Pediatric Care, Safety, and Standardization
Part of the
book series (HI)
The Institute of Medicine (IOM) defines patient safety as “freedom from accidental injury due to medical care, or medical errors,” and promotes the establishment of systems and processes to improve the reliability of patient care as one route to making health care safer.1 In his recent book, Patient Safety, Charles Vincent offers two different approaches to achieving this aim, each founded in a distinct “vision of safety.”2 One vision highlights the expertise and skills that providers regularly channel into creating safe patient care, and promotes the adoption of new and enhanced skills such as teamwork training and mindfulness as keys to improving patient safety. The other vision recognizes the fallibility of human beings, and seeks to improve safety by replacing or supporting the health care provider using technical and procedural interventions such as standardization, guidelines, and information technology. The important role of information technology was underscored in the IOM's report, “Crossing the Quality Chasm.”3 Standardization of practice patterns is one aspect of clinical care that is very amenable to the use of informatics.4 By reducing process variability, standardization can potentially reduce errors and make outcomes more predictable, thereby improving care processes. In this chapter we will explore various strategies currently being used to standardize care, and their impact on patient safety.
KeywordsBlood Stream Infection Care Bundle Safe Patient Care Central Line Bundle Serum Gentamicin Level
Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System
. Washington, DC: National Academy Press; 2000.Google Scholar
Vincent C. Patient Safety
. Toronto: Elsevier Churchill Livingston; 2006.Google Scholar
Institute of Medicine. Crossing the Quality Chasm
. Washington, DC: National Academy Press; 2000.Google Scholar
Bakken S, Cimino JJ, Hripcsak G. Promoting patient safety and enabling evidence-based practice through informatics. Med Care
Smith H. A model for validating an expert's opinion in medical negligence cases. J Leg Med. 2005;26:207–231.PubMedCrossRefGoogle Scholar
Field MJ, Lohr KN eds. Guidelines for Clinical Practice: From Developments to Use
. Washington, DC: Institute of Medicine, National Academy Press; 1992.Google Scholar
U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. Depression Guideline Panel. Depression in Primary Care: Volume 1. Detection and Diagnosis. Clinical Practice Guideline 5
. Publication AHCPR 93-0550; 1993.Google Scholar
Andrews EJ, Redmond HP. A review of clinical guidelines. Br J Surg
. 2004;100:956–964.CrossRefGoogle Scholar
Woolf SH. Practice guidelines: a new reality in medicine. I. Recent Dev Arch Intern Med.
Homer CJ, Lannon CM, Harbaugh N, et al. Classifying recommendations for clinical practice guidelines. Pediatrics
. 2004;114:874–877.CrossRefGoogle Scholar
Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet
. 1993;342:1317–1322.PubMedCrossRefGoogle Scholar
Odwazny R, Hasler S, Abrams R, McNutt R. Organizational and cultural changes for providing safe patient care. Q Manage Health Care
. 2005;14:132–143.Google Scholar
Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA
. 1999;282:1458–1465.PubMedCrossRefGoogle Scholar
Christakis DA, Rivara FP. Pediatricians' awareness of and attitudes about four clinical practice guidelines. Pediatrics
. 1998;101(5):825–830.PubMedCrossRefGoogle Scholar
Cohen AL, Rivara FP, Davis R, Christakis DA. Compliance with guidelines for the medical care of first urinary tract infections in infants: a population-based study. Pediatrics
. 2005;115(6):1474–1478.PubMedCrossRefGoogle Scholar
Glickman SW, Ou FS, DeLong ER, et al. Pay for performance, quality of care, and outcomes in acute myocardial infarction. JAMA
. 2007;297(21):2373–2380.PubMedCrossRefGoogle Scholar
Walter LC, Davidowitz NP, Heineken PA, Covinsky KE. Pitfalls of converting practice guidelines into quality measures. Lessons learned from a VA performance measure. JAMA
. 2004;291:2466–2470.PubMedCrossRefGoogle Scholar
The McDonnell Norms Group. Enhancing the use of clinical guidelines: the social norms perspective. J Am Coll Surg
. 2006;202:826–836.CrossRefGoogle Scholar
Chin HL, Wallace P. Embedding guidelines into direct physician order entry: simple methods, powerful results. Proc AMIA Symp
. 1999;221–225.Google Scholar
Asaro P V, Sheldahl AL, Char DM. Embedded guideline information without patient specificity in a commercial emergency department computerized order-entry system. Acad Emerg Med.
