Description of the characteristics of the clinical incidents reported in 2020 to the voluntary reporting system of a pediatric hospital in Costa Rica

Abstract

The objective of this manuscript was to describe the clinical incidents that were sent to the voluntary reporting system during 2020 at the National Children's Hospital of Costa Rica, belonging to the Costa Rican Social Security Fund. A descriptive observational study of the consolidated data that was sent during the months of January to December of the year 2020 was carried out. During 2020, 1.6% of the patients treated in the hospital experienced some type of clinical incident. The total discharges decreased by 38.4% compared to the discharges of the year 2019, however, the reported clinical incidents increased in the year 2020 by 37.6%, especially from the month of August. Sentinel events were not reported this year. The services that made the highest number of reports were Intensive Care (14.3%), General Surgery (12%), Neonatology (9.8%) and Infectiology (9%). The day on which the most incidents were reported was Wednesday (27.8%), in the first hospital shift most of the cases were reported (48.1%) and these incidents occurred predominantly to male individuals (66%). Regarding the age of the patients, the majority were in the age range from 1 year to less than 5 years (36.1%), followed by the age range from over 29 days to under 1 year (24, 1%). Most of the cases were related to the care provided to the patient (63.9%). 41.4% of the incidents required clinical measures but the sequelae were transitory. 51.1% of the cases merited some type of additional medical care to their therapeutic scheme upon admission. 96% of clinical incidents were reported by nursing staff. Most of the clinical incidents (35.3%) in this period were errors related to notes in the digital file.

Moderate and severe adverse events in pediatrics: characteristics of incidents reported during the COVID-19 pandemic

“…The data from this research are similar to the results found in other studies that address the characteristics of safety incidents before and also during the COVID-19 period (9,(12)(13)(14) . It is worth noting that institution A had more than triple the number of incident records (n=105) compared to institution B (n=32), a fact that may be related to the greater encouragement and proposal of strategies for notification in the institution A, for the continuous development of a safety culture and for having an international certification process by the Joint Commission International.…”

“…However, some research differs as to which gender is most affected. A study conducted during the pandemic shows that 60.2% of incidents affected children between 29 days and 5 years old, with these incidents occurring predominantly in males (66%) (13) . The IU (n=66; 48.2%), ICU (n=38; 27.7%) and surgical center (n=11; 8.0%) represented the places with the highest prevalence of AEs in this research.…”

“…Another variable analyzed was the severity of the harm, with the majority of AEs classified as moderate (n=100; 73%) in this study. Research conducted in Costa Rica during the pandemic period showed that 42% of events caused harm to the patient, of which 18% were related to moderate harm and 2% to severe harm (13) . Another study conducted with 842 children hospitalized in a Pediatric ICU analyzed the record of severe incidents, finding that 142 (16.86%) suffered AE, 6 (0.71%) presented morbidity and 33 (3.92%) progressed to death.…”

“…The notification system has advantages such as low cost, easy access, and anonymity, however, there are several reasons why healthcare professionals do not notify, and among the most frequent is the fear of punitive culture from supervisors or the institution. Additionally, AEs with harm can have repercussions on the professional's life beyond the hospital setting (5)(6)(7)(8)(9)(10)(11)(12)(13) . Underreporting was already considered a limitation in the area of patient safety and incident reporting even before the advent of the pandemic.…”

Eventos adversos moderados e graves em pediatria: características dos incidentes notificados durante a pandemia COVID-19

“…Os dados desta pesquisa são similares aos resultados encontrados em outros estudos que abordam as características dos incidentes de segurança antes e também durante o período da COVID-19 (9,(12)(13)(14) . Cabe ressaltar que, a instituição A teve mais do que o triplo de registros de incidentes (n=105) em comparação a instituição B (n=32), fato que pode ser relacionado ao maior incentivo e proposição de estratégias para a notificação na instituição A, pelo desenvolvimento contínuo de uma cultura de segurança e por ter um processo de certificação internacional pela Joint Commission International.…”