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Making Quality and Safety a Priority in Health Care for Our Children

Posted By Administration, Thursday, January 26, 2017
Updated: Thursday, January 19, 2017

New journal seeks to disseminate results of pediatric quality and safety work 

The first to focus solely on improving the medical systems that care for our most precious resource: our infants and children.

by Richard J. Brilli, MD, FAAP, MCCM


Dr. Richard Brilli


When the first medical journal was published in the United States, doctors were still debating the merits of bloodletting, anesthesia was an emerging concept, and the stethoscope had not yet been invented. By today’s standards, of course, medicine back then was still very primitive and physicians relied more on instinct in their practices than on collective knowledge.

In January of 1812, that began to change. That month, the first issue of the New England Journal of Medicine was published, and in its opening paragraph, editor Dr. John Warren called on doctors to be “directed by a knowledge of preceding discoveries.” Instead of practicing medicine as individuals, the publication encouraged doctors to document their experiences and share that information.

It was a milestone in American medicine. Publishing their experiences allowed physicians and researchers to accumulate knowledge, step-by-step, across a vast array of conditions. Soon, other journals were founded that focused on specific diseases and conditions. Now, more than two centuries later, we take another small but important step along that journey.

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Last fall, I was privileged to help launch the journal Pediatric Quality and Safety. While most peer-reviewed medical journals since the early 19th century have focused on disease, this is the first to focus solely on improving the medical systems that care for our most precious resource: our infants and children. Quality improvement (QI) was once only a peripheral concern for many organizations, but the time has come to make it a priority in pediatrics.

Though QI science has been maturing over the past few decades, it became apparent to me, as chief medical officer at Nationwide Children’s Hospital, that the pediatric perspective is unique. The mechanisms and types of injuries and preventable harm that children suffer while being cared for in the hospital, such as surgical-site infections and adverse drug events, are often different from those seen in adult care.

In an effort to address those pediatric-specific issues, our team at Nationwide Children’s Hospital developed an initiative called Zero Hero. The idea was simple: we needed to not only lower the rate of preventable harm and injuries in the children we care for, we needed to strive for zero instances.

The idea caught on, and in 2009 all 8 children’s hospitals in Ohio joined together to form a collaborative called the Ohio Children’s Hospitals Solutions for Patient Safety. Together, we followed the lead of Dr. Warren, freely sharing information about our experiences and openly debating and establishing best practices. Within the first few years, using QI science methodology, we attained considerable success in lowering preventable harm rates.

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So successful were we that the concept has gone national. Today, more than 100 children’s hospitals across the country have joined our initiative, working to eliminate 10 hospital-acquired conditions, including adverse drug events, catheter-associated urinary tract infections, central line–associated bloodstream infections, pressure ulcers, and ventilator-associated pneumonia, among others.

Since 2012, through May of 2016, the Solutions for Patient Safety Collaborative has saved 6,686 children from serious, preventable harm, which has led to an estimated savings of more than $121 million dollars in medical costs. That’s an average of saving more than 4 children from harm and more than $76,000 in costs every day, with a consistent upward trend each month.

We still have work to do, which is where this new journal will play a key role. As children’s hospitals everywhere strive to develop and deliver quality, evidence-based care, the journal will provide a perfect vehicle for collaboration. We will be able to collect and concentrate data and information from all over the world in one place, where it can be freely shared, easily disseminated, and rigorously debated.

It was this approach that proved so effective for Dr. Warren more than 200 years ago, and it’s time we dedicate the same focused efforts to safe and quality care for our children.


Pediatric Quality and Safety (PQS) is an international, peer-reviewed, open-access, online periodical that publishes results of quality improvement and patient safety initiatives that impact the lives of children. For details about submitting a manuscript visit the website.


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Richard J. Brilli, MD, FAAP, MCCM, is co-editor-in-chief of the journal Pediatric Quality and Safety and Chief Medical Officer at Nationwide Children’s Hospital in Columbus, Ohio.


