Itemizing Patient Safety Events in a New Children's Mental Health Hospital
Abstract
Introduction: Patient safety is an expanding field of interest for healthcare professionals and policymakers aiming to enhance quality of care and minimize preventable harm. Despite progress in patient safety across all medical specialties, challenges exist in newer domains such as pediatric psychiatric inpatient units. In October 2022, the Children's Hospital of The King's Daughters (CHKD) opened the Children's Pavilion (CP), a 60-bed pediatric unit for acute inpatient mental health care. This study aims to categorize the types of safety events and the frequencies at which they occur over the first 17 months of the CP's operation.
Methods: Safety events were tabulated with duplicate and non-patient events subtracted. The events were then divided into three broad categories: Behavioral, Care Management, and Patient Protection. Each category had specific subcategories such as assault (on patient/staff or patient/patient), communication issues, medication events, and contraband. Data on restraints and patient demographics (age, biological sex, race, ethnicity) were also collected. Descriptive statistics summarized the frequency and distribution of events.
Results: 959 safety events were documented and classified into major categories. Removing duplicate and non-patient safety-related events resulted in 772 total events. Preliminary results revealed that behavioral events accounted for 58% of all safety events, while care management and patient protection made up 20% and 22%, respectively. Assaults on staff constituted 70% of behavioral events, followed by patient assault on patients at 16%, and general aggression/escalation without assault at 11%. 209 events involving restraints were documented.
Conclusion: Initial findings suggest that behavioral events constitute most of the safety incidents at the CP, emphasizing the need for interventions to address issues related to aggression and violence within the unit. Enhancing staff training and implementing de-escalation techniques may help reduce assault-related incidents. These preliminary results underscore areas for safety improvement in pediatric psychiatric inpatient units, particularly focusing on reducing behavioral events and strengthening staff support. Further analysis is crucial to refining these strategies and developing effective interventions.