The Partnership for Patients (P4P) program launched hospital engagement networks (HEN) in 2011 to reduce hospital-acquired harms. This study reports on the outcomes of eight conditions from one HEN, Children's Hospitals' Solutions for Patient Safety (SPS). While the results do show a reduction in harms, the authors state earlier claims of improvement may have been overstated due to failure to not adjust for secular improvements. The co-director of Partnership for Patients, Dr. Paul McGann, was interviewed in 2016 for a PSNet perspective.

Heuristics provide cognitive shortcuts in the face of complex situations, and thus serve an important purpose. This survey of pediatricians found that identification of diagnostic heuristics was limited. Most respondents expressed discomfort discussing diagnostic errors in public settings, citing fear regarding loss of reputation.

The Centers for Medicare and Medicaid Services no longer reimburses hospitals for certain hospital-acquired conditions—an increasingly recognized source of preventable harm to patients. Researchers describe how they were able to reduce harm resulting from hospital-acquired conditions at their institution by more than 30% through improved use of electronic health record data and reporting tools.

Trigger tools are widely used as a means of detecting adverse events, but most of the existing triggers were developed and validated in adult populations. This study reports on the validation of a trigger tool for hospitalized pediatric patients, based on the Institute for Healthcare Improvement's Global Trigger Tool. In a retrospective chart review across six academic children's hospitals, the tool identified harm in 40% of admissions—a proportion comparable to a similar study in adult inpatients. Nearly half of these incidents were considered preventable. Other studies using slightly different pediatric trigger tools have found a lower incidence of adverse events. The use of trigger tools was discussed in a previous AHRQ WebM&M perspective.

A standardized handoff protocol for cardiac surgery patients between the operating room and intensive care unit led to decreases in unplanned extubations and the amount of time spent on ventilators.

This study implemented an order verification screen, including the patient's photograph, to reduce the risk that orders will be placed in an unintended patient's electronic health record. In a limited analysis, it appeared to be effective.

This study describes the development of a pediatric safety and quality program across two academic medical center campuses. The authors describe the challenges they faced as well as important improvements that can be fostered through a shared set of goals and committed leadership.