Disclose Pediatric Errors Without Fear

Pediatricians must disclose adverse events and medical errors to children and their families, according to an updated policy statement from the American Academy of Pediatrics.

The new statement expands upon a 2016 version that said health systems need to create a work culture in which clinicians feel they can report incidents to their employers — as well as patients and their families — without fear of repercussions. The updated statement says health systems should make disclosure and reporting an automatic and embedded practice, even when not required by law.

“Providers are committed to the principle of transparency and openness but struggle turning that commitment into practice,” said Thomas Gallagher, MD, a professor of medicine and associate chair of Patient Care Quality, Safety and Value at University of Washington Medicine in Seattle, who was not involved with the policy statement. “Our human nature when something goes wrong is to hide it and hope it just blows over.”

Most pediatric care occurs in outpatient settings, and most errors are related to medications, vaccines, diagnoses, and coordination of care transitions, the statement said. Far less data exist on events that occur in pediatric care compared with adults, despite similar requirements for both groups of patients. A 2023 study found only 3.1% of reports filed with the US Food and Drug Administration’s Adverse Event Reporting System, a voluntary reporting database, involved children.

Patient Safety Starts With Provider Culture

Improving patient safety starts with continuing to shift the healthcare industry’s culture around reporting errors, according to the AAP’s statement.

“Increasingly, the culture of pediatrics, and healthcare in general, is to promptly disclose to patients and families after an [adverse event] has taken place,” the statement said. “Shame, fear of professional and legal repercussions, and lack of training remain barriers to disclosure.”

The AAP outlines how clinicians and healthcare administrators can make reporting and disclosure an automatic part of practice. These steps include:

• Developing policies and procedures for identifying and disclosing adverse events to patients and families in an honest and empathetic way.
• Developing policies and procedures to support staff involved in adverse events, including opportunities for education and fostering an environment where reporting events is not associated with penalty but is rather a normal part of caring for patients.
• Teaching staff to recognize which patients are at higher risk of experiencing adverse events.

Medical schools and training staff should develop programs that teach healthcare workers how to talk to families and pediatric patients when medical errors occur.

“This needs to become a routine part of medical training so we learn how to prevent them from happening,” said Danielle Thurtle, MD, CPPS, a pediatrician and patient safety officer with Sanford Health in Bismarck, North Dakota, and an author of the policy statement.

Laura Sigman, MD, an assistant professor of pediatrics at Johns Hopkins Children’s Center in Baltimore, who helped write the policy statement, said she has already noticed a difference among newer clinicians who received education on the importance of reporting errors during medical school.

“We see trainees now that never question that they would disclose a medical error, and there is really an opportunity to tailor our education to make sure people have training on the protocol,” Sigman said.

Caring for High-Risk Communities

Children are three times more likely than adults to experience an adverse event related to medication, according to the Joint Commission, a nonprofit that certifies and accredits healthcare organizations. And medical errors in pediatrics are often underreported and disjointly collected, particularly in outpatient care.

Newer research on which pediatric patients may be most susceptible to errors prompted the AAP to add direction on identifying high-risk patients to its guidelines.

Children and teens from low-income families, who have special health needs and those who speak English as a second language, are at a greater risk for medical errors, according to the AAP.

“Kids who are nonverbal or cannot speak up for themselves have less of an ability to communicate what they are experiencing, so we think adverse events related to medication are much higher than we think in outpatient settings,” Sigman said.

Disjointed Practices

Part of the problem of underreporting and disclosure is a patchwork of standards from states and employers, said Ulfat Shaikh, MD, MPH, a professor of pediatrics and medical director for Healthcare Quality at the University of California Davis Health, Sacramento.

“There is quite a bit of variation,” Shaikh said.

Laws regarding what events health organizations must report to outside entities, such as federal databases or nonprofit accreditation organizations, change state by state, as do laws that protect clinicians from legal ramifications after reporting. Each health system also has its own set of standards its employees are expected to follow.

Pediatric providers “absolutely need to have a centralized reporting system,” Thurtle said.

Statement authors reported no relevant financial disclosures.