Two decades ago, the seminal Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine) report To Err Is Human: Building a Safer Health System first highlighted the influence of poorly designed health care delivery systems and suboptimal processes as contributors to patient safety. Substantial progress has occurred since then, including creation of a federally mandated Child Health Patient Safety Organization, which uses a standardized taxonomy for patient safety events, contributory factors, and severity of harm, with shared learning by dissemination of reports to individual institutions and to the public. In this issue of Pediatrics, Burrus et al analyze and report on 4 years of serious safety events (SSEs) from 44 Child Health Patient Safety Organization–participating hospitals regarding the types of safety events, severity of harm, and contributory factors. Their results underscore the overall improvement in pediatric safety in these institutions during...

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