The Pediatric Index of Mortality as a Trigger Tool for the Detection of Serious Errors and Adverse Events

Objectives: To test the hypothesis that patients who die in a PICU despite a low predicted mortality at PICU admission are affected by serious errors and adverse events. Design: Retrospective cross-sectional review of medical records for serious errors and adverse events. Setting: Tertiary interdisciplinary neonatal PICU. Patients: All admissions to our PICU who died despite a low expected mortality (Pediatric Index of Mortality) of less than 10% (trigger-positive admissions). They were compared with a random sample of 100 PICU admissions with a Pediatric Index of Mortality of less than 10% who survived (trigger-negative admissions). Interventions: None. Measurements and Main Results: There were 7,383 admissions (91%) with a Pediatric Index of Mortality 2 below 10%. Seventy-two trigger-positive admissions and 100 trigger-negative admissions met the criteria for detailed chart review. Forty-five serious errors and adverse events were identified, 0.47 per trigger-positive admission and 0.11 per trigger-negative admission (p

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