Impact of clinical risk management in pediatric intensive care units: a systematic review

Background\r\nClinical risk is the probability that a patient is the victim of an adverse event attributable to medical care, albeit unintentionally; clinical risk management is therefore a key area for the quality of healthcare, especially in care-intensive settings; even more for pediatric patients. The objective of this review is to assess the impact of the application of tools and methodologies for clinical risk management in pediatric care-intensive settings.\r\n\r\nMethods\r\nPubmed and Web of Science were queried to carry out a systematic review, using the PICO methodology to formulate the research strategy and query (June 2019). Application experiences of clinical risk management that had quantitative and qualitative impacts in pediatric intensive care units were included.\r\n\r\nResults\r\nA total of 1178 papers were reviewed and 22 articles were included, most of them from the US (8). Out of the 22 experiences described, 11 were related to reactive management tools, 7 to proactive tools; 4 experiences reported the use of both reactive and proactive tools; 11 articles made explicit a reduction in adverse events following the intervention in the study (29.8%-78.8%, p < 0.001); 8 articles made explicit organizational changes triggered by the intervention; 2 proactive tools were also used in order to specifically assess the economical savings related to the changes that occurred as a result of the intervention; 1 article compared two reactive clinical risk management systems in the same context, underlining that a more innovative system tended to highlight more systemic errors, while a more traditional one focused on errors that were less common but potentially more dangerous; 14 studies were specifically dedicated to risk in drug management.\r\n\r\nConclusions\r\nThe application of clinical risk management tools made changes in pediatric intensive care units; the integrated use of different methodologies, both proactive and passive, for the management of clinical risk is highlighted in many studies.\r\n\r\nKey messages\r\nMethodologies for clinical risk management can have significant impacts on organizational processes and outcomes of pediatric intensive care units, improving safety of patient and operators.\r\n\r\nThe simultaneous use of several clinical risk management tools, both proactive and reactive, is increasingly widespread.