Pediatric Informatics: Computer Applications in Child Health (Health ...

Chapter 9
Pediatric Care, Safety, and Standardization
Anne Matlow and John M. A. Bohnen
Objectives
To distinguish between standard of care and standardized care
To review cognitive and workflow tools to improve safety through standardization
9.1 Introduction
The Institute of Medicine (IOM) defines patient safety as “freedom from accidental
injury due to medical care, or medical errors,” and promotes the establishment of systems
and processes to improve the reliability of patient care as one route to making
health care safer. 1 In his recent book, Patient Safety, Charles Vincent offers two different
approaches to achieving this aim, each founded in a distinct “vision of safety.” 2 One
vision highlights the expertise and skills that providers regularly channel into creating
safe patient care, and promotes the adoption of new and enhanced skills such as teamwork
training and mindfulness as keys to improving patient safety. The other vision
recognizes the fallibility of human beings, and seeks to improve safety by replacing
or supporting the health care provider using technical and procedural interventions
such as standardization, guidelines, and information technology. The important role of
information technology was underscored in the IOM’s report, “Crossing the Quality
Chasm.” 3 Standardization of practice patterns is one aspect of clinical care that is very
amenable to the use of informatics. 4 By reducing process variability, standardization
can potentially reduce errors and make outcomes more predictable, thereby improving
care processes. In this chapter we will explore various strategies currently being used
to standardize care, and their impact on patient safety.
9.2 Standard of Care Versus Standardized Care
It is useful first to understand the distinction between “standard of care” and “standardization
of care.”
C.U. Lehmann et al. (eds.), Pediatric Informatics: Computer Applications 119
in Child Health, Health Informatics,
© Springer Science + Business Media, LLC 2009