Is your hospital safe for children? Applying home safety principles to the hospital setting.

Objectives: To review the risks of injury to children in the hospital setting and to provide an overview of the factors which influence the approach to hospital safety, including institutional liability, hospital accreditation, patient safety and risk management issues.

Methods: Fatal and nonfatal injuries to children in the hospital setting were identified using searches of the published literature and searches of incident, complaint and claims data sources, including regulatory agency databases, litigation and claims data, and medical device hazard databases. Canadian hospital law, accreditation, patient safety and risk management literature was reviewed and summarized.

Results: Injuries occur in over 1% of hospitalized children, and are typically due to falls. Serious injuries are infrequent; however, a significant number of fatal injuries have been reported, mostly involving entrapment in beds and cribs, but also due to choking, strangulation and electrocution. Hospitals are liable for injuries to patients and visitors occurring on their premises. Canadian accreditation standards include provisions for the safety of equipment, supplies, medical devices and space, but do not provide specific guidance for children. Addressing injury hazards to children is an important aspect of the new patient safety movement, and falls within the scope of existing risk management and quality improvement programs.

Conclusions: Most hazards to children in the hospital setting can be easily corrected by proactively incorporating basic child safety principles. Paediatricians can play an important role in advocating for a safe hospital environment and should encourage administrators to consider child safety in routine hospital operation and policies.