Design and development of a risk map for improving patient safety in pediatric emergency departments

INTRODUCTION: Emergency departments are critical settings for patient safety. Risk mapping is a proactive tool for risk management. OBJECTIVE: To develop a risk map for pediatric emergency care within the Spanish Society of Pediatric Emergency Medicine (SEUP). METHODS: Study conducted between November 2021 and May 2023 in four phases: (1) Design: Four pediatricians with expertise in care quality and patient safety created an initial map, defining processes and identifying failure modes, effects, and contributory factors. (2) Consensus: Forty-one consultants from 22 hospitals refined the map using the Delphi method, resulting in the final version. (3) Validation: assessment of the frequency, severity, and detectability of each failure mode (scored from 1 to 5). (4) Final design: three versions of the risk map were defined following calculation of risk profile numbers (RPNs): complete risk map, recommended map (risks with RPN > 50th percentile), and core map (risks with RPN > 90th percentile). RESULTS: The group identified 8 processes and 104 failure modes. The median RPN in the complete risk map was 18, with a 90th percentile of 33.4. The recommended map included 45 failure modes and the core map 13. The most frequent contributory factors were related to the work environment and the characteristics of the staff and the task. CONCLUSIONS: The risk map is a valuable tool that can facilitate the implementation of proactive risk management models. Identifying contributory factors helps prioritize strategies to enhance patient safety.