UK child survival in a European context: recommendations for a national Countdown Collaboration

Wolfe, Ingrid; Donkin, Angela; Marmot, Michael; Macfarlane, Alison; Cass, Hilary; Viner, Russell

doi:10.1136/archdischild-2014-306752

Cited by 36 publications

(47 citation statements)

References 22 publications

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“…We support the call for action by Wolfe et al 1 to address the UK’s high child mortality rates relative to some other European countries. We agree that preventive public health strategies are crucial for reducing child mortality in the UK.…”

supporting

confidence: 79%

Where do the differences in childhood mortality rates between England and Wales and Sweden originate?

Zylbersztejn

Gilbert²,

Hardelid³

et al. 2015

Arch Dis Child

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supporting

confidence: 79%

Where do the differences in childhood mortality rates between England and Wales and Sweden originate?

Zylbersztejn

Gilbert²,

Hardelid³

et al. 2015

Arch Dis Child

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“…The United Kingdom (UK) has one of the highest child mortality rates in Western Europe: the 2,000 excess child deaths that occur annually compare unfavorably with Sweden, which is the best performing country in this region [1–3]. Intercountry variability in rates of child mortality is a well-described global problem.…”

Section: Introductionmentioning

confidence: 99%

“…The safety of care provided to children in this setting is not well understood [6]. For example, in the UK, deaths from meningitis and pneumococcal infection—conditions whose outcomes rely heavily on “first access” services—are considerably higher than in other European countries [3,7,8]. Yet, the avoidable causative factors have not been identified with sufficient clarity for planning action that will prevent the delivery of unsafe care.…”

Section: Introductionmentioning

confidence: 99%

Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis

et al. 2017

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BackgroundThe UK performs poorly relative to other economically developed countries on numerous indicators of care quality for children. The contribution of iatrogenic harm to these outcomes is unclear. As primary care is the first point of healthcare contact for most children, we sought to investigate the safety of care provided to children in this setting.Methods and FindingsWe undertook a mixed methods investigation of reports of primary care patient safety incidents involving sick children from England and Wales’ National Reporting and Learning System between 1 January 2005 and 1 December 2013. Two reviewers independently selected relevant incident reports meeting prespecified criteria, and then descriptively analyzed these reports to identify the most frequent and harmful incident types. This was followed by an in-depth thematic analysis of a purposive sample of reports to understand the reasons underpinning incidents. Key candidate areas for strengthening primary care provision and reducing the risks of systems failures were then identified through multidisciplinary discussions.Of 2,191 safety incidents identified from 2,178 reports, 30% (n = 658) were harmful, including 12 deaths and 41 cases of severe harm. The children involved in these incidents had respiratory conditions (n = 387; 18%), injuries (n = 289; 13%), nonspecific signs and symptoms, e.g., fever (n = 281; 13%), and gastrointestinal or genitourinary conditions (n = 268; 12%), among others. Priority areas for improvement included safer systems for medication provision in community pharmacies; triage processes to enable effective and timely assessment, diagnosis, and referral of acutely sick children attending out-of-hours services; and enhanced communication for robust safety netting between professionals and parents. The main limitations of this study result from underreporting of safety incidents and variable data quality. Our findings therefore require further exploration in longitudinal studies utilizing case review methods.ConclusionsThis study highlights opportunities to reduce iatrogenic harm and avoidable child deaths. Globally, healthcare systems with primary-care-led models of delivery must now examine their existing practices to determine the prevalence and burden of these priority safety issues, and utilize improvement methods to achieve sustainable improvements in care quality.

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“…In 2015, we proposed a ‘Countdown for UK Child Survival’ initiative to track progress in reducing these disparities in mortality trends and make recommendations for improvement 4. Our Countdown proposal built on learning from the Millennium Development Goals-associated Countdown for reducing child mortality.…”

Section: Introductionmentioning

confidence: 99%

Countdown for UK Child Survival 2017: mortality progress and targets

Viner

Wolfe²

2018

Arch Dis Child

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UK child survival in a European context: recommendations for a national Countdown Collaboration

Cited by 36 publications

References 22 publications

Where do the differences in childhood mortality rates between England and Wales and Sweden originate?

Where do the differences in childhood mortality rates between England and Wales and Sweden originate?

Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis

Countdown for UK Child Survival 2017: mortality progress and targets

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