Home care incidents affect nearly 12% of children with medical complexity, national analysis finds
· Medical Xpressby Ann & Robert H. Lurie Children's Hospital of Chicago
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More than one in 10 children with medical complexity had an incident reported by home care agency staff, according to a multi-state study recently published in JAMA Network Open. Half of reported events were safety related and a quarter caused harm to the child.
Why complex home care is risky
"Children with medical complexity often require complicated home care regimens, such as gastrostomy tubes and invasive ventilation, but we have not really known how often health care safety issues might be happening at home, which makes it hard to track and make improvements to this type of care," said lead author Carolyn Foster.
"Our study is a first step toward tracking safety event rates so that we can start identifying patterns and then develop interventions to prevent their occurrence."
Children with medical complexity are a growing population of medically fragile patients (~3 million) with multisystem conditions who receive long-term care at home. They increasingly require administration of dozens of medications and rely on implanted devices that need frequent adjustment and maintenance for life-sustaining treatment. These children can also have functional impairments that place them at risk for falls and bed sores.
What the multi-state study found
Dr. Foster and colleagues analyzed data from staff incident reports from a national pediatric home health care agency with sites in 11 American states. The study included 2,901 patients under 21 years of age, who received home care from September 2022 to September 2023. Six hundred and eighty-seven incident reports were filed for nearly 12% of children.
Researchers found that errors most often involved medications (38.8%) and implanted devices (32.7%). Harmful errors were most frequently related to non-pressure skin injuries (26.8%) and falls (17.9%). About half of all errors (47.8%) required additional monitoring and 16.2% required emergency care.
Which children face highest risks
In the study, children with the highest level of medical complexity who received nursing-level care were more likely to have a patient safety event. Children with invasive home ventilation were particularly susceptible to safety events, compared to children with other types of implanted medical technology.
"Our findings call for targeted interventions to keep these highly vulnerable children safe," said Dr. Foster. "We also need to integrate family caregivers into reporting events and involve them in developing interventions to improve safety as the leaders, if you will, within the home itself. At the policy level, children need to be included in national reporting of home care events to ensure accountability and detailed training standards for pediatric nursing is happening for children just like with adults."
Publication details
Carolyn C. Foster et al, Patient Safety Events Among Children Receiving Home Health Care, JAMA Network Open (2026). DOI: 10.1001/jamanetworkopen.2026.10321
Journal information: JAMA Network Open
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PediatricsChildren's healthAllied healthCommon illnesses & Prevention Provided by Ann & Robert H. Lurie Children's Hospital of Chicago Who's behind this story?
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