Brian R. Jacobs, MD, MS, FAAP, Guest Editor

Max J. Coppes, MD, PhD, MBA, Guest Editor

As alarming as the momentous Institute of Medicine 2000 report To Err is Human: Building a Safer Healthcare System may have been, it needed not come as a surprise. As medical caregivers, we need only to listen to our patients and their families to realize that, despite our best intentions, we regularly fall short in meeting their expectations. We therefore elected to kick off this issue of The Pediatric Clinics of North America by giving parents a voice on safety. The article by Dale Ann Micalizzi and Marie Bismark is poignant. We encourage our readers to heed the comments and quotes made in this article by patients and family members and “to interpret such comments within the context they were made.” While certainly true, the issue is not to find excuses or extenuating circumstances for why we failed patients and parents; rather, the point is that we did fail them and in doing so also lost their trust. We contend that none of us get up in the morning with the intention of failing or making a mistake, quite the contrary. But it is essential for us all to start accepting that, despite our training, expertise, team work, experience, and commitment to providing the very best care possible to each and every patient with high reliability performance, we remain human and therefore prone to making errors both at work and at home. Embracing this reality seems essential to developing systems that minimize the number of errors we providers make as well as the number of errors that reach our patients. If one thing is clear from Micalizzi and Bismark, parents do not expect infallibility or perfection, but they do expect us to recognize and acknowledge our own failures immediately and respond empathetically to those we affect by our failing. Parenthetically, this likely includes coworkers and colleagues, although little research has been performed to document this. Similarly, we suggest that failure also affects one’s trust. In short, performance failure in health care has many serious consequences beyond patient morbidity or even mortality. Therefore high reliability performance and patient safety have increasingly become an important focus in health care.

This issue spends a considerable amount of time examining what we know today regarding the role of technology in ensuring patient safety. In the last decade, health information technology has taken on an important worldwide role and is often discussed as a centerpiece of health care reform. Erika Abramson and Rainu Kaushal kick off the technology discussion examining the growing body of information on the role of computerized provider order entry in patient safety. The authors review how computerization has affected the safety of the front end of the medication management cycle––prescribing and transcribing. Continuing in the technology theme, Matthew Scanlon reviews the positive and negative aspects of smart infusion pumps on the sharp end of medication safety––drug administration. Dr Scanlon’s article presents compelling information on these devices, which should leave the reader well informed on their role in preventing administration errors. Next up, Valere Lemon and David Stockwell from Children’s National Medical Center describe their innovative journey automating the detection of potential adverse events and errors using data derived from the electronic health record. Their work in building a national collaborative around this methodology is both novel and exciting.

Wallace Crandall and his colleagues at Nationwide Children’s Hospital then take the reader on a deep dive into the study of preventable harm. They elaborate on a new approach utilizing aggregated safety metrics. Andrew Shin and associates at Lucille Packard Children’s Hospital then launch a wonderfully insightful discussion on their work around mortality associated with adverse events. We next turn to Jay Deshpande from Arkansas Children’s Hospital for information on the methods used in his organization to standardize the way morbidity and mortality reviews are conducted and the lessons learned from their approach at that organization.

Fatigue clearly plays a role in the safety cultures of many industries across the world. Health care is perhaps the last industry to recognize the importance of adequate rest on good outcome for both patients and providers. Glenn Rosenbluth and Chris Landrigan elaborate on the role of sleep and work fatigue in both patient and provider safety in the health care setting. These authors leave us all with a comprehensive background in the necessary balance between work and rest. Sharon Griswold and colleagues then move us into the area of simulation training, reviewing the role and great importance of simulation in the promotion of patient safety in a variety of medical disciplines.

Much of the work in this issue is devoted to safety-related issues in the acute and critical care environment. Not to be ignored, the ambulatory environment has its own set of safety concerns in pediatric health care. Daniel Neuspiel’s article focuses on what we know and what we can do in this important care delivery setting. Although much of the weight of safety prevention in children lies on the shoulders of the health care provider and the family, there remains a clear and important role of the regulatory agency in device, medication, and biologic product safety. Marilyn Flack and colleagues from the Food and Drug Administration (FDA) review the important role that the FDA plays in ensuring safety for our patients in the provision of health care. Finally, in rounding out this issue, Kate Carr and Angela Mickalide provide the readers a glimpse of the Safe Kids Worldwide program and the impact that this program has had on patient safety around the globe in recent years.

Patient safety is paramount to our mission of providing the optimal health care delivery environment for children and their families. Patients and families expect their health care providers to be expert in this area. This issue of Pediatric Clinics of North America clearly sets the stage in moving forward into the next decade of safe pediatric care delivery.

Sincerely,