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Analysis

Sepsis Is Among Top 5 Patient-Safety Priorities at Children's Hospitals

By Christopher Cheney  
   March 20, 2019

Survey data collected from children's hospital leaders targets primary patient-safety challenges. Find out what other focus areas topped the list.

The journal Pediatrics recently published a list of 24 children's hospital patient-safety challenges ripe for research. The list was developed from survey data collected from more than 100 children's hospital leaders and parents.

James Hoffman, PharmD, MS, chief patient safety officer at St. Jude Children's Research Hospital in Memphis, Tennessee, and Stephen Muething, MD, chief quality officer at Cincinnati Children's Hospital Medical Center, spoke with HealthLeaders recently about the top five patient-safety research priorities identified in the list.

"The intent was for researchers to take this list and know where to focus their efforts," says Hoffman, who helped craft the list of 24 research priorities and served as lead author of the Pediatrics article that details the patient-safety challenges list.

In 1999, the Institute of Medicine published To Err Is Human: Building a Safer Health System, which included the alarming statistic that as many as 98,000 Americans were dying annually due to medical errors. Estimates of annual patient deaths due to medical errors have since risen steadily to 440,000 lives, which make medical errors the country's third-leading cause of death.

In a February 2019 policy statement, the American Academy of Pediatrics noted that medical errors "affect as many as one-third of all hospitalized children," citing articles in JAMA and Pediatrics.

Following are the top five pediatric patient-safety focus areas in prioritized order.

1. Achieving high reliability
 

"The discussions about the necessity of building a high-reliability culture have been relentless among our children's hospitals over at least the past five years at all levels—from the boards to the CEOs to the clinicians," Muething says.

Hoffman says achieving high reliability is consistent with the goals of the Solutions for Patient Safety network, a group featuring 130 children's hospitals that supported the effort to identify the top 24 research priorities. "Embracing high-reliability principles is a huge focus for SPS—it's a common thread across the organization."

The experience of striving for high reliability at St. Jude Children's Research Hospital demonstrates the need for examining how to implement high-reliability initiatives, Hoffman says.

"We have a relatively new quality and patient care strategic plan, where we worked to adopt high-reliability principles, and we have wrestled with putting principles into place and finding out what the principles really mean."

2. Maintaining a safety culture
 

Improving safety requires more than effort to prevent common harms such as central line infections, adverse drug events, and falls, Muething says.

"You are not going to get anywhere near your [patient-safety] goal unless you build a culture where people are talking about safety and are focused on safety everywhere they go. It's not as simple as creating processes or getting the right equipment—everybody in the organization needs to be thinking about safety every day."

Establishing a safety culture requires commitment, Hoffman says. "It's easy to do your safety culture survey once every year, or once every other year. It's a whole other matter to go deeply into your results, look at every unit, and actually do something. That's what we try to do at St. Jude."

3. Improving the speed and accuracy of predicting patient deterioration
 

Most children's hospitals have made a commitment to share information on patient safety, and predicting patient deterioration has become a top priority, Muething says. "The leading hospitals with the research groups are putting a lot of energy into these areas. We have researchers, IT, and clinicians working on this."

"There is also a parent component to this—patient deterioration was the highest rated challenge by the parents," Hoffman says

4. Encouraging open communication between families and care teams
 

Engaging with patients and families is essential at children's hospitals, Muething says. "In pediatrics, patient and family engagement is second nature to us. I'm a pediatrician, and you learn early on that you are not getting anywhere in taking care of a child unless you learn how to work effectively with the rest of the family."

For pediatric care teams it is not innate to know how to engage families effectively, he says.

"You have to learn how to gauge—as quickly as you can—how much information and detail a particular family wants and how active they want to be in making decisions. You can't treat every family the same. Some families want to be active and want to know every detail. Other families can be stressed out—they don't want that much detail."

Pediatric care teams need more evidence-based approaches to engaging patients and their families, Hoffman says. "Everywhere you look in patient safety, there is a communication opportunity. We need to have more standardized methods and approaches for communication. There are various approaches out there. One is I-PASS for care handoffs."

5. Detecting sepsis in pediatric patients
 

To advance patient safety, detection of sepsis is equally as important as speedily recognizing patient deterioration, Muething says. "Because children's hospitals have been sharing information with each other, we know that recognizing clinical deterioration and sepsis are the most common causes of preventable serious harm at children's hospitals."

Improving sepsis detection capabilities is a paramount concern at children's hospitals, Hoffman says. "It's very top of mind in pediatrics."

Learning about patient safety from children's hospitals
 

While there is still work for hospital leaders to do to increase pediatric patient-safety, Hoffman says adult acute-care hospitals can benefit from adopting approaches to patient safety occurring at children's hospitals.

  • The high level of cohesion in the children's hospital community promotes the sharing of patient-safety information and data.
     
  • Children's hospitals routinely include patients and family members on teams dedicated to preventing harm.
     
  • There is widespread establishment of patient and family advisory councils at children's hospitals. These advisory councils have been established at 40% of hospitals nationwide, according to research published in 2014.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Patient safety is a vexing problem for the healthcare sector, with about 440,000 deaths annually linked to medical errors.

In a recent survey of children's hospital leaders and parents, achieving high reliability was the top target for research.

Children's hospitals and adult hospitals share several safety-related concerns such as boosting patient and family engagement.


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