Safe care for children: A scoping review of what we know, and what we need to find out

Article type
Authors
Thomson D1, Seto I1, Scanlon M2
1Cochrane Child Health Field, Department of Pediatrics, University of Alberta, Edmonton, Canada
2Department of Pediatrics, Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
Abstract
Background: Children differ from adults in many profound ways. These unique aspects to childhood affect all aspects of medical care, including patient safety. Therefore, any study of pediatric patient safety must be carried out on the basis of research which explicitly incorporates an understanding of the physiological and psychosocial stages of childhood.

Objectives: To map the research published in pediatric patient safety in the period 1999-2010. To establish what this research demonstrates about the characteristics of childhood that affect patient safety, as well as the gaps that remain.

Methods: We carried out a scoping review of literature in pediatric patient safety from the period 1999-2010. Scoping reviews illustrate the volume, nature and characteristics of a body of research. They identify and map all relevant literature, regardless of study design, and identify research gaps (Arksey and O’Malley 2005). We searched for all literature, and then identified a subset concerned specifically with pediatrics. We analysed this subset to identify what is known about pediatric characteristics of patient safety.

Results: Preliminary results: pediatric trials are between 1.47% and 7.21% of total published studies each year, whereas children in the 0-19 age range make up 34.9% of the world’s population (US Census Bureau). Final results will be discussed at the Cochrane Colloquium. We found two broad categories to pediatric aspects of patient safety: 1) Nature of childhood (varies across age groups), e.g. physiological, developmental, social/family context; and 2) Aspects of the system of care (varies across settings), e.g. medication prescribing and administration, organizational approaches (including staffing, education and training), and technology (e.g. computerized physician order entry systems).

Conclusions: Addressing pediatric patient safety needs to be based on evidence that considers the particular physiological and psychosocial aspects of childhood and adolescence, as well as the settings in which pediatric care is administered.