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.1 Substantial progress has occurred since then, including creation of a federally mandated Child Health Patient Safety Organization,2 which uses a standardized taxonomy for patient safety events, contributory factors, and severity of harm,3 with shared learning by dissemination of reports to individual institutions and to the public.4 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.5 Their results underscore the overall improvement in pediatric safety in these institutions during...
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September 2021
Commentaries|
September 01 2021
Pediatric Patient Safety: Shared Learning to Improve Patient Outcomes
Prashant Mahajan, MD, MPH, MBA
Department of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan
Address correspondence to Prof Prashant Mahajan, CS Mott Children’s Hospital of Michigan, 1540 East Hospital Dr Room 2-737, SPC 4260, Ann Arbor MI 48109-4260. E-mail: pmahajan@med.umich.edu.
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Address correspondence to Prof Prashant Mahajan, CS Mott Children’s Hospital of Michigan, 1540 East Hospital Dr Room 2-737, SPC 4260, Ann Arbor MI 48109-4260. E-mail: pmahajan@med.umich.edu.
POTENTIAL CONFLICT OF INTEREST: The author has indicated he has no potential conflicts of interest relevant to this article to disclose.
FINANCIAL DISCLOSURE: The author has indicated he has no financial relationships relevant to this article to disclose.
Pediatrics (2021) 148 (3): e2021051017.
Article history
Accepted:
June 24 2021
Citation
Prashant Mahajan; Pediatric Patient Safety: Shared Learning to Improve Patient Outcomes. Pediatrics September 2021; 148 (3): e2021051017. 10.1542/peds.2021-051017
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