For the first time, medical researchers are taking a close look at preventable complications - some fatal - that occur at children's hospitals nationwide. In most cases, the complications do not lead to deaths, but to infections and other maladies

Dr. Matthew P. Kronman of Philadelphia's Children's Hospital and his colleagues reviewed more than 400,000 records of patient discharges in 2006 from 38 pediatric hospitals, among them St. Louis's Children's Hospital. The researchers looked for 12 complications including infections, accidental punctures, foreign objects left in bodies after surgery, and in-hospital or post-surgery death.

The study is seen as a major step forward for pediatric hospitals. "The same [research] has been done in adult hospitals for years," said Joyce Hayes-Berkowitz RN, Infection Control Coordinator for Cardinal Glennon Children's Hospital, a hospital not included in the study. "This is an opportunity to see if the same safety measures are in place for pediatric hospitals."

Dr. F. Sessions Cole, Children's Hospital's Chief Medical Officer, agrees: "I welcome this study as it provides us information to focus on in our relentless search for improvement in caring for children."

The Numbers Speak

The researchers found that the most common adverse events were general infection resulting from medical care, and post-surgery respiratory failure. The hospitals in the study were more likely to see more complications because they are specialty or tertiary-care facilities as opposed to community-based hospitals. They generally get the tougher cases.

The researchers also found that adverse events were linked to increased length of stay as well as increased costs of care. Prolonged hospital stays attributable to complications ranged from 2.8 days for accidental puncture to 23.5 days for post-surgical sepsis (a generalized infection of the bloodstream and other body tissues). And excess costs ranged from $34,884 to as high as $337,226 for in-hospital death following heart surgery.

It Takes a Village

Improved hand hygiene, better sterilization, preventative antibiotic treatments and other techniques can help reduce hospital-based complications such as infection.

Berkowitz agrees, "The best thing to do is hand hygiene. This is for parents themselves and anyone else coming in the room: doctors, nurses, friends and family."

Following sterile and safe techniques according to evidence-based guidelines is also key. Berkowitz cites the example of central line insertion. "If best practices are used, the risk of infection is reduced to almost nothing."

Communication is King

Experts also advise parents to stay informed. Cardinal Glennon, along with many other pediatric hospitals nationwide, has implemented a family-focused protocol, where parents and children have the opportunity each day to be included on the health care team's plan of care for the day.

And don't be afraid to step in to say "no" when appropriate. If your child is having an invasive procedure "it is a fair question to ask why," Berkowitz said. Also fair game: "'Do you follow the best technique according to the guidelines?' and 'What can you do to protect my child'?" she said.

Her best advice to all parents? "Always ask the question. It's okay to keep asking until [the answer is] clear."

Children's Simulation Center

Children's Hospital is taking things a step further with the Saigh Pediatric Simulation Center, due to open first quarter of 2009. In this center, health care team members will learn how to improve techniques, including working on enhancing their communication skills with patients and families in complex situations. These skills are honed in a simulated environment with direct feedback and guidelines for improvement.

Washington University already has such a center in place for adult medicine and this will be the premier version of such of a facility for pediatric patients.