Green G, Defoe EC Jr. What is a clinical algorithm? Clin Pediatr (Phila)
. 1978;17:457–463.CrossRefGoogle Scholar
Margolis CZ. Uses of clinical algorithms. JAMA
. 1983;249(5):627–632.PubMedCrossRefGoogle Scholar
Margolis CZ, Warshawsky SS, Goldman L, Dagan O, Wirtschafter D, Pliskin JS. Computerized algorithms and pediatricians' management of common problems in a community clinic. Acad Med.
Fischer MA, Lilly CM, Churchill WW, Baden LR, Avorn J. An algorithmic computerized order entry approach to assist in the prescribing of new therapeutic agents. Case study of activated protein C at an academic medical center. Drug Saf.
Neidig JR, Megel ME, Koehler KM. The critical path: an evaluation of nursing case management in the NICU. Nursing Manage
. 1992;11:45–52.Google Scholar
Chu S, Cesnik B. Improving clinical pathway design: lessons learned from a computerized prototype. Int J Med Inform.
The Joint Commission. Raising the bar with bundles: treating patients with an all-or-nothing standard. Jt Comm Perspect Patient Saf.
Department of Health, London. Comprehensive Critical Care; A Review of Adult Critical Care Services
; 1999.Google Scholar
Institute for Healthcare Improvement. Bundle Up for Safety; 2004. Available at: http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/ImprovementStories/BundleUpforSafety.htm
. Accessed December 20, 2008.
Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf.
Fulbrook P, Mooney S. Care bundles in critical care: a practical approach to evidence-based practice. Nurs Crit Care.
Crunden E, Boyce C, Woodman H, Bray B. An evaluation of the impact of the ventilator care bundle. Nurs Crit Care.
Levy MM, Pronovost PJ, Dellinger RP, et al. Sepsis change bundles: converting guidelines into meaningful change in behavior and clinical outcome. Crit Care Med.
2004;32(11 Suppl):S595–S597.PubMedCrossRefGoogle Scholar
Institute for Healthcare Improvement. Pursuing Perfection: Report from HealthPartners' Regions Hospital on Reducing Hospital-Acquired Infection: Ventilator-Associated Pneumonia and Catheter-Related Bloodstream Infection; 2004. Available at: http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare
/ImprovementStories/PursuingPerfection ReportfromHealthPartnersonReducingVAPCRBSI.htm. Accessed December 20, 2008.
Edson BS, Williams MC. 100,000 lives campaign and the application to children. JSPN
. 2006;11:138–142.PubMedGoogle Scholar
Pediatric Affinity Group. How to Guide Pediatric Supplement: Central Line Associated Infection; 2002. Available at: http://www.childrenshospitals.net
/AM/Template.cfm?Section= Homepage&Template=/CM/ContentDisplay.cfmContentFileID=2358. Accessed December 20, 2008.
Nolan T, Berwick DM. All-or-none measurement raises the bar on performance. JAMA
. 2006;295(10):1168–1170.PubMedCrossRefGoogle Scholar
Degani A. (1990) Human Factors of Flight-Deck Checklists: The Normal Checklist
. Ames Research Center, National Aeronautics and Space Administration.Google Scholar
Horwitz LI, Kosiborod M, Lin Z, Krumholz HM. Changes in outcomes for internal medicine inpatients after work-hour regulations. Ann Intern Med.
Beckmann U, Gillies DM, Berenholtz SM, Wu AW, Pronovost P. Incidents relating to the intra-hospital transfer of critically ill patients: an analysis of the reports submitted to the Australian Incident Monitoring Study in Intensive Care. Intensive Care Med.
2004;30:8, 1579–1585.PubMedCrossRefGoogle Scholar
Streitenberger K, Matlow A. Check and Cross-Check: Using a Standardized Checklist to Reduce Adverse Events During Patient Transfer
. National Initiative for Child Health Quality (NICHQ) 4th Annual Meeting. San Diego, CA.Google Scholar
Berenholtz SM, Pronovost PJ, Lipsett PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med.
