Medical errors are a concern across the economic spectrum worldwide. This commentary describes an educational effort to develop champions to lead patient safety, quality improvement, and infection control initiatives in health systems in low- and middle-income countries. The authors highlight the importance of contextualizing training to consider local needs and resources.

Improving safety culture is an organizational challenge. This quality improvement study describes a partnership in which a large privately owned group of hospitals, postacute facilities, and outpatient clinics partnered with an academic health system to enhance safety culture and metrics. The program included an assessment of the quality at each site followed by an individual improvement plan. Each site embarked on a multimodal intervention that included leadership engagement, team training, audit and feedback, and traditional quality improvement strategies such as Plan–Do–Study–Act cycles. The authors report significant improvements across measures of patient safety such as health care–associated infections and readmissions.

Emergency departments harbor conditions that can hinder safe medication administration for pediatric patients. This policy statement identifies and prioritizes improvements such as implementing kilogram-only weight-based dosing, involving pharmacists in frontline emergency care, and utilizing computerized provider order entry and clinical decision support systems.

Handoff improvement is a national patient safety priority, and residency programs are required to provide formal training in signouts. In this study, a simulation-based educational intervention for teaching handoffs to pediatric residents did not result in enhanced perception of handoff quality or improvement in clinical outcomes.

This pre-post study found improvements in safety culture, as measured by the Safety Attitudes Questionnaire, following the implementation of AHRQ's TeamSTEPPS tools. These findings add to the body of research supporting teamwork training as a way to enhance safety.

This review identifies technological advances in diagnostic imaging and outlines concerns that must be addressed to ensure safe radiation dosing.

A nurse-led comprehensive unit-based safety program identified numerous important safety issues in an intensive care unit. Executive walkrounds helped overcome barriers to address these problems.

Executive walkrounds are widely used for improving safety culture, but their effect on specific patient safety attitudes and outcomes is not well established. This retrospective study found that leadership walkrounds participation was strongly associated with positive safety climates and greater risk reductions. While the application of leadership walkrounds varies widely from institution to institution, this multicenter study used a standardized strategy that included monthly hospital executive visits and scripted, open-ended questions meant to engage staff in patient safety discussions. An AHRQ WebM&M perspective discussed the importance of involving hospital leadership with safety and quality.

The Josie King Care Journal is a tool intended to improve communication between the health care team and families of hospitalized children. This study reports on the implementation of the journal in a pediatric intensive care unit. Use of the tool was associated with perceived improvements in communication by both clinicians and parents.

Reviewing evidence on transitions in care, this article describes how one university health system developed a comprehensive handoff curriculum to address educational needs in the context of changes to resident duty hours.

Some hospitals have begun allowing patients and families to directly summon a rapid response team. This implementation study reports on the training process for establishing a family-activated rapid response team at a children's hospital.

Use of a computerized interactive algorithm significantly improved residents' ability to correctly manage simulated cases of anaphylactic shock.

This policy statement provides context regarding medical errors in pediatric emergency care and offers recommendations to support patient safety improvements in this setting.

This study developed a simulation model in the radiology environment and identified the need for greater resuscitation aids to treat unexpected clinical events. A past AHRQ WebM&M commentary discussed the role of simulation as a method to practice both behavioral and technical skills.

The authors describe the implementation of a safety program to instill a culture of safety following a high-profile sentinel event.

… the tools and resources that supported that work. … Alton M; Frush K; Brandon D; Mericle J. …

The authors describe the creation and implementation of a system-wide educational and awareness program to support the development of a culture of safety.

… improved dosing accuracy and administration time. … Frush K, Hohenhaus S, Luo X, Gerardi M, Wiebe RA. Evaluation …