Implementation of Surveillance System for Evaluating the Impact of Non-Infectious Adverse Events in Pediatric Critical Patients: Results

Background: The safety and care quality of health services have proved a continuing challenge for the systems in the world, leading to the creation in 2002 of a Working Group of the World Health Organization in order to study methods of systematic evaluation of risks to patient safety. These events have an estimated incidence of 2.9 to 16.6%, and critical patients are particularly vulnerable. Research methods in non-standard, changes in concepts, culture of infallibility of health professionals, lack of an acceptable range of exposure and vulnerability of systems are the main challenges for the development of these studies. Faced with this challenge comes FHEMIG systematizing since 2006 the notification of infectious adverse events in their Intensive Care Unit (ICU).

Objective: Describe the incidence of non-infectious adverse events associated with  invasive procedures  and care in intensive care pediatric units.

Methods: A prospective, multi-center 3 ICU's pediatric tertiary care hospitals (28 beds) of the State of Minas Gerais, Brazil, September 2006 to June 2009. Defined by the compulsory reporting by professionals, data validation by the senior management of ICU and sending monthly e-on central administration in 2006, becoming voluntary reporting in 2009. The classification and definitions have been proposed by Pedrosa and Couto (2003), classifying the event for the affected systems as the device / procedure associated, skin and soft tissues and others. Descriptive statistical techniques and graphical inspection of the temporal evolution of the data for the choice of mathematical models explaining was used.  
Results: There was a significant exponential increase in the incidence of reported events per 100 admissions from 2006 to 2009 (p = 0.039). The incidence density approached the quadratic model of progression (p = 0.09). The frequencies and rates per ICU are presented in table 1.

Table 1 – Pooled adverse events rates per pediatric ICU, january 2007 through june 2009, Fhemig, Brazil.

		2006	2007	2008	2009	Global Fhemig	R²	p
AE (n)		99	233	199	227	758
Patient-days		3150	10533	8411	5292	27386
Admissions		274	508	371	236	1389
Global rate	per 1000 patient-days	31,4	22,1	23,7	42,9	27,7	97,5	0,09
	Per 100 admissions (%)	36,1	45,9	54	96	54,6%	88,4	0,04
Rates per ICU (per 1000 patient-days)	Pediatric trauma	28,4	5,5	10,6	31,1
	Pediatric  1	15,4	15,2	14,2	27,8
	Pediatric  2	69	46,5	51,7	77,7

Conclusions: The system of notification of adverse events temporally proposed to assess the impact on quality of care capabilities and protocols. The overall increase in rates suggests that removing the incentive of notification does not seem to be affecting the institutional culture of surveillance of adverse events noninfectious established.