6637 How do families mitigate paediatric safety incidents in emergency departments? A multi-method national analysis of incident reports

Objectives Healthcare-associated harm is an international public health issue.1 Children are a particularly vulnerable group, with 15%–35% of hospitalised children experiencing harm whilst receiving medical care.2Whilst many factors increase the risk of adverse events, such as a child's dependency on others to recognise and respond to illness, children have a unique protective factor in the form of their parents (guardians and families), who are well placed to detect and prevent unsafe care. Martha's Rule highlights the need to more effectively enable parents to function as safety advocates.3 We aimed to characterise the role of parents in mitigating patient safety incidents involving children within Emergency Departments.4 Methods Free text of patient safety incident reports submitted from Emergency Departments in England and Wales between 2014–2020 to the National Reporting Learning System (now the Learning from Patient Safety Events Service) were searched for terms like *parent*, *dad*, and *mother*. We were provided with 12,300 reported and created a weighted sample of 4000 reports.4 Two trained paediatricians and a general practitioner reviewed reports which were included for analysis if there was clear evidence in the narrative of parental involvement directly related to the reported incident. Reports were systematically coded using the Patient Safety (PISA) classification system.5 An inductive thematic analysis in NVivo informed the development of a mitigatory factor framework. An exploratory descriptive analysis identified the most frequent semantic relationships between type of incident, mitigating factors, and harm outcomes. Results A total of 1065 (27%) reports were included for analysis. Parents were involved in mitigating incidents in over two thirds of reports (714, 67%). The most common mitigatory factors included: 'family advocates for child', 'parent expresses concern about care given', and 'family chases healthcare appointment'. The most frequent incidents with parental mitigatory factors related to diagnosis and assessment (157, 22%), e.g., a missed diagnosis, medication (150, 21%), e.g., wrong medication prescribed, and treatment (89, 13%), e.g., insufficient treatment given. In 229 (32%) of these reports, parents prevented harm or further harm. Conclusion Parents play a key role in preventing safety incidents and harms when their children receive healthcare in Emergency Departments. Identification of mitigation factors within incident report narratives will support health systems to identify where they should investigate further or intervene to improve safety. Our analysis has identified priority areas to enable the co-development of recommendations and strategies to deliver safer paediatric care and support parents as child safety advocates. References Global Patient Safety Action Plan 2021–2030. World Health Organization, 2021. Walsh, et al. Preventing health care-associated harm in children. JAMA, 2014 NHS to introduce Martha's rule for hospital patients. BBC News, 2023. Rees, et al. Family role in paediatric safety incidents: a retrospective study protocol. BMJ Open, 2023. Carson-Stevens. A cross-sectional mixed methods study protocol to generate learning from patient safety incidents reported from general practice. BMJ Open, 2015.