Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

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

Stockwell, David Christopher MD, MBA; Bisarya, Hema MHSA, RD; Classen, David C. MD; Kirkendall, Eric S. MD; Lachman, Peter I. MBBS; Matlow, Anne G. MD; Tham, Eric MD; Hyman, Dan MD; Lehman, Samuel M. MD; Searles, Elizabeth RN; Muething, Stephen E. MD; Sharek, Paul J. MD

doi: 10.1097/PTS.0000000000000139
Original Articles

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.

From the *Division of Critical Care Medicine, Department of Pediatrics, School of Medicine, The George Washington University, Washington, DC; †Center for Quality and Improvement Science, Children's National Medical Center, Washington, DC; ‡Children's Hospital Association, Overland Park, KS; §Department of Infectious Disease, School of Medicine, University of Utah, Salt Lake City, UT; ∥Pascal Metrics, Washington, DC; ¶Division of Biomedical Informatics, Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH; #James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; **Medical Directors Office, Quality and Safety, Great Ormond Street Hospital NHS Foundation Trust, London, England; ††Departments of Paediatrics and Medicine and Centre for Patient Safety, University of Toronto, Toronto, ON; ‡‡Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO; §§Research Institute, and ∥∥Department of Quality and Patient Safety, Children's Hospital Colorado, Aurora, CO; ¶¶Department of Anesthesia and Critical Care Medicine, and ##Department of Quality, Children's Hospital Central California, Madera, CA; ***Division of General Pediatrics, Department of Pediatrics, School of Medicine, Stanford University palo Alto, CA; and †††Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, CA.

Correspondence: David Christopher Stockwell, MD, MBA, Center for Quality and Improvement Science, Children's National Medical Center, 111 Michigan Ave, NW, Suite M-4800, Washington, DC 20010 (e-mail:

The authors disclose no conflict of interest.

Supported by the Children's Hospital Association.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved