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Family Safety Reporting in Hospitalized Children

August 2, 2022

Blog: Family Connections with Pediatrics

Every day, we worry about the safety of our children. Did they make it to the bus stop safely, or did they make the right choices at school? However, for those who have children with chronic health conditions, the types and number of concerns may be even higher. In this month’s Pediatrics, Mercer et al publish an article entitled, “Family Safety Reporting in Hospitalized Children with Medical Complexity,” in which they explore family -reported safety concerns and the role of families as partners in safety (10.1542/peds.2021-055098).

What have past studies by these authors and others found?

Previous studies have found that there are higher rates of medical errors and adverse events for hospitalized children with medical complexity (CMC). This is because CMC have a lot of medications, medical devices that can malfunction, longer hospital stays, and frequent readmissions. Because there are usually many people caring for CMC, there is also a bigger chance of miscommunication. Previous studies also found families of children with more than one chronic condition are twice as likely to report errors and adverse events during hospitalization. However, medical records often do not document these family-reported errors.  

What did the study in this article look at?

In this study, the authors wanted to look more closely at questions like:

  • how often do families report safety concerns and to whom
  • if they know how to report them
  • who reported concerns
  • how often they share concerns
  • how staff handle reported concerns

The authors also looked at the experience of both families and staff with safety and safety reporting.

How did the authors do the study?

The authors gave surveys to families and staff in 5 complex care units in children’s hospitals over a 12-month period. English and Spanish speaking families did surveys before hospital discharge. Staff did surveys during meetings and shifts.

What are some of the results and conclusions of this study?


  • 43% of parents had more than 1 safety concern
  • Doctors who reviewed the concerns found 69% were medical errors
  • Only 32% of families knew how to report safety concerns
  • Education and longer hospital stays were often linked to family safety concerns
  • Families often noted medical errors during hospitalization, but they did not know how to report them

Key Conclusions

  • Hospitals should provide clear ways for families to share safety concerns
  • Active family involvement in safety allows hospitals to develop a better and more patient/family-centered view of safety
  • More studies of family safety reporting in CMC are needed
  • Leveraging family expertise can improve care for patients. For example:
  • On an individual level, families can notice clinical decompensation and help prevent adverse events earlier than medical staff
  • On a systems-level, families can highlight under-recognized safety issues and prioritize quality improvement efforts

What can you do with this article?

  1. Read this article to know you are not alone. The article shares great data about types of safety concerns, how often they happen, and if families report them. It lays out how families have skills that make them key partners in safety. The article can help you believe in your skills and role in caring for your child, as a member of the team caring for your child, and as a partner in safety for the hospital or clinic.
  2. Share this article with your child’s doctor as a way to talk about or ask for help with safety concerns. While you can look at past concerns, you can also work with your child’s doctor to figure out how to share concerns in the future. For example, you may fear that sharing a concern will affect the care your child receives or that no one will listen to you. Talk with your child’s doctor to make sure that you have a way to be a partner in safety.
  3. If you are an advisor for a hospital patient and family advisory council, consider sharing this article with the group. Use it to ask how your hospital informs families about reporting a safety concern. If nothing exists or it is time for an update, use the article to start to talk about how to plan for a quality improvement project.
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