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

386 D.C. Stockwell and A.D. Slonim
defined. The Joint Commission requires accredited hospitals to collect and submit
performance data on care for three of the following conditions: acute myocardial
infarction, heart failure, pregnancy and related conditions, community acquired
pneumonia. These measures are publicly reported by the Department of Health and
Human Service (DHHS) and are linked to reimbursement. 4 For pediatrics, quality
measures have only recently become available for inpatient asthma care but little
else. Despite this limitation, pediatric institutions have been proactive in identifying,
defining and sharing quality measures publicly. 5
30.2.2 Safety
Safety is the first step in achieving healthcare quality. Safe care minimizes risks and
optimizes benefits. Medical care involves medications, procedures and treatments
that offer benefits but also have inherent risks that can result in patient harm.
The first step in increasing safety is to improve communication about risks and
potential side effects of interventions. Thus, communication with the patients and
their families is a central focus of safety initiatives. Improving communication
within the medical team is important in addressing safety, and not surprisingly, the
IOM promotes “effective team functioning,” 1,2 as many safety problems are due to
the lack of communication and coordination between members of the healthcare
team. Improving communication within the provider team can improve outcomes, 6
and successful team dynamics are essential to achieve the goal of delivering safe
healthcare.
30.2.3 Errors
An error is a problem in the process of care. 7 Processes are sequences of operations
or events that produce outcomes. Examples of healthcare processes include:
insertion and removal of central venous catheters, preparation, administration
and documentation of vaccine delivery and medication ordering, dispensing and
administration.
Etiologies of errors are multi-factorial. The complexities of processes create
opportunities for error at any step. Human knowledge deficits in performing a task
can be difficult to identify and correct. Errors of omission, such as failure to utilize
DVT prophylaxis in ICU care when indicated (many pediatric patients do not
require this but post-menarchal females should receive it unless contraindicated), 8
may also occur. A recent study that involved patients in adult ICUs and on the
wards suggested that patients in the United States receive, on average, only half of
the recommended care that they should receive. 9