Wall RJ, Ely EW, Elasy TA, et al. Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit. Qual Saf Health Care
. 2005;14(4):295–302.PubMedCrossRefGoogle Scholar
Rall M, Dieckmann P. Safety culture and crisis resource management in airway management: general principles to enhance patient safety in critical airway situations. Best Pract Res Clin Anaesthesiol
. 2005;19(4):539–557.PubMedCrossRefGoogle Scholar
Lingard L, Espin S, Rubin B, et al. Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR. Qual Saf Health Care.
Kingdon B, Newman K. Determining patient discharge criteria in an outpatient surgery setting. AORN J
. 2006;83(4):898–904.PubMedCrossRefGoogle Scholar
Hart EM, Owen H. Errors and omissions in anesthesia: a pilot study using a pilot's checklist. Anesth Analg
. 2005;101(1):246–250.PubMedCrossRefGoogle Scholar
Schwarz SK. Can items on an aviation-style checklist for preparation of cesarean delivery under general anesthesia present a threat for patient safety? Anesth Analg
. 2006;102(3):970.PubMedCrossRefGoogle Scholar
Chassin MR. Is health care ready for Six Sigma quality? Milbank Q
. 1998;76(4):565–591.PubMedCrossRefGoogle Scholar
George ML. Lean Six Sigma: Combining Six Sigma Quality with Lean Speed
. New York: McGraw Hill.Google Scholar
Eldridge NE, Woods SS, Bonello RS, et al. Using the six sigma process to implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in four intensive care units. J Gen Intern Med.
2006;21(Suppl 2):S35–S42.PubMedCrossRefGoogle Scholar
Frankel HL, Crede WB, Topal JE, Roumanis SA, Devlin MW, Foley AB. Use of corporate Six Sigma performance-improvement strategies to reduce incidence of catheter-related bloodstream infections in a surgical ICU. J Am Coll Surg
. 2005;201(3):349–358.PubMedCrossRefGoogle Scholar
Resar RK. Making noncatastrophic health care processes reliable: learning to walk before running in creating high-reliability organizations. Health Serv Res.
2006;41(4 Pt 2):1677–1689.PubMedCrossRefGoogle Scholar
Muething SE, Kotagal U. Reliability of the health care delivery system. J Pediatr
. 2005;146:581–582.PubMedCrossRefGoogle Scholar
Amalberti R, Auroy Y, Berwick D, Barach P. Five system barriers to achieving ultrasafe health care. Ann Intern Med.
Render ML, Brungs S, Kotagal U, et al. Evidence-based practice to reduce central line infections. Jt Comm J Qual Patient Saf.
Drenckpohl D, Bowers L, Cooper H. Use of the six sigma methodology to reduce incidence of breast milk administration errors in the NICU. Neonatal Netw.
Nolan T, Resar R, Haraden C, Griffin FA. Improving the reliability of health care. Institute for Healthcare Improvement; 2004. Available at: http://www.ihi.org/NR/rdonlyres/7BD559B7-11A0-4BA5-ABDE-BF10003788F1/0/ReliabilityWhitePaper2004revJune06.pdf
. Accessed December 20, 2008.
Hyams AL, Brandenburg JA, Lipsitz SR, Shapiro DW, Brennan TA. Practice guidelines and malpractice litigation: a two-way street. Ann Int Med.
McDonagh RJ, Lavis JN, Sharpe G. Clinical practice guidelines as explicit standards of care: medico-legal considerations. Ann RCPSC
. 2002;35: 9–12.Google Scholar
Hurwitz B. How does evidence based guidance influence determinations of medical negligence? BMJ
. 2004;329:1024–1028.PubMedCrossRefGoogle Scholar
Biondich PG, Downs SM, Carroll AE, Shiffman RN, McDonald CJ. Collaboration between the medical informatics community and guideline authors: fostering HIT standard development that matters. AMIA Annu Symp Proc.
© Springer Science+Business Media, LLC 2009