More than 1 in 10 children with complex medical conditions experience an incident reported by home health agency staff, according to a recently published multi-state study. JAMA network open. Half of the reported incidents involved safety and a quarter involved harm to children.
Children with complex medical conditions often require complex home care plans, such as gastrostomy tubes or invasive mechanical ventilation, but we don’t really know how often medical safety issues occur in the home, making it difficult to track and improve this type of care. Our research is a first step in tracking the incidence of safety events so we can begin to identify patterns and develop interventions to prevent their occurrence. ”
Carolyn Foster, MD, MSc; Lead author, Director of the Health@Home Initiative at the Stanley Mann Children’s Research Institute at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine
Children with complex medical conditions represent a growing population of medically fragile patients (approximately 3 million) with multisystem disease who receive long-term care at home. They increasingly require the administration of dozens of drugs and rely on implantable devices that require frequent adjustments and maintenance for life-sustaining treatments. These children may also have functional impairments that put them at risk for falls and pressure sores.
Dr. Foster and colleagues analyzed data on staff incident reports from a national pediatric home health agency based in 11 states in the United States. The study included 2,901 patients under the age of 21 who received home care from September 2022 to September 2023. 687 incident reports were filed for nearly 12% of children.
The researchers found that most of the errors involved medications (38.8%) and implantable devices (32.7%). Harmful errors were most often related to non-compressive skin injuries (26.8%) and falls (17.9%). Approximately half (47.8%) of all errors required additional monitoring and 16.2% required emergency treatment.
In this study, children with the highest medical complexity and who received nursing-level care were more likely to experience patient safety events. Children using invasive home ventilation were particularly susceptible to safety events compared to children using other types of implantable medical technology.
“Our findings call for targeted interventions to keep these highly vulnerable children safe,” Dr. Foster said. “We also need to include family caregivers in event reporting and, as leaders in the home, participate in the development of interventions to improve safety. At a policy level, children need to be included in national reporting of home care events to ensure that the same accountability and detailed training standards in pediatric nursing are met for children as for adults.”
This study was conducted under the Patient Safety Learning Lab, funded by Grant Number 1R18HS029638-01 from the Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services (HHS). The Learning Lab brought together experts from Lurie Children’s Hospital, Vanderbilt University Medical Center, Boston Children’s Hospital, and various home care agencies and families to use a systems-level approach to caring for children in the home.
Dr. Foster is a Yeager Family Research Scholar at Lurie Children’s Center.
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Ann & Robert H. Lurie Children’s Hospital of Chicago
Reference magazines:
Foster, C.C.; others. (2026). Patient safety incidents for children receiving home health care. JAMA network open. DOI: 10.1001/jamanetworkopen.2026.10321. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2848562
