Children are the most vulnerable of patients, so providing safe healthcare must always be a high priority. Improving the care of children in our hospital system was the focus of measures announced in August 2023 by Victorian Health Minister Mary-Anne Thomas.
These measures were part of a number of recommendations made in Safer Care Victoria’s 2021-2022 Sentinel Events Annual Report. Safer Care Victoria, part of the Department of Health, focuses on improving healthcare safety and oversees hospital notifications of sentinel events. Sentinel events are defined as unexpected incidents resulting in death or serious harm to a patient because of a system or process deficiency.
Between July 2021 and June 2022, 240 sentinel events were reported to Safer Care Victoria, a 43% increase from the year before, and resulted in 1,149 recommendations for improvement. While, as the report notes, the overall increase in notifications may reflect better awareness of the need to report such adverse events and improved transparency, the trend is worrying. Also concerning is about a third of the reported sentinel events are related to delays in recognising and responding to patient deterioration. In cases involving children, this accounted for about half of the sentinel events, with the report stating that “deterioration was the common risk factor leading to sentinel events in children and young people.”
Watching an unwell child deteriorating right before your eyes is one of the hardest experiences for a parent, and worse still is the pain of losing a child or a child being left with a permanent injury. When the injury or death is found to have been preventable and the result of a lack of appropriate medical care, the impact is compounded further.
Unwell children can deteriorate quickly, and very young children can’t communicate in a way that adults can about what is happening to them. The difference between a passing viral condition and a life-threatening bacterial one is critical in terms of the consequences and time matters. Ensuring that children at risk of deterioration are identified and receive the treatment they require promptly is vital.
In response to the Sentinel Events report, the government has launched Safer Care for Kids, a family-led project designed to improve health outcomes and tasked to implement the report’s three key recommendations relating to children and young people.
One of the recommendations is to ensure that all Hospitals treating children use the same observation assessment tool and standardised charts to detect deterioration. This chart is already in use for recording vital signs in some Hospitals. It is welcome that this will now be mandatory to ensure that all children receive consistent care and the treatment they need.
The introduction of a 24-hour virtual assessment service on hand to ensure that all children across the state, regardless of distance or region, have access to specialist paediatric experts and are not disadvantaged is also welcome.
The most significant recommendation is the introduction of a state-wide patient escalation process to empower carers to raise concerns, including changes in children's health conditions, through an alternative pathway.
Having acted on behalf of many injured patients and their families, our medical negligence team has seen firsthand the devastating impact that preventable injury and disability have on patients. We work closely with families who have lost loved ones and children after poor medical treatment and can provide insights from our experience to advocate for improved patient safety.
Many parents and carers have told us that, while they are not medically trained, they know their child and when their child is unwell. They can provide valuable insights, including individual factors that can be relevant in arriving at the correct diagnosis and treatment. And some have told us of the anguish of not being listened to and not having their concerns taken seriously.
Many serious adverse outcomes could be avoided now that carers and parents in Victoria will be able to escalate their concerns and have access to another assessment and independent review.
Access to an alternative pathway and potential second opinion will allow for an independent reworking of the diagnosis and fresh eyes, which is less influenced by the working diagnosis of the treating team. This can allow for the identification of a deteriorating condition or a correct diagnosis to be made and for prompt treatment.
Many hospitals have other internal escalation mechanisms in place; for example, where a patient develops certain symptoms or has more than one presentation within a certain period, a review is triggered. Other Australian states already have escalation processes, such as the one introduced in Victoria for children.
These are positive initiatives, but it is vital that a best practice review or escalation process be in place in all hospitals to help prevent avoidable deaths and disability.
Maurice Blackburn has long called for a nationwide patient escalation process as an important step to improve patient safety in our healthcare system. Providing such a process for children across Victoria is a step in the right direction. We urge for this to be followed by a nationally consistent escalation process available to all patients in both public and private hospitals across Australia, in cities and the regions. It is critical that there be a process to obtain a second opinion for all patients and carers if they feel they are not being listened to or have concerns about a deteriorating condition.
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