Development of an Electronic Pediatric All-Cause Harm Measurement Tool Using a Modified Delphi Method

David Stockwell, Hema Bisarya, David C. Classen, Eric S. Kirkendall, Peter I. Lachman, Anne G. Matlow, Eric Tham, Dan Hyman, Samuel M. Lehman, Elizabeth Searles, Stephen E. Muething, Paul J. Sharek

Research output: Contribution to journalArticle

Abstract

Objectives To have impact on reducing harm in pediatric inpatients, an efficient and reliable process for harm detection is needed. This work describes the first step toward the development of a pediatric all-cause harm measurement tool by recognized experts in the field. Methods An international group of leaders in pediatric patient safety and informatics were charged with developing a comprehensive pediatric inpatient all-cause harm measurement tool using a modified Delphi technique. The process was conducted in 5 distinct steps: (1) literature review of triggers (elements from a medical record that assist in identifying patient harm) for inclusion; (2) translation of triggers to likely associated harm, improving the ability for expert prioritization; (3) 2 applications of a modified Delphi selection approach with consensus criteria using severity and frequency of harm as well as detectability of the associated trigger as criteria to rate each trigger and associated harm; (4) developing specific trigger logic and relevant values when applicable; and (5) final vetting of the entire trigger list for pilot testing. Results Literature and expert panel review identified 108 triggers and associated harms suitable for consideration (steps 1 and 2). This list was pared to 64 triggers and their associated harms after the first of the 2 independent expert reviews. The second independent expert review led to further refinement of the trigger package, resulting in 46 items for inclusion (step 3). Adding in specific trigger logic expanded the list. Final review and voting resulted in a list of 51 triggers (steps 4 and 5). Conclusions Application of a modified Delphi method on an expert-constructed list of 108 triggers, focusing on severity and frequency of harms as well as detectability of triggers in an electronic medical record, resulted in a final list of 51 pediatric triggers. Pilot testing this list of pediatric triggers to identify all-cause harm for pediatric inpatients is the next step to establish the appropriateness of each trigger for inclusion in a global pediatric safety measurement tool.

Original languageEnglish (US)
Pages (from-to)180-189
Number of pages10
JournalJournal of patient safety
Volume12
Issue number4
DOIs
Publication statusPublished - Dec 1 2016
Externally publishedYes

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Keywords

  • adverse event
  • Delphi method
  • harm
  • harms
  • patient safety
  • trigger

ASJC Scopus subject areas

  • Leadership and Management
  • Public Health, Environmental and Occupational Health

Cite this

Stockwell, D., Bisarya, H., Classen, D. C., Kirkendall, E. S., Lachman, P. I., Matlow, A. G., ... Sharek, P. J. (2016). Development of an Electronic Pediatric All-Cause Harm Measurement Tool Using a Modified Delphi Method. Journal of patient safety, 12(4), 180-189. https://doi.org/10.1097/PTS.0000000000000139