Chapter 154: Patient Safety

High-Yield Facts

• The science of patient safety has evolved over the past decade, leading to our current understanding of PS as a discipline that utilizes a systems approach to improving healthcare processes and outcomes.

• Medical errors and adverse events are most often the result of systems flaws, not character flaws, as demonstrated by the “Swiss cheese” model of organizational accidents developed by James Reasons.

• A culture of safety is characterized not as “blame-free,” but as a “culture of accountability” in which leaders support and encourage clinicians to make safe choices that can reduce the risk of harm to pediatric patients.

• Medication safety is a particular concern in the pediatric emergency care setting due to the hectic environment in the emergency department (ED), a lack of standard pediatric drug dosing and formulations, and the use of IT systems that frequently lack pediatric safety features.

• Reduction in harm requires the active involvement of leaders who make patient safety a priority, create a strategy and structure for improvement, and foster an environment of teamwork and mutual respect.

• Multidisciplinary, high-performing teams are essential for safe care of children in the ED.

• A growing body of evidence shows that effective teamwork and communication among healthcare providers are linked to better patient outcomes.

Introduction

“Patient safety” was at one time something that many patients and healthcare providers assumed. After all, no clinician comes to work to hurt anyone, and patients entrust their care to highly trained and dedicated healthcare professionals to provide the best care, and certainly to keep them safe. Yet over the past decade, we have gained a whole new understanding of the concept of “patient safety.” In November 1999, we learned from the IOM report, “To err is human,” that 44,000 to 98,000 people die from medical errors each year in this country.¹ In the ensuing years we learned that the scope of harm was even greater, and the definition of patient safety evolved from efforts to “prevent unintended harm” to a discipline that utilizes a systems approach to improving healthcare processes and outcomes.² The complexity of modern healthcare has surpassed the capability of any single provider and requires a shift from a focus on individual performance to the application of systems thinking, safety science, and teamwork.² In this chapter, we will describe a framework for providing safe and reliable care to children in the emergency department (ED) setting (Fig. 154-1).

Current State

Though emergency services personnel and ED providers are hardworking and well intended, they sometimes lack the training, tools and resources required to provide safe, high-quality care to children in the emergency setting.³ This problem was described two decades ago in a 1993 report published by the Institute of Medicine (IOM), ...