Parental involvement in patient safety events in paediatric emergency care: a multi-method analysis.

introductionParents are central to keeping children safe when receiving healthcare. National scrutiny of failures to recognise and respond to clinical deterioration in children led to the introduction of Martha's Rule by National Health Service (NHS) England, which formalises families' rights to request an urgent clinical review for children. Given rising paediatric emergency department (ED) attendances and evidence of healthcare-associated harm within EDs, we examined how parents contribute to and mitigate unsafe care in this care context.

methodsThis was an exploratory multi-method analysis of anonymised paediatric safety incidents from EDs. We sought reports reported by EDs between 2014 and 2020. 4000 reports were reviewed to identify whether a patient safety incident had occurred and whether there was parental involvement to mitigate or contribute to the harm. Reports were categorised by incident type (what happened), contributory (why it happened), mitigatory factors (actions taken to reduce or prevent harm), outcome (patient impact) and harm severity.

resultsOf 658 reports that met the definition of a patient safety incident and included parental involvement, 591 (90.0%) described parents mitigating harm and 67 (10.0%) described inadvertent contribution to incidents. Parents most commonly mitigated harms by advocating for their children, prompting reassessments where necessary and supporting care. However, poor communication involving clinical information, particularly allergies or pertinent medical history, contributed to harm, leading to multiple safety incidents, including the administration of contraindicated medication within EDs.

conclusionParents are important participants in paediatric safety within EDs, and we have identified diverse ways in which they prevent harm. As policy initiatives formalise escalation pathways, healthcare systems must strengthen mechanisms to support partnership working with families across healthcare settings, while addressing paediatric vulnerabilities that contribute to harm.