New Pediatric Medical Journal

HM Epstein hmepstein at GMAIL.COM
Sat Jan 28 16:50:18 UTC 2017

As of September 2016, a new medical journal focused on improving pediatric hospital safety and quality was started. Below is an article by the editor. The good news is that over 100 children's hospitals are participating in sharing knowledge and that the articles will not have a pay wall. The bad news is that in their first two issues there has been no mention of diagnostics as a patient safety issue or as an area of improvement that is needed. In the latest issue there is a study titled "Impact of a Longitudinal Quality Improvement and Patient Safety Curriculum on Pediatric Residents" and the word "diagnosis" is never mentioned. (I actually searched for "diagnos" so I could find all forms.) 

Perhaps our pediatric researchers and SIDM leadership can change that. 


Making Quality and Safety a Priority in Health Care for Our Children
New journal seeks to disseminate results of pediatric quality and safety work 

The first to focus solely on improving the medical systems that care for our most precious resource: our infants and children.

by Richard J. Brilli, MD, FAAP, MCCM

When the first medical journal was published in the United States, doctors were still debating the merits of bloodletting, anesthesia was an emerging concept, and the stethoscope had not yet been invented. By today’s standards, of course, medicine back then was still very primitive and physicians relied more on instinct in their practices than on collective knowledge.

In January of 1812, that began to change. That month, the first issue of the New England Journal of Medicine was published, and in its opening paragraph, editor Dr. John Warren called on doctors to be “directed by a knowledge of preceding discoveries.” Instead of practicing medicine as individuals, the publication encouraged doctors to document their experiences and share that information.

It was a milestone in American medicine. Publishing their experiences allowed physicians and researchers to accumulate knowledge, step-by-step, across a vast array of conditions. Soon, other journals were founded that focused on specific diseases and conditions. Now, more than two centuries later, we take another small but important step along that journey.

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Last fall, I was privileged to help launch the journal Pediatric Quality and Safety. While most peer-reviewed medical journals since the early 19th century have focused on disease, this is the first to focus solely on improving the medical systems that care for our most precious resource: our infants and children. Quality improvement (QI) was once only a peripheral concern for many organizations, but the time has come to make it a priority in pediatrics.

Though QI science has been maturing over the past few decades, it became apparent to me, as chief medical officer at Nationwide Children’s Hospital, that the pediatric perspective is unique. The mechanisms and types of injuries and preventable harm that children suffer while being cared for in the hospital, such as surgical-site infections and adverse drug events, are often different from those seen in adult care. 

In an effort to address those pediatric-specific issues, our team at Nationwide Children’s Hospital developed an initiative called Zero Hero. The idea was simple: we needed to not only lower the rate of preventable harm and injuries in the children we care for, we needed to strive for zero instances.

The idea caught on, and in 2009 all 8 children’s hospitals in Ohio joined together to form a collaborative called the Ohio Children’s Hospitals Solutions for Patient Safety. Together, we followed the lead of Dr. Warren, freely sharing information about our experiences and openly debating and establishing best practices. Within the first few years, using QI science methodology, we attained considerable success in lowering preventable harm rates.

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So successful were we that the concept has gone national. Today, more than 100 children’s hospitals across the country have joined our initiative, working to eliminate 10 hospital-acquired conditions, including adverse drug events, catheter-associated urinary tract infections, central line–associated bloodstream infections, pressure ulcers, and ventilator-associated pneumonia, among others.

Since 2012, through May of 2016, the Solutions for Patient Safety Collaborative has saved 6,686 children from serious, preventable harm, which has led to an estimated savings of more than $121 million dollars in medical costs. That’s an average of saving more than 4 children from harm and more than $76,000 in costs every day, with a consistent upward trend each month.

We still have work to do, which is where this new journal will play a key role. As children’s hospitals everywhere strive to develop and deliver quality, evidence-based care, the journal will provide a perfect vehicle for collaboration. We will be able to collect and concentrate data and information from all over the world in one place, where it can be freely shared, easily disseminated, and rigorously debated.

It was this approach that proved so effective for Dr. Warren more than 200 years ago, and it’s time we dedicate the same focused efforts to safe and quality care for our children.

Pediatric Quality and Safety (PQS) is an international, peer-reviewed, open-access, online periodical that publishes results of quality improvement and patient safety initiatives that impact the lives of children. For details about submitting a manuscript visit the website.

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Richard J. Brilli, MD, FAAP, MCCM, is co-editor-in-chief of the journal Pediatric Quality and Safety and Chief Medical Officer at Nationwide Children’s Hospital in Columbus, Ohio.

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