Safety Gaps Found in Home Healthcare for Children with Medical Complexity
A new study sheds light on an understudied area of healthcare safety: the risks faced by children with complex medical needs receiving care at home.
Key Findings
- A study published in JAMA Network Open analyzed staff incident reports from a national pediatric home healthcare agency across 11 US states.
- Of 2,901 patients under 21 receiving home care from September 2022 to September 2023, 687 incident reports were filed for 11.8% of children.
- Half of reported events were safety-related; a quarter caused harm to the child.
- Medication errors accounted for 38.8% of events, device-related errors for 32.7%.
- Harmful errors most often involved non-pressure skin injuries (26.8%) and falls (17.9%).
- About 47.8% of errors required additional monitoring; 16.2% required emergency care.
"Healthcare safety issues in home care for these children have been understudied, and the study is a first step toward tracking safety events to identify patterns and develop interventions." — Dr. Carolyn Foster, lead author
Background
Children with medical complexity—approximately 3 million in the US—have multisystem conditions and rely on complex home care regimens including medications, implanted devices, and functional support.
The study was conducted under a Patient Safety Learning Lab funded by AHRQ, involving Lurie Children's, Vanderbilt University Medical Center, Boston Children's Hospital, and home care agencies.
Call to Action
Dr. Foster called for targeted interventions to protect vulnerable children and recommended integrating family caregivers into event reporting and intervention design. She also advocated for:
- Including children in national home care event reporting systems
- Establishing training standards for pediatric nursing