BACKGROUND AND OBJECTIVES Hospitalized children with medical complexity (CMC) are at high risk of medical errors. Their families are an underutilized source of hospital safety data. We evaluated safety concerns from families of hospitalized CMC and patient/parent characteristics associated with family safety concerns. METHODS We conducted a 12-month prospective cohort study of English- and Spanish-speaking parents/staff of hospitalized CMC on 5 units caring for complex care patients at a tertiary care children's hospital. Parents completed safety and experience surveys predischarge. Staff completed surveys during meetings and shifts. Mixed-effects logistic regression with random intercepts controlling for clustering and other patient/parent factors evaluated associations between family safety concerns and patient/parent characteristics. RESULTS A total of 155 parents and 214 staff completed surveys (>89% response rates). 43% (n = 66) had ≥1 hospital safety concerns, totaling 115 concerns (1-6 concerns each). On physician review, 69% of concerns were medical errors and 22% nonsafety-related quality issues. Most parents (68%) reported concerns to staff, particularly bedside nurses. Only 32% of parents recalled being told how to report safety concerns. Higher education (adjusted odds ratio 2.94, 95% confidence interval [1.21-7.14], P = .02) and longer length of stay (3.08 [1.29-7.38], P = .01) were associated with family safety concerns. CONCLUSIONS Although parents of CMC were infrequently advised about how to report safety concerns, they frequently identified medical errors during hospitalization. Hospitals should provide clear mechanisms for families, particularly of CMC and those from disadvantaged backgrounds, to share safety concerns. Actively engaging patients/families in reporting will allow hospitals to develop a more comprehensive, patient-centered view of safety.

中文翻译：

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医疗复杂性住院儿童的家庭安全报告。


背景和目标 患有医疗复杂性 (CMC) 的住院儿童发生医疗差错的风险很高。他们的家人是医院安全数据的未充分利用的来源。我们评估了住院 CMC 家庭的安全问题以及与家庭安全问题相关的患者/家长特征。方法 我们对一家三级护理儿童医院的 5 个护理复杂护理患者的住院 CMC 的讲英语和西班牙语的家长/工作人员进行了为期 12 个月的前瞻性队列研究。家长在出院前完成了安全和经验调查。工作人员在会议和轮班期间完成了调查。混合效应逻辑回归与控制聚类和其他患者/家长因素的随机截距评估了家庭安全问题与患者/家长特征之间的关联。结果 共有 155 名家长和 214 名工作人员完成了调查（回复率 >89%）。 43% (n = 66) 存在 ≥1 个医院安全问题，总共 115 个问题（每个问题 1-6 个）。在医生审查中，69% 的担忧是医疗错误，22% 的担忧是与安全无关的质量问题。大多数家长（68%）向工作人员，尤其是床边护士表达了担忧。只有 32% 的家长回忆起被告知如何报告安全问题。高等教育（调整后优势比 2.94，95% 置信区间 [1.21-7.14]，P = .02）和较长的住院时间（3.08 [1.29-7.38]，P = .01）与家庭安全问题相关。结论 尽管 CMC 的家长很少被告知如何报告安全问题，但他们经常在住院期间发现医疗错误。医院应为家庭（特别是 CMC 家庭和弱势家庭家庭）提供明确的机制，以分担安全问题。 积极让患者/家属参与报告将使医院形成更全面、以患者为中心的安全观。