Children's Hospitals Today - Spring 2018 - 30

VITALS / NEWS AND UPDATES

Understanding the source of harm

A safety report points to top patient safety vulnerabilities and areas for action.

C

hildren's hospitals have a strong
history of making great strides in
improving patient safety by working
together. The stakes are high-one
instance of serious harm can have
catastrophic consequences for a
child and his or her family. The Child
Health Patient Safety Organization
(PSO), the nation's only PSO dedicated
to children's hospitals, provides a
confidential place for children's hospitals to prevent serious patient harm
through active surveillance, an early
warning system and shared learning. In this safe community, learning
within the PSO is federally protected
to promote participation across state

lines. Hospitals share opportunities
with each other to mitigate harm and
improve patient safety.
For every children's hospital, zero
harm is the only acceptable patient
safety goal. The 2017 Child Health PSO
annual report, "Perfecting Detection,"
shows how 60 children's hospitals are
sharing information on harm events
and learning from each other to
identify risks before harm occurs in
their organizations.
A
new
analysis
based
on
reported cases reveals the top
safety vulnerabilities for children's
hospitals,
which
health
care
organizations can use to set future

A CLOSER LOOK

Causes of serious
safety events
Here's a look at the top
causes of harm. Hospitals
can address the shared
vulnerabilities that lead to
serious and moderate harm.

SOCIAL DETERMINANTS
SCREENING TOOLS

Growing evidence
demonstrates the importance
of addressing social needs,
which affect 20 percent of a
person's health, to achieve
positive medical outcomes. A
new CHA report, "Screening
for Social Determinants of
Health: Children's Hospitals
Respond," outlines how
children's hospitals are
implementing social
determinant screening to
understand factors that affect
a child's overall health. This
screening report focuses on

30

MOST SERIOUS HARM

MODERATE HARM

creating strong community
resource connections,
provides examples of
screening tools being used in
children's hospitals and offers
questions to consider when
implementing a new screening
strategy. Learn more at
childrenshospitals
.org/sdhreport2018.

5 PROJECTS READY
FOR REPLICATION

If any part of your day focuses
on improving the quality and
safety of care, on-demand
sessions from the 2018 Quality
and Safety in Children's Health

CHILDREN'S HOSPITAL S TODAY Spring 2018

priorities to improve patient safety.
The report also includes a review of
new pediatric-specific strategies and
tools for three high-risk safety topics
that have resulted in harm: diabetes
care management, thermal injuries
and retained foreign objects.
The PSO is continuously monitoring
emerging pediatric trends that reveal
patient safety risks. The group's
intention is to proactively identify
risks and alert providers to ensure
serious harm isn't repeated.
View the 2017 Child Health PSO annual
report at childrenshospitals.org/pso17.

Failure to recognize
or lack of situational
awareness

Error in
medical
decision making

Missed
diagnosis

1

2

3

Failure to recognize
or lack of situational
awareness

Failure to
communicate
effectively

Process
failures

Conference can give guidance
or spark ideas for better care.
Representatives from more
than 90 hospitals convened in
March to share the progress
and pitfalls they encountered
when implementing quality
improvements. Several session
recordings are available, and
the subjects cover a range of
ideas that organizations of any
size can use, from improving
clinical effectiveness and
sepsis detection in the
emergency department to
engaging families to improve
patient safety. Learn more and
watch the presentations at
childrenshospitals.org/projects.

SAVE THE DATE:
LEADERSHIP CONFERENCE

Don't miss the premier
conference for children's
hospital leaders and
executives. Join your peers
for presentations and
discussions about care
delivery and payment models,
consumerism, organizational
effectiveness and strategy and
innovation. The 2018 Annual
Leadership Conference and
Meeting of the Membership
is Nov. 5-7 in San Antonio.
Registration opens Aug. 2
at childrenshospitals.org/
leadership18.


http://www.childrenshospitals.org/pso17 http://www.childrenshospitals.org/leadershio18 http://www.childrenshospitals.org/leadershio18 http://www.childrenshospitals.org/projects

Table of Contents for the Digital Edition of Children's Hospitals Today - Spring 2018

Contents
Children's Hospitals Today - Spring 2018 - Intro
Children's Hospitals Today - Spring 2018 - Cover1
Children's Hospitals Today - Spring 2018 - Cover2
Children's Hospitals Today - Spring 2018 - Contents
Children's Hospitals Today - Spring 2018 - 2
Children's Hospitals Today - Spring 2018 - 3
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Children's Hospitals Today - Spring 2018 - Cover3
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