Quality Improvement, Education, and Outcomes Research in Pediatric Surgery

  • Steven Teich
  • Marc P. Michalsky


Historically, there has been a great disparity in the advancement of pediatric clinical services and the development of pediatric quality and safety indicators. The development and expansion of pediatric care in the United States began with the opening of the Children’s Hospital of Philadelphia in 1855. Despite this major advancement in the organization and administration of medical care for the pediatric population, a formalized mechanism to specifically address medical errors, quality of care, quality improvement, and longitudinal outcomes analysis did not take form until the middle of the twentieth century. In 1934 Ernest Codman, an orthopedic surgeon, advocated that every hospital should follow patients to determine if their treatment had been successful. Over the past half century, pediatric hospitals have become highly specialized facilities for delivering state-of-the-art medical care. The progression of medical specialization into pediatric subspecialties has led to a commitment to provide the best care possible for pediatric patients.


Medication Error Pediatric Surgery Biliary Atresia National Surgical Quality Improvement Program Computerize Physician Order Entry 
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Suggested Reading

  1. Calkins C. Contemporary outcomes research: tools of the trade. Semin Pediatr Surg. 2008;17:69–78.CrossRefPubMedGoogle Scholar
  2. Christakis DA, Johnston BD, Connell FA. Methodologic issues in pediatric outcomes research. Ambul Pediatr. 2001;1:59–62.CrossRefPubMedGoogle Scholar
  3. Codman EA. The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Boston: T. Todd Company; 1934.Google Scholar
  4. Dillon P, Hammermeister K, Morrato E, et al. Developing a NSQIP module to measure outcomes in children’s surgical care: opportunity and challenge. Semin Pediatr Surg. 2008;17:131–40.CrossRefPubMedGoogle Scholar
  5. Engum S, Breckler F. An evaluation of medication errors-the pediatric surgical service experience. J Pediatr Surg. 2008;43:348–52.CrossRefPubMedGoogle Scholar
  6. Forrest CB, Simpson L, Clancy C. Child health services research. Challenges and opportunities. JAMA. 1997;277:1787–93.CrossRefPubMedGoogle Scholar
  7. Forrest C, Shipman S, Dougherty D, et al. Outcomes research in pediatric settings: recent trends and future directions. Pediatrics. 2003;111:171–8.CrossRefPubMedGoogle Scholar
  8. Gore D. National survey of surgical morbidity and mortality conferences. Am J Surg. 2006;191:708–14.CrossRefPubMedGoogle Scholar
  9. Hardin W, Stylianos S, Lally K. Evidence-based practice in pediatric surgery. J Pediatr Surg. 1999;34:908–13.CrossRefPubMedGoogle Scholar
  10. Kaplan SH, Greenfield S, Connolly GA, et al. Methodologic issues in the conduct and interpretation of pediatric effectiveness research. Ambul Pediatr. 2001;1(1):163–70.CrossRefGoogle Scholar
  11. Kaushal R, Bates D, Landrigan C, et al. Medication errors are common in pediatric inpatient settings, and further efforts are needed to reduce them. JAMA. 2001;285:2114–20.CrossRefPubMedGoogle Scholar
  12. Khuri S, Henderson W, Barbour G, et al. The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg. 1995;180:519–31.PubMedGoogle Scholar
  13. Khuri S, Daley J, Henderson W, et al. The Department of Veterans Affairs NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Quality Improvement Program. Ann Surg. 1998;228:491–507.CrossRefPubMedGoogle Scholar
  14. Leape LL, Brennan TA, Laird NM, et al. The nature of adverse events in hospitalized patients: results from the Harvard Medical Practice Study II. N Engl J Med. 1991;324:377–84.CrossRefPubMedGoogle Scholar
  15. McGuire HH, Horsley JS, Salter DR, Sobel M. Measuring and managing quality of surgery. Statistical vs. incidental approaches. Arch Surg. 1992;127:733–7.PubMedGoogle Scholar
  16. Meurer JR, Yang H, Guse CE, Scanlon MC, Layde PM, Wisconsin Medical Injury Prevention Program Research Group. Medical injuries among hospitalized children. Qual Saf Health Care. 2006;15:202–7.CrossRefPubMedGoogle Scholar
  17. Michalsky MP, Pratt D, Caniano DA, Teich S. Streamlining the care of patients with hypertrophic pyloric stenosis: application of a clinical pathway. J Pediatr Surg. 2002;37:1072–5.CrossRefPubMedGoogle Scholar
  18. Miller MR, Elixhauser A, Zhan C. Patient safety events during pediatric hospitalizations. Pediatrics. 2003;111:1358–66.CrossRefPubMedGoogle Scholar
  19. Morrato E, Dillon P, Ziegler M. Surgical outcomes research: a progression from performance audits, to assessment of administrative databases, to prospective risk-adjusted analysis-how far have we come? Curr Opin Pediatr. 2008;20:320–5.CrossRefPubMedGoogle Scholar
  20. Rosenfeld JC. Using the Morbidity and Mortality Conference to teach and assess the ACGME general competencies. Curr Surg. 2005;62:664–9.CrossRefPubMedGoogle Scholar
  21. Stiles B, Reece T, Hedrick T, et al. General surgery morning report: a competency-based conference that enhances patient care and resident education. Curr Surg. 2006;63:385–90.CrossRefPubMedGoogle Scholar
  22. Stylianos S, APSA Trauma Committee. Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. J Pediatr Surg. 2000;35:164–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryOhio State University, Nationwide Children’s HospitalColumbusUSA

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