Adverse Events Sustained by Children in The Intensive Care Unit: Guiding local quality improvement

  • Christopher James Paediatric Intensive Care Unit Melbourne, Victoria, Australia
  • Carmel Delzoppo Paediatric Intensive Care Unit Melbourne, Victoria Australia
  • James Tibballs Paediatric Intensive Care Unit Melbourne, Victoria, Australia
  • Siva Namachivayam Paediatric Intensive Care Unit Melbourne, Victoria Australia
  • Warwick Butt Paediatric Intensive Care Unit Melbourne, Victoria Australia
Keywords: quality improvement, paediatric, intensive care, adverse events

Abstract

Objective: To determine the frequency, nature and consequence of adverse events sustained by children admitted to a combined general and cardiac paediatric intensive care unit (PICU).

Design: Retrospective analysis of data collected between January 1st 2008 and December 31st 2017 from PICU.

Setting: The Royal Children’s Hospital, a paediatric tertiary referral centre in Melbourne, Victoria, Australia. The PICU has thirty beds.

Results: During the study period, PICU received 15208 admissions, of which 73% sustained at least one adverse event with a frequency of 67 adverse events per 100 PICU-days and 3 per admission. One adverse event was sustained for every 35 hours of care. The risk of an adverse event was highest in children less than a month of age, or if mechanically ventilated, a high Pediatric Index of Mortality (PIM2) score, longer PICU length of stay, had a pre-existing disability or a high risk adjustment for congenital heart surgery (RACHS) score. Those patients who sustained an adverse event, as compared to those who did not, were mechanically ventilated for longer (80 hrs Vs. 7 hrs, p=<0.001), had a longer PICU length of stay (131 hrs Vs. 35 hrs, p=<0.001), had a longer hospital length of stay (484 hrs Vs. 206 hrs, p=<0.001) and had a higher mortality rate (3% vs. 0.1%, p=<0.001).

Conclusion: Whilst admission to PICU is an essential aspect of care for many patients, the risk of adverse events is high and is associated with significant clinical consequences. Monitoring of adverse events as part of quality improvement enables targeted intervention to improve patient safety.

Author Biographies

Christopher James, Paediatric Intensive Care Unit Melbourne, Victoria, Australia

Murdoch Children’s Research Institute, Melbourne, Australia     
University of Melbourne - Paediatrics, Melbourne, Australia

Carmel Delzoppo, Paediatric Intensive Care Unit Melbourne, Victoria Australia

Paediatric Intensive Care Unit; Melbourne, Victoria, Australia
Murdoch Children’s Research Institute: Melbourne, Australia

James Tibballs, Paediatric Intensive Care Unit Melbourne, Victoria, Australia

University of Melbourne - Paediatrics, Melbourne, Australia

Siva Namachivayam, Paediatric Intensive Care Unit Melbourne, Victoria Australia

Murdoch Children’s Research Institute, Melbourne, Australia

Warwick Butt, Paediatric Intensive Care Unit Melbourne, Victoria Australia

Murdoch Children’s Research Institute, Melbourne, Australia

University of Melbourne - Paediatrics, Melbourne, Australia

Published
2018-12-16
How to Cite
James, C., Delzoppo, C., Tibballs, J., Namachivayam, S., & Butt, W. (2018). Adverse Events Sustained by Children in The Intensive Care Unit: Guiding local quality improvement. Asia-Pacific Journal of Health Management, 13(3), i20. https://doi.org/10.24083/apjhm.v13i3.113
Section
Research Articles