Ohio children's hospitals' solutions for patient safety: A framework for pediatric patient safety improvement

Journal for Healthcare Quality

Volumn 38, Issue 4, 2016, Pages 213-222

  Lyren, Anne ^a   Brilli, Richard ^b   Bird, Michael ^c   Lashutka, Nicholas ^e   Muething, Stephen ^d  

^a CASE WESTERN RESERVE UNIVERSITY   (United States)

^b Children's Hospital   (United States)

^c AKRON CHILDREN'S HOSPITAL   (United States)

^d Cincinnati Children's Hospital   (United States)

^e NONE

Author keywords

culture safety culture patient safety pediatrics

Indexed keywords

BEHAVIOR; CHILD; EMPLOYEE; HUMAN; MAJOR CLINICAL STUDY; OHIO; ORGANIZATION; PATIENT SAFETY; PEDIATRICS; RELIABILITY; HOSPITAL; ORGANIZATION AND MANAGEMENT; ORGANIZATIONAL CULTURE; STANDARDS; TOTAL QUALITY MANAGEMENT;

HOSPITALS, PEDIATRIC; HUMANS; OHIO; ORGANIZATIONAL CULTURE; PATIENT SAFETY; QUALITY IMPROVEMENT;

EID: 84986001337     PISSN: 10622551     EISSN: 19451474     Source Type: Journal    
DOI: 10.1111/jhq.12058     Document Type: Article

References (24)

1. Bigham, M.T., Amato, R., Bondurrant, P., Fridiksson, J., Krawczeski, C. D., & Raake, J., et al. Ventilator-Associated pneumonia in the pediatric intensive care unit: Characterizing the problem and implementing a sustainable solution. Journal of Pediatrics 2009;154:582-587
2. Brilli, R.J., McClead, R.E., Crandall, W.V., Stoverock, L., Berry, J.C., & Wheeler, T.A., et al. A comprehensive patient safety program can significantly reduce preventable harm, associated costs, and hospital mortality Journal of Pediatrics 2013, Jul 30. doi:pii: S0022-3476(13)00790-7. 10.1016/j.jpeds 2013.06.031. [Epub ahead of print.]
3. Brilli, R.J., McClead, R.E., Jr., Davis, T., Stoverock, L., Rayburn, A., & Berry, J.C., et al. The preventable harm index: An effective motivator to facilitate the drive to zero. Journal of Pediatrics 2010;157:681-683
4. Brilli, R.J., Sparling, K.W., Lake, M.R., Butcher, J., Myers, S.S., & Clark, M.D., et al The business case for preventing ventilatorassociated pneumonia in pediatric intensive care unit patients. Joint Commission Journal on Quality and Patient Safety 2008;34:629-637
5. Denham, C.R., Angood, P., Berwick, D., Binder, L., Clancy, C.M., & Corrigan, J.M., et al. Chasing zero: Can reality meet the rhetoric? Journal of Patient Safety 2009;5:216-222
6. Healthcare Performance Improvement, LLC HPI: Innovative solutions in healthcare performance. 2012. Retrieved September 17, 2012, from hpiresults.com
7. Hendrich, A., Tersigni, A.R., Jeffcoat, S., Barnett, C.J., Brideau, L. P., & Pryor, D. The Ascension Health journey to zero: Lessons learned and leadership perspectives. Joint Commission Journal on Quality&Patient Safety 2007;33:739-749
8. Institute of Medicine. To err is human: Building a safer health system. Washington, DC: National Academy Press. 2000
9. Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. 2001
10. Langley, G.J., Moen, R.D., Nolan, K.M., Nolan, T.W., Norman, C.L., & Provost, L.P The improvement guide: A practical approach to enhancing organizational performance. San Francisco, CA: Jossey-Bass. 2009
11. Miller, M.R., Niedner, M.F., Huskins, W.C., Colantuoni, E., Yenokyan, G., &Moss, M., et al National Association of Childrens Hospitals and Related Institutions pediatric intensive care unit central line-Associated bloodstream infections quality transformation teams. Pediatrics 2011;128:e1077-e1083
12. Muething, S.E., Goodie, A., Schoettker, P.J., Donnelly, L.F., Goodfriend, M.D., & Bracke, T.M., et al. Quality improvement initiative to reduce serious safety events and improve patient safety culture. Pediatrics 2012;130:e423-e431
13. Nowak, J.E., Brilli, R.J., Lake, M.R., Sparling, K.W., Butcher, J., & Schulte, M., et al. Reducing catheter-Associated bloodstream infections in the pediatric intensive care unit: Business case for quality improvement. Pediatric Critical Care Medicine 2010;11:1-8
14. Ohio childrens hospital solutions for patient safety (OCHSPS).Report, 2011, January. Retrieved September 19, 2012, from solutionsforpatientsafety.org/files/SPS-January2011Report.pdf
15. Ohio Childrens Hospital Solutions for Patient Safety(OCHSPS).Measures and operational definitions table. 2012. Retrieved September 19, fromsolutionsforpatientsafety.org/files/measurestableandopdefinitions.pdf
16. Peterson, T. H., Teman, S.F., &Connors, R.H.A safety culture transformation: Its effects at a childrens hospital. Journal of Patient Safety 2012;8:125-130
17. Pronovost, P.J., & Colantuoni, E. Measuring preventable harm: Helping science keep pace with policy. JAMA 2009;301: 1273-1275
18. Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., &Cosgrove, S., et al. An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine 2006;355:2725-2732
19. Pryor, D.B., Tolchin, S.F., Hendrich, A., Thomas, C.S., & Tersigni, A.R. The clinical transformation of Ascension Health: Eliminating all preventable injuries and death Joint Commission Journal on Quality & Patient Safety 2006;32:299-308
20. Sharek, P.J., McClead, R.E., Takemoto, C., Luria, J.W., Takata, G.S., & Walti, B., et al An intervention to decrease narcotic-related adverse drug events in childrens hospitals Pediatrics 2008;122:e861-e866
21. Sparling, K.W., Ryckman, F.C., Schoettker, P.J., Byczkowski, T.L., Helpling, A., & Mandel, K., et al. Financial impact of failing to prevent surgical site infections. Quality Management in Health Care 2007;16:219-225
22. State of ohio 129th general assembly. Ohio House Bill 153, 2012, Retrieved September 28, 2012, from
23. Tham, E., Calmes, H.M., Poppy, A., Eliades, A.B., Schlafly, S.M., &Namtu, K.C., et al. Sustaining and spreading the reduction of adverse drug events in a multicenter collaborative. Pediatrics 2011;128:e438-e445
24. Weick, S.E., & Sutcliffe, K.M. Managing the unexpected: Resilient performance in an age of uncertainty San Francisco, CA: Jossey-Bass. 2007