To develop a risk map in a paediatric ED of a tertiary teaching hospital, combining proactive and reactive strategies.Methods
Between June and December 2013, a multidisciplinary committee in a paediatric Emergency Department (ED) in Bilbao (Basque Country of Spain) mapped the patient's journey and identified potential risks to patients (proactive strategy). The researchers also analysed incidents reported by professionals and caregivers (mainly parents) in the paediatric ED from November 2004–December 2013 (reactive strategies). Combining the results of both strategies, we applied the ‘Failure mode and effects analysis’ tool to identify and prioritise high or very high-risk situations and apply them to the risk map.Results
Using proactive strategies, 49 opportunities for failures, 60 effects and 252 causes were identified. The most common failures were related to the discharge of the patient; the most common effects were complaints by parents, long stay in the ED, delay in diagnosis/treatment and unnecessary treatment. Main causes were not including the family in the process, shift change, incorrect identification of the patient and computer errors. Using reactive strategies, 1795 reported incidents were analysed. The most common incidents were related to medical equipment (38%), resources/organisation of staff (17%), clinical process (15%), facilities (12%) and medication errors (5%). Proactive strategies identified risks in tests, treatment and discharge. The reactive strategy added risks concerning prehospital transfer, triage, medical care, tests, treatment and discharge.Conclusions
Proactive and reactive strategies, involving professionals and caregivers, can complement each other in identifying potential patient safety risks in a paediatric ED.