Abstract
Patient safety events for hospitalized children occur at a rate comparable to hospitalized adults. There are also many safety issues that are unique to children’s health care, which are related to the four Ds of childhood: developmental change, dependence on adults, different disease epidemiology, and unique demographics. Medication errors are the most common adverse events in hospitalized patients, the majority of which are associated with rotating general surgery residents. Standardized order sets for common pediatric surgical conditions and routine perioperative order sets reduce the potential for medication error, overall hospital charges, and length of stay. Surgical morbidity and mortality conference is the most important meeting for surgical education and quality assurance in the surgery department at teaching institutions. The educational value of the surgical M&M conference can be improved by applying several techniques including direct questioning of the audience, more thorough explanation of cases, questions directed to attending surgeons, the use of radiographic images, and teaching points specifically made for the medical students in attendance. NSQIP Pediatric is designed to measure the quality of surgical care within an institution utilizing prospective entry of patient risk and outcome data and the determination of risk-adjusted 30-day outcomes.
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Bhalla VK, Boone L, Lewis F, Gucwa AL, Kruse EJ. The utility of the matrix format for surgical morbidity and mortality conference. Am Surg. 2015;81(5):503–6.
Bruny JL, Hall BL, Barnhart DC, Billmire DF, Dias MS, Dillon PW, Fisher C, Heiss KF, Hennrikus WL, Ko CY, Moss L, Oldham KT, Richards KE, Shah R, Vinocur CD, Ziegler MM. American College of Surgeons National Surgical Quality Improvement Program Pediatric: a beta phase report. J Pediatr Surg. 2013;48(1):74–80.
Calkins C. Contemporary outcomes research: tools of the trade. Semin Pediatr Surg. 2008;17:69–78.
Christakis DA, Johnston BD, Connell FA. Methodologic issues in pediatric outcomes research. Ambul Pediatr. 2001;1:59–62.
Codman EA. The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Boston: T. Todd Company; 1934.
Engum S, Breckler F. An evaluation of medication errors-the pediatric surgical service experience. J Pediatr Surg. 2008;43:348–52.
Forrest CB, Simpson L, Clancy C. Child health services research. Challenges and opportunities. JAMA. 1997;277:1787–93.
Forrest C, Shipman S, Dougherty D, et al. Outcomes research in pediatric settings: recent trends and future directions. Pediatrics. 2003;111:171–8.
Gore D. National survey of surgical morbidity and mortality conferences. Am J Surg. 2006;191:708–14.
Gross ER, Christensen M, Schultz JA, Cassidy LD, Anderson Y, Arca MJ. Does the American College of Surgeons NSQIP-Pediatric accurately represent overall patient outcomes? J Am Coll Surg. 2015;221(4):828–36.
Hardin W, Stylianos S, Lally K. Evidence-based practice in pediatric surgery. J Pediatr Surg. 1999;34:908–13.
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.
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.
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.
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.
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.
McGuire HH, Horsley JS, Salter DR, Sobel M. Measuring and managing quality of surgery. Statistical vs. incidental approaches. Arch Surg. 1992;127:733–7.
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.
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.
Miller MR, Elixhauser A, Zhan C. Patient safety events during pediatric hospitalizations. Pediatrics. 2003;111:1358–66.
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.
Rosenfeld JC. Using the morbidity and mortality conference to teach and assess the ACGME general competencies. Curr Surg. 2005;62:664–9.
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.
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.
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Teich, S., Michalsky, M.P. (2017). Quality Improvement, Education, and Outcomes Research. In: Mattei, P., Nichol, P., Rollins, II, M., Muratore, C. (eds) Fundamentals of Pediatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27443-0_7
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DOI: https://doi.org/10.1007/978-3-319-27443-0_7
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