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. 2019 Sep 23;4(5):e220.
doi: 10.1097/pq9.0000000000000220. eCollection Sep-Oct 2019.

Using a Second Stakeholder-Driven Variance Reporting System Improves Pediatric Perioperative Safety

Free PMC article

Using a Second Stakeholder-Driven Variance Reporting System Improves Pediatric Perioperative Safety

Akemi L Kawaguchi et al. Pediatr Qual Saf. .
Free PMC article


Despite recognizing the occurrence of variances, we noted a low rate of reporting with the established computer variance program. Therefore, we developed and introduced a simple, handwritten variance reporting system. The goal of this study was to compare our pediatric perioperative handwritten variance cards to our established computerized variance reporting system.

Methods: We developed a handwritten variance card program through a stakeholder-driven quality-improvement initiative. We collected variances from handwritten cards in 4 perioperative locations and also from the established computerized variance system. We analyzed the variances and categorized them into 6 safety domains and 5 variance categories.

Results: Over 6 consecutive years, 3,434 variances were reported (687 computerized and 2,747 handwritten). For safety domains, the computerized system was more likely to capture adverse events and near-misses (8.7% vs. 1.1%, P < 0.001; 23.5% vs. 8.6%, P < 0.001, respectively) while the handwritten system was more likely to identify the safety process and other non-safety issues (20.1% vs. 38.3%, P < 0.001). Both systems addressed policy/process issues most often, with 37.9% of the handwritten cards and 66.6% of the computerized variance reports. Of the handwritten cards with a patient identifier (n = 1,407), only 5.1% (n = 72) also had a computerized variance filed about the same event. Thus, staff reported >1,300 additional variances that were not identified with the computerized variance system alone.

Conclusion: The handwritten, stakeholder-driven variance reporting system was essential to identify local and system issues that would not have been identified by the computerized variance reporting system alone.


Fig. 1.
Fig. 1.
Comparison of handwritten and electronic variances, with and without medical record numbers (MRN).
Fig. 2.
Fig. 2.
Comparison of types of handwritten and electronic variances.

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