Tags:  children's hospitals  patient safety research  pediatric safety 

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Evidence As a Seed for Collaboration: Separating the Wheat from the Chaff

Posted By Administration, Wednesday, July 6, 2016
Updated: Tuesday, July 5, 2016

Organizations should have individuals who monitor published research in order to help their clinicians and executives apply findings to address local gaps.

by Lorri Zipperer, MA


I have been monitoring the patient safety literature for more than two decades now, first as the information project manager at the National Patient Safety Foundation, and for more than a decade as the development editor for AHRQ Patient Safety Network. As those in patient safety might attest and applaud, the evidence base has gotten more robust over the years, spurred by increased funding for research and public interest in the topic.


This expanding wealth of literature creates a challenge for organizations and individual practitioners. The unintended consequence of this explosion is that there is more wheat to sift through. The growing set of materials makes tracking useful evidence more cumbersome while in turn increasing the messiness of translating existing research results into actions that make sense and conclusions that are credible. We know that just because it’s science doesn’t necessarily mean it’s good science. We know that just because it’s published, identified, and shared within an organization, community, or team that evidence derived from science is not necessarily applied or able to be translated for use on the front line.(Zipperer 2016)


While somewhat editorial in nature,
Dr. Shojania’s presentation brought nuance
to seeing how the evidence exploring these areas
can play a part in our understanding of them.

There are tools out there to help with creating awareness of materials, such as AHRQ Patient Safety Net and the NPSF Current Awareness subscription service. However, not only should organizations have individuals trained to monitor these resources, also the search for particular evidence needs to address local gaps in understanding and effectively disseminate the literature to decision makers. Someone in the organization should navigate this output in order to help their clinicians and executives apply it if it is going to enrich the design of interventions and implementation of programs and contribute to enhancing the reliability of their patient safety work.


We could all use someone like Dr. Kaveh Shojania to help translate what is written to help create actionable knowledge in health care.


Dr. Shojania—with whom I work in my role at AHRQ Patient Safety Network, as he is on the editorial team—has for three consecutive NPSF Congresses provided a thoughtful and provocative analysis of key articles and the trends they indicate for conference attendees. This year’s session, entitled “Hot Topics in Patient Safety: Selected Papers Advancing the Field in the Past Year,” did not disappoint. Dr. Shojania covered literature on 6 important topics:

  • Diagnostic errors
  • Rudeness’ impact on team performance
  • Trends in adverse events over time
  • Incident reporting
  • Fall prevention
  • Reducing high-risk prescribing in primary care, with a focus on the current opioid abuse/misuse epidemic in the US

These themes should be no surprise to those in the patient safety community. While somewhat editorial in nature, Dr. Shojania’s presentation brought nuance to seeing how the evidence exploring these areas can play a part in our understanding of them. While some analysis of research design was applied, and the value of results was discussed, Dr. Shojania’s insights should enhance our ability to be more critical of what is published and by whom.


Imagine the opportunity that the sort of dialogue generated by this type of expert assessment could provide in an organization. The exercise could be brought to our care environments as more than a social or intellectually opportunity. If positioned as a patient safety improvement tactic, it could serve a more impactful role.


Dr. Shojania was challenged by an attendee, and his response provided thoughtful seeds for all of us who seek to partner to “plant” evidence-based solutions in the patient safety community garden. Imagine the learning and collaboration that could be generated in organizations if teams had these types of conversations on a regular basis, with accountability assigned to do something with the issues raised. Could the dialogues support increasing the transparency around sharing of ideas, forming of shared mental models, leveling of hierarchy, and engaging of individuals to form multidisciplinary teams to do research to reflect the frontline needs of improvers? Could be.

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What tools, techniques, and team members do you use to identify, analyze, and infuse the most relevant literature to innovate and anchor patient safety efforts throughout your organization? Comment on this post below. Note: to post a comment you must be logged in. Register or log in.


Zipperer L. Jones BB, Esparza JM, Wahr J. Evidence, information, and knowledge as elements of safe surgical care. In: Stahel P, ed. Surgical Patient Safety. New York: McGraw-Hill Education; in press.


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Lorri Zipperer, MA, is the principal at Zipperer Project Management in Albuquerque, NM, specializing in patient safety and knowledge management efforts and bringing multidisciplinary teams together to envision, design, and implement knowledge sharing initiatives. Her latest collaboration was with The Risk Authority Stanford as a co-editor and contributing author of their 2016 publication Inside Looking Up. Contact her at

Tags:  2016 NPSF Congress  patient safety research 

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