Racial and ethnic disparities in common inpatient safety outcomes in a children’s hospital cohort

Abstract

BackgroundEmerging evidence has shown racial and ethnic disparities in rates of harm for hospitalised children. Previous work has also demonstrated how highly heterogeneous approaches to collection of race and ethnicity data pose challenges to population-level analyses. This work aims to both create an approach to aggregating safety data from multiple hospitals by race and ethnicity and apply the approach to the examination of potential disparities in high-frequency harm conditions.MethodsIn this cross-sectional, multicentre study, a cohort of hospitals from the Solutions for Patient Safety network with varying race and ethnicity data collection systems submitted validated central line-associated bloodstream infection (CLABSI) and unplanned extubation (UE) data stratified by patient race and ethnicity categories. Data were submitted using a crosswalk created by the study team that reconciled varying approaches to race and ethnicity data collection by participating hospitals. Harm rates for race and ethnicity categories were compared with reference values reflective of the cohort and broader children’s hospital population.ResultsRacial and ethnic disparities were identified in both harm types. Multiracial Hispanic, Combined Hispanic and Native Hawaiian or other Pacific Islander patients had CLABSI rates of 2.6–3.6 SD above reference values. For Black or African American patients, UE rates were 3.2–4.4 SD higher. Rates of both events in White patients were significantly lower than reference values.ConclusionsThe combination of harm data across hospitals with varying race and ethnicity collection systems was accomplished through iterative development of a race and ethnicity category framework. We identified racial and ethnic disparities in CLABSI and UE that can be addressed in future improvement work by identifying and modifying care delivery factors that contribute to safety disparities.

Making lemonade out of lemons: an approach to combining variable race and ethnicity data from hospitals for quality and safety efforts

“…Lyren and colleagues performed a secondary analysis of data from 25 children's hospitals in the Solutions for Patient Safety network in the USA, 5 to describe racial and ethnic disparities in safety events across the hospitals. In designing the study, the authors were confronted with the current reality of race and ethnicity data collection efforts-substantial variation.…”

“…Lyren and colleagues were not able to assess hospital-level performance due to small sample sizes. This has been addressed in prior work by assessing performance over longer time periods (7 years 18 compared with the 18 months in Lyren and colleagues 5 ). Longer measurement periods in QI efforts can delay detection of the effects associated with an equity intervention, due to long lag times between the intervention and a repeat measure to assess changes.…”

“…2 Currently, adequate efforts require several steps: the decision to collect data, ensuring the quality of data being collected, and reconciliation of race and ethnicity data across frequently nonstandardised data collection systems. 4 The study by Lyren and colleagues 5 in this issue of BMJ Quality & Safety focuses on the third step, providing a replicable method to use race and ethnicity data while data standardisation efforts continue. Data collection and analytics are a core principle of advancing health equity, positioned within a larger framework to ultimately improve individual and population-level health.…”

The benefits and opportunities: Engaging patients in identifying and reporting patient safety incidents

“…Additionally, researchers identified patient safety disparities exist related to race and ethnicity. 30 Thus, methods to address inequities in reporting are likely also required. Further, there may be other barriers preventing patients from raising patient safety incidents.…”