The unexpected arrival of a critically ill child at paediatric emergency departments: are we sufficiently prepared? An process risk analysis

Background: It is very rare that critically ill children are admitted to paediatric emergency departments without prior treatment from ambulance services. Thus, appropriate routine and standards in these settings might be lacking. The use of risk analysis methods-an already established tool in clinical risk management-might provide more assurance and confidence for staff by analysing process risks and offering appropriate preventive measures. Methods: A clinical case study-the hospital admission of a critically ill child without prior notice-will be used to introduce risk analysis as a method of clinical risk management. Subdividing processes into smaller sections will allow for the creation of risk profiles which can be used to further classify risks according to their probability of occurrence or their severity. This will help to find the most urgent preventive measures for process optimisation. Conclusion: Risk assessment of clinical processes can help to detect covert risks in hospital settings. Moreover, it is a very reliable tool for finding potential risk-reducing measures. For our case study we identified four main process risks: undertriage, no or inadequate diagnostics, medication errors and selection of incorrect devices, insufficient infrastructure and lack of interdisciplinary treatment. Finally, we ascertained specific preventive measures for our case and assessed necessary resources.