Implementation of or upgrades to new electronic health records (EHR) is a complex process which sometimes results in unforeseen negative consequences. This study examines hospital-acquired conditions (HACs) and care bundle compliance rates at 27 pediatric hospitals before, during, and after implementation or upgrade of EHR systems. Contrary to previous studies, no significant differences were found in either HAC or bundle compliance rates.

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.

Achieving high reliability is an ongoing goal for health care. This survey of 25 pediatric organizations participating in a patient safety collaborative identified an inverse association between safety culture and patient harm, but found that elements of high-reliability, leadership, and process improvement were not associated with reduced patient harm.

Prior research has found that perceptions about safety climate varies across neonatal intensive care units (NICUs). This large cross-sectional study examining the impact of caregiver perceptions of safety climate on clinical outcomes found that stronger safety climates were associated with lower risk of healthcare-associated infections, but climate did not affect mortality rates.

… J Patient Saf … J Patient Saf … Prior research has shown that health care …

… Jt Comm J Qual Patient Saf … Jt Comm J Qual Patient Saf … High reliability industries such as … Randall KH, Slovensky D, Weech-Maldonado R, Patrician PA, Sharek PJ. Self-Reported Adherence to High Reliability …

… Commission journal on quality and patient safety … Jt Comm J Qual Patient Saf … Surgical time outs are a required …

This study used a trigger tool (the Global Assessment of Pediatric Patient Safety) to examine temporal trends in adverse event rates at 16 randomly selected children's hospitals. Adverse event rates did not significantly change at either teaching or nonteaching hospitals from 2007 to 2012. Interestingly, nonteaching hospitals had lower error rates than teaching facilities, although the increased complexity of patients at teaching hospitals may account for this finding. The results of this study mirror those of a similar study conducted in adult hospitals from 2002 to 2007. An accompanying editorial notes that quality improvement collaboratives have achieved reductions in hospital-acquired conditions at children's hospitals and speculates that these discordant findings could be due to the fact that trigger tools are able to detect a broader range of adverse events and thus may provide a more accurate picture of safety. A WebM&M commentary discussed a preventable medication error at a children's hospital.

The Centers for Medicare and Medicaid Services (CMS) has successfully reduced preventable harm from hospital-acquired conditions (HACs) through financial penalties to hospitals. Hospitals nationwide have invested substantial resources in reducing the HACs on the CMS nonpayment list, raising concern about whether institutions may be neglecting other types of preventable harm. Researchers used an all-cause harm trigger tool to assess what proportion of harms that occurred at six children's hospitals were HACs versus harms excluded from the CMS list. Only 58 of 240 harms were considered HACs. Some common harms identified outside the scope of HACs were intravenous catheter infiltration, surgical complications, and pain. Prior WebM&M commentaries have discussed harms from hospital-acquired infections as well as the unintended consequences of public hospital quality reporting.

Researchers surveyed pediatric cardiac intensive care unit providers across three tertiary cardiac centers in the United States. More than 80% of respondents perceived diagnostic errors to be common and 65% reported errors causing permanent harm to patients. Improving feedback and teamwork were frequently suggested as strategies for reducing diagnostic error.

Improving patient safety often involves multifaceted interventions intended to change complex workflows. This prospective cohort study examined whether a collaborative improvement initiative across 33 pediatric hospitals could augment patient safety. Hospitals volunteered to be part of the collaborative and paid an annual fee to participate. All but one submitted their safety data for inclusion in the study. The intervention involved identification and dissemination of evidence-based practices to reduce hospital-acquired conditions and prevent serious adverse events. Each hospital implemented these best practices locally according to their preferences. The collaborative provided virtual and in-person training for patient safety processes, such as unit-based safety rounds, root cause analysis, and inclusion of patients and families on hospital committees. Rates of hospital-acquired conditions and serious adverse events declined over time during the 3-year study. Because there were no concurrent control hospitals, it is not clear whether these improvements can be attributed to the intervention. The authors conclude that participation in a learning collaborative can enhance patient safety.

… Journal of patient safety … J Patient Saf … Detecting  and measuring patient safety …

Health care organizations measure safety climate by surveying providers and staff at all levels. Investigators assessed safety culture and teamwork in 44 neonatal intensive care units using two different survey tools—the Safety Attitudes Questionnaire and the Hospital Survey on Patient Safety Culture. They found significant variation in safety and teamwork climate scales of both tools, indicating that the instruments should not be used interchangeably.

… Commission journal on quality and patient safety … Jt Comm J Qual Patient Saf … Checklists and debriefing improve …

… Jt Comm J Qual Patient Saf … Jt Comm J Qual Patient Saf … This implementation study examined …

Trigger tools are a widely used method for detecting safety hazards in hospitalized patients. However, there is limited literature on using trigger tools in pediatric patients, as most existing tools were developed in adult patient populations. This study reports on the development and refinement of a novel trigger tool for hospitalized children. In testing at academic and community hospitals, the tool was found to accurately identify adverse events. Although other studies have raised concerns about the interrater reliability of trigger tools, in this study, agreement between reviewers regarding the presence of an adverse event improved with increased experience with the tool. The authors state that the tool can be used for measurement purposes, allowing institutions to track their performance over time and compare rates of safety events across institutions.

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.

… Commission journal on quality and patient safety … Jt Comm J Qual Patient Saf … This before-and-after study demonstrated …

Discontinuity between providers is a well-known source of errors, with problems arising from handoffs and signouts both in hospital and at hospital discharge. This quality improvement initiative aimed to enhance handoffs in 23 children's hospitals over a 12-month period. Following introduction of a structured handoff tool, handoff-related care failures declined and provider satisfaction with handoffs increased. Handoff-related care failures were defined as insufficient information transfer that affected the patient, such as reporting inaccurate test results or miscommunication that led to duplicated medications. This study is the largest to date of a standardized handoff approach, and these results are consistent with prior smaller studies. A past AHRQ WebM&M commentary describes pitfalls of handoffs.

Leadership WalkRounds, in which senior leadership visits directly with frontline staff on their clinical units with the goal of identifying and addressing safety concerns, has shown potential as a means of improving safety culture. However, initial enthusiasm for this approach has been tempered by a recent qualitative study and a randomized trial—both showed that walkrounds had little effect on safety culture. Conducted in 44 neonatal intensive care units, this cross-sectional study found that units who received feedback from walkrounds had lower rates of burnout and more positive perceptions of safety culture. The results of this investigation may help explain why walkrounds were not associated with improvements in other studies—when walkrounds are performed in a perfunctory fashion or when senior leadership does not systematically follow up on issues identified, frontline workers may become cynical and perceptions of safety culture may actually worsen.