Do Pediatric Adverse Events Occur More Often in Teaching Facilities?

By Megan Headley

In a July 2018 article from the Academy of Pediatrics, researchers took a close look at data from 16 teaching and non-teaching hospitals around the country to explore whether efforts to reduce adverse events (AE) have had an impact—and the answer should sound an alarm for pediatric clinicians and safety officers everywhere.

In their examination of 3,790 records, the researchers found that not only did AE rates in pediatric inpatients not improve during the six-year period examined, but those rates “were substantially higher in teaching hospitals” compared to community hospitals.

The project arose out of the Pediatric Quality Measure Program, a series of grants to medical centers to develop measures of the quality of pediatric care. For this examination, the research team developed the Global Assessment of Pediatric Patient Safety (GAPPS) surveillance tool, which was formally approved by the National Quality Forum as a Pediatric Performance Measure in 2017. Using GAPPS, the researchers measured AE rates and trends from 2007 through 2012.

Through their research, the authors identified 414 AEs, roughly half of which (210) they classified as preventable AEs. The majority of those events were the result of hospital-acquired infections (HAI). On average, teaching hospitals had AE rates of 26.2 vs. 5.1 compared to nonteaching hospitals. Neither teaching nor nonteaching hospitals experienced significant AE rate variations.

The researchers acknowledge that the dated records might not account for processes put in place since 2012 to reduce AE rates. However, Christopher Landrigan, professor of pediatrics at Harvard Medical School, research and fellowship director for Boston Children’s Hospital inpatient pediatric services, and co-author on the study, notes, “This is really consistent with data from adult hospitals that shows while we have improved on rates of harm compared to certain processes, like HAIs, hospitalwide rates of harm have really not shown rates of improvement as yet.”

David Stockwell, pediatric intensivist and associate professor of pediatrics in the Pediatric Critical Care Medicine department at Children’s National Health System, and study co-author, elaborates that other factors could be limiting the results. “The academic facilities may have more complex procedures, and we didn’t capture that variable. The community hospitals may just intrinsically be better taking care of their patients; that’s certainly possible,” he adds. “There’s also the possibility that the complex chronic conditions variable that we used didn’t represent other complexities that may lead to more harm events in academic facilities.”

Regardless, Stockwell concludes, that difference between academic and community hospital AEs is striking.

Yoshihiro Aoki, with the Pediatrician Department of Intensive Care Medicine of Osaka Women’s and Children’s Hospital, suggested another possibility in a comment on the article: The quality of medical records might differ across hospital settings. “There might be differences in the quality and quantity of medical records maintained for each patient since teaching hospitals presumably have a higher number of medical staff, including residents and fellows for whom medical recording is one important aspect of their training,” Aoki wrote.

In other words, he explained, “we hypothesize that insufficiencies in the medical records in non-teaching hospitals might have allowed for events that should have been identified as AEs with proper medical recordkeeping resulted in the lack of detection by the trigger list.” Aoki cited research conducted by teaching hospitals to assess the quality of their medical records, whereas non-teaching hospitals might lag behind in this area.

Regardless of the discrepancies, the researchers agree that the latest data should be a wake-up call for hospitals everywhere.

“I think regardless of whether you’re in an academic hospital or community center, the message here to me is you still have a long way to go to improve care,” Landrigan says. “I do think there are major differences across settings and facilities, but all of us need to focus on these processes that need to be addressed to drive harm rates further.”

Megan Headley is a freelance writer and owner of ClearStory Publications. She has covered healthcare safety and operations for numerous publications. Headley can be reached at