Quality improvement in pediatric care

Abstract

We often overlook the importance of several safety issues such as identification of patients, timeout procedure, hand hygiene, handoff communication, and many others. This ignorance, along with many other issues, leads to medical error being ranked as a third leading cause of death in the U.S. Consequently, quality improvement (QI) has become one of the major subjects in healthcare despite a relatively short history. Improving quality is about making healthcare safe, effective, patient-centered, timely, efficient, and equitable. Understanding the need and methodology of QI as well as participation is now essential for physicians. Although basic QI methodology has not changed, one of the most fascinating changes in recent QI is conducting large-scale QI projects through multicenter networks. Prospective multicenter QI projects utilizing the Korean Neonatal Network are a substantial initiation of pediatric QI in Korea. The Korean Pediatric Society should set ambitious goals for QI activities for every primary care pediatrician and pediatric subspecialist.

Fig.1 Swiss Cheese Model of accident causation.

Fig.2 Plan-Do-Check-Act cycle: the wheel of continuous improvement.

References

1. Reddy GK, Brown B, Nanda A. Fatal consequences of a simple mistake: how can a patient be saved from inadvertent intrathecal vincristine? Clin Neurol Neurosurg 2011;113:68–71.

2. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 1991;324:370–376.

3. Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press, 2000.

4. Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ 2016;353:i2139.

9. Piazza AJ, Brozanski B, Provost L, Grover TR, Chuo J, Smith JR, et al. SLUG Bug: quality improvement with orchestrated testing leads to NICU CLABSI reduction. Pediatrics 2016;1;137(1): [Epub].

10. Chinnadurai K, Fenlason L, Bridges B, Espahbodi M, Chinnadurai S, Blood-Siegfried J. Implementation of a sustainable ventilator-associated pneumonia prevention protocol in a Pediatric Intensive Care Unit in Managua, Nicaragua. Dimens Crit Care Nurs 2016;35:323–331.

11. Patton LJ, Tidwell JD, Falder-Saeed KL, Young VB, Lewis BD, Binder JF. Ensuring safe transfer of pediatric patients: a quality improvement project to standardize handoff communication. J Pediatr Nurs 2017;34:44–52.

12. Tham E, Calmes HM, Poppy A, Eliades AB, Schlafly SM, Namtu KC, et al. Sustaining and spreading the reduction of adverse drug events in a multicenter collaborative. Pediatrics 2011;128:e438–e445.

13. Lannon CM, Peterson LE. Pediatric collaborative improvement networks: background and overview. Pediatrics 2013;131(Suppl 4): S189–S195.

14. Lannon CM, Peterson LE. Pediatric collaborative networks for quality improvement and research. Acad Pediatr 2013;13(6 Suppl): S69–S74.

15. Chang YS, Park HY, Park WS. The Korean Neonatal Network: an overview. J Korean Med Sci 2015;30(Suppl 1): S3–S11.