Safety Events in Children Receiving Home Health Care

Key Takeaways

• Incident reports involved 11.9% of children receiving care in this multistate pediatric home health cohort.
• Medication-related and implanted-device errors were most common, and harmful errors were the largest severity category.
• Nearly half of errors required additional monitoring, 16.2% required emergency care, and events were more likely in children with invasive home ventilation.

In a retrospective cohort of children receiving home health care, 348 of 2,901 children had at least one incident report during the study year. The cohort came from a pediatric agency with sites in 11 US states and included care delivered from September 1, 2022, to August 31, 2023. That proportion was 11.9%, or roughly 1 in 9 children. Staff filed 678 incident reports, and 307 reports, or 45.3%, met criteria for patient safety events. Together, these figures outline the reported safety burden in this pediatric home health care setting.

Participants were younger than 21 years and received home health care, while psychiatric home health care was excluded. The cohort had a mean age of 8.7 years, 59.0% were male, and the median duration of care was 98.0 days. The interquartile range for home health care duration was 14.0 to 312.0 days, indicating wide variation in time receiving services. Three trained clinician reviewers examined staff incident reports and classified patient safety events with the National Coordinating Council for Medication Error Reporting and Prevention Index. The analysis was based on staff-reported incidents reviewed after submission and provided the framework for sorting event type and severity.

Patient safety events occurred at a mean of 0.68 per 1000 home health care-days across the study period. Among errors, the most frequent types involved medications, 108 errors (38.8%), and implanted devices, 91 errors (32.7%). Harmful errors were the largest severity group, with 168 events (54.7%), followed by 110 nonharmful errors (35.8%) and 22 hazards (7.2%). Among harmful errors, non-pressure-related skin injuries accounted for 45 events (26.8%), and falls accounted for 30 (17.9%). Consequences were common, with 133 errors (47.8%) requiring additional monitoring and 45 (16.2%) requiring emergency care.

Patient safety events were also more likely in children with invasive home ventilation than in children with other implanted medical technology. Investigators placed the findings in a community setting where safety issues remain infrequently described and systems approaches are still nascent. They described quantifying and categorizing incidents as a first step toward prevention and called for further work on contributing factors, prevention, and parent perspectives.

The study describes the reported safety burden and its consequences in pediatric home health care over one year.