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Patient Safety and Quality

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Study examines the relevance and applications of the Institute of Medicine's quality aims on pediatric critical care

The Institute of Medicine's six aims for improving quality of care, cited in its report Crossing the Quality Chasm, provide a useful framework to advance the quality of care in pediatric intensive care, note George Washington University School of Medicine researchers, Anthony D. Slonim, M.D., M.P.H., and Murray M. Pollack, M.D., M.B.A. Supported in part by the Agency for Healthcare Research and Quality (HS14009), they reviewed the literature to assess the relevance, potential impact, and effect of these aims (safety, effectiveness, equity, timeliness, patient-centeredness, and efficiency) on pediatric critical care practice.

They point out that safety is critical to reduce medical errors and adverse events in the high-risk pediatric intensive care units (PICUs). These problems range from diagnostic and treatment errors to hospital-acquired infections, procedural complications, and failure to prevent problems such as pressure ulcers. Second, PICU care must be effective. Even well-known and accepted guidelines, such as treatment of septic shock, may be commonly violated by PICU staff. Third, there are pediatric and neonatal ICU inequities associated with access to care, insurance status, and race. For example, emergency PICU admissions from lower socioeconomic status populations are more severely ill and are consistent with a lack of quality prehospital care.

Fourth, timely communication and management of medical orders or problems is critical to PICU care quality and safety. Fifth, patient-centeredness is particularly important for vulnerable PICU patients and their families, who complain most of inadequate information and lack of care coordination. Communicating procedures and their child's progress with families is important, and allowing them to be present during procedures may be beneficial, which is why it is becoming more common. Finally, a PICU must be efficient, that is, achieve appropriate clinical outcomes while keeping costs to a minimum.

More details are in "Integrating the Institute of Medicine's six quality aims into pediatric critical care: Relevance and applications," by Drs. Slonim and Pollack, in the May 2005 Pediatric Critical Care Medicine 6(3), pp. 264-269.

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