pediatric Research in Inpatient Settings Network across 4 US regions from January 2007 to December 2012. Disparities in AEs for hospitalized children were identified on the basis of patient race/ethnicity (black, Latino, white, or other; N = 17 336 patient days) and insurance status (public, private, or self-pay/no insurance; N = 19 030 patient days). RESULTS: Compared with hospitalized non-Latino white children, hospitalized Latino children experienced higher rates of all AEs (Latino: 30.1 AEs per 1000 patient days versus white: 16.9 AEs per 1000 patient days; P ≤ .001), preventable AEs (Latino: 15.9 AEs per 1000 patient days versus white: 8.9 AEs per 1000 patient days; P = .002), and high-severity AEs (Latino: 12.6 AEs per 1000 patient days versus white: 7.7 AEs per 1000 patient days; P = .02). Compared with privately insured children, publicly insured children experienced higher rates of preventable AEs (public: 12.1 AEs per 1000 patient days versus private: 8.5 AEs per 1000 patient days; P = .02). No significant differences were observed among other groups. CONCLUSIONS: The GAPPS analysis revealed racial and/or ethnic and socioeconomic disparities in rates of AEs experienced by hospitalized children across a broad range of geographic and hospital settings. Further investigation may reveal underlying mechanisms of these disparities and could help hospitals reduce harm.

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“…Su estudio analizó más de 900 pacientes y halló 11,11 eventos adversos a medicamentos por cada 100 pacientes, concordante, en términos de relevancia, con nuestros datos. Stroupe et al, 14 en un estudio canadiense que utilizó el Global Assessment of Pediatric Patient Safety (GAPPS), 15 hallaron tasas menores que las nuestras y que las de los autores mencionados en este estudio sobre 100 casos: el 4,87 % de eventos adversos. Davenport et al, 9 encontraron 26 eventos cada 100 admisiones y 1,4 gatillos por paciente con índices de daño y de gatillos mayores que los de nuestro estudio (0,53 gatillos por paciente y 11 eventos cada 100 admisiones en nuestro estudio).…”

Section: Discussionunclassified

Medición de la incidencia de eventos adversos atribuidos a la atención sanitaria en un Departamento de Pediatría de un hospital universitario

Fajreldines¹,

Schnitzler²,

Torres³

et al. 2019

Arch Argent Pediat

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RESUMENIntroducción. Los eventos adversos pueden ser detectados por diversas herramientas de pesquisa. En la población pediátrica, la Pediatric Global Trigger Tool busca gatillos en la historia clínica para detectar daño asociado al cuidado, tanto prevenible como no prevenible. Objetivo. Medir la incidencia de eventos adversos en el Departamento de Pediatría utilizando dicha herramienta. Conocer los tipos de eventos y las variables asociadas. Población y métodos. Estudio de incidencia, de corte longitudinal. Resultados. Se estudiaron 318 pacientes; media de edad: 2,99 años (rango: 0-17); porcentaje de mujeres: 164 (el 51,57 %). Se halló un 11 % de eventos por cada 100 admisiones, 15,5 eventos cada 1000 días-paciente. Los eventos más frecuentes fueron asociados a medicación: el 48,57 % (n = 17); a bacteriología (infecciones): el 42,85 % (n = 15); y a cuidados: el 8,57 % (n = 3). Diecinueve eventos fueron leves (el 54,28 %), 14 (el 40 %) prolongaron la hospitalización (moderados) y 2 (el 5,71 %) requirieron soporte vital (graves). Se hallaron 168 gatillos, 0,53 gatillos por paciente, 74,4 gatillos cada 1000 días-paciente y 4,8 gatillos por cada evento adverso. En el análisis de regresión logística multivariada, las variables asociadas a la aparición de los eventos adversos fueron medicamentos de alto riesgo, sexo femenino, peso, número de transferencias dentro del hospital y estancia superior a 5 días. Conclusiones. La utilización de la Pediatric Global Trigger Tool permite identificar eventos adversos en pacientes pediátricos hospitalizados y ayudar a encauzar acciones de mejora, de acuerdo con las variables asociadas. Palabras clave: Global Trigger Tool, eventos adversos, niño hospitalizado.

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Performance of the Global Assessment of Pediatric Patient Safety (GAPPS) Tool

Cited by 51 publications

References 23 publications

Families as Partners in Hospital Error and Adverse Event Surveillance

Families as Partners in Hospital Error and Adverse Event Surveillance

Racial, Ethnic, and Socioeconomic Disparities in Patient Safety Events for Hospitalized Children

Medición de la incidencia de eventos adversos atribuidos a la atención sanitaria en un Departamento de Pediatría de un hospital universitario

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