Patient safety and quality improvement: What the pediatric trainee needs to know

Patient safety and quality improvement in healthcare has been a principle focus for more than a decade. Deaths attributable to medical errors have been estimated to be the third leading cause of mortality in the United States. As such, the healthcare industry has avidly pursued means to reduce errors by studying models of high reliability used in the nuclear power and aviation industries. Pediatric studies have also shown the importance of patient safety events, and their contributory role to deaths and increased hospital charges and length of stay. While safety and quality improvement are now being added to medical school curricula, it is essential that exposure of pediatric trainees (residents and fellows) to quality improvement principles occur during to their training. These include: the importance of error detection and timely reporting, error investigation and prevention techniques, and the importance of error disclosure to patients and families. With increasing public focus and heightened expectations from insurers around patient safety, it is paramount to actively involve pediatric residents and fellows in quality improvement. It is, also, essential for training programs to teach our impressionable learners to be part of a fair culture around medical errors. Recognition that most medical errors can be attributable to imperfect systems is an important starting point. Further, these trainees are part of a health care system that focuses on redesigning a better system to make it more difficult to commit future errors. Immersion of pediatric trainees in a hospital culture that emphasizes the value of a multidisciplinary team approach to health care where all members at all levels of training are respected will go a long way in transforming our future caregivers who will impact healthcare quality and safety for decades to come. This type of environment allowing the trainee to feel safe to speak up will increase engagement, allow for increased event reporting, and create future champions for a culture of high reliability in the hospital setting.