Pediatric Quality & Safety Program

Patient safety is a cornerstone of healthcare excellence, particularly in pediatrics, where the most vulnerable patients require the highest standards of care. At the Yale Department of Pediatrics and Yale New Haven Children’s Hospital, we are committed to fostering a culture of safety, equipping our teams with high-reliability organization (HRO) training, and rigorously tracking and responding to safety events to ensure continuous improvement. Below is an overview of our comprehensive approach to patient safety.

Our department prioritizes a culture of safety where every team member, regardless of their role, feels empowered and obligated to voice concerns, report potential risks, and contribute to safety initiatives. Core tenets of our safety culture include:

• Open Communication: Encouraging transparent and respectful dialogue about safety concerns.
• Non-Punitive Reporting: Ensuring that staff feel safe reporting errors or near-misses without fear of retribution.
• Teamwork: Promoting interdisciplinary collaboration to address safety challenges.
• Learning Environment: Leveraging mistakes as opportunities to learn and prevent recurrence.

High-reliability organizations operate in complex, high-risk environments yet achieve exceptionally low rates of failure. To embed HRO principles, the Yale Department of Pediatrics provides ongoing training to our staff. Key components include:

• Preoccupation with Failure: Focusing on errors and potential errors and addressing them before they escalate into critical events.
• Reluctance to Simplify Interpretations: Consistently asking why and seeking opinions from diverse perspectives.
• Sensitivity to Operations: Maintaining situational awareness and developing teams that speak up
• Commitment to Resilience: Preparing teams to adapt and respond effectively to unforeseen challenges.
• Deference to Expertise: Relying on the most knowledgeable individuals during high-stakes situations, regardless of hierarchy.

We maintain a robust system for event reporting, which is essential for identifying trends, understanding root causes, and implementing corrective actions. Features of our approach include:

• User-Friendly Reporting Tools: SAFER reporting is easily accessible via the EPIC tools tab and filling out the reports are simple.
• Morning Safety Report: Events from the past 24 hours are reported each morning, with follow-ups on previous reports also provided.
• Comprehensive Analysis: Utilizing data analytics to identify patterns and prioritize interventions.
• Feedback Loop: Communicating outcomes and lessons learned to all staff to reinforce the value of reporting.

If you know of a safety concern, please click here.

Preventing HACs is a priority, requiring a proactive and multidisciplinary approach. Our key initiatives involve:

• Evidence-Based Protocols: Implementing best practices to prevent conditions such as CLABSIs, CAUTIs, and pressure injuries.
• Continuous Monitoring: Tracking HAC rates and comparing them with national benchmarks to assess progress.
• Collaborative Interventions: Engaging diverse teams to design and implement safety improvements.
• Transparency: Presenting our data on the Children’s Hospital Website (https://www.ynhh.org/childrens-hospital/services/quality-safety/quality-scores)

Patient safety is a continuous journey. We rely on ongoing education, open communication, and analytical insights to adapt and evolve. Together, we ensure the highest standards of care for our pediatric patients and inspire a collective commitment to excellence.

Quality improvement (QI) projects play a vital role in enhancing patient care, safety, and efficiency within the Department of Pediatrics. By systematically identifying areas for improvement and implementing evidence-based strategies, QI initiatives help optimize clinical outcomes, streamline workflows, and ensure adherence to best practices. These projects foster a culture of continuous learning and innovation, empowering healthcare providers to address challenges such as reducing hospital-acquired infections, improving vaccination rates, and enhancing communication between caregivers and families. Ultimately, quality improvement efforts contribute to better patient experiences, improved health outcomes, and a higher standard of care for pediatric patients. Below are a selection of active quality improvement projects within the department.

Quality improvement tools help organizations systematically enhance processes, improve efficiency, and achieve better outcomes. AIM statements define clear, measurable goals for improvement efforts. Key driver diagrams visually map the factors influencing a desired outcome, helping teams focus on critical areas. Process maps illustrate workflows, identifying bottlenecks and inefficiencies. The Plan-Do-Study-Act (PDSA) cycle provides a structured approach for testing changes on a small scale before broader implementation. Together, these tools enable continuous improvement by fostering data-driven decision-making and iterative learning.

In pediatric healthcare, accurate and comprehensive data collection is essential for ensuring optimal patient outcomes. The integration of electronic medical records (EMRs) has revolutionized the way pediatricians document, analyze, and utilize patient information. Our Data program, led by Dr. Emily Powers allows us to follow process and outcome data in real time. We are able to collect data on a growing number of pediatric conditions and allow providers to understand the details of the care they are delivering for specific pediatric populations.

Below is an example of one of our data screens. We can track how often we use our clinical pathways for infants with fevers and how often we appropriately avoid performing a lumbar puncture.

By tracking health disparities, we can highlight gaps in our healthcare delivery and develop targeted interventions to close the gaps in care. Below is an example of one of our data screens. Urine toxicology screens are often obtained on newborns but very rarely add new information and are therefore rarely indicated. Initially at Yale, we were obtaining too many urine toxicology screens on newborns and we also noticed a disparity in the rates of these tests. After improvement efforts we were able to reduce the overall rate of urine toxicology screens and eliminate the disparity.

The Pediatric Care Signature Clinical Pathways Program aims to improve the quality of care provided to pediatric patients across the Yale New Haven Health System. The Program incorporates evidence-based recommendations and expert consensus into streamlined clinical tools that outline the recommended course of treatment for various conditions, helping assure that our patients get the care they need and need the care they get, regardless of which delivery network they may present.

The clinical pathways built in AgileMD integrate directly EPIC, which improves accessibility and allows providers to place orders from the pathways. The use of pop-up windows helps streamline the pathways while also providing further educational information. A list of currently available clinical pathways can be found on the Children’s Hospital website.

If you are Interested in developing a pathway or have feedback for our team, please click here.

Please click here for more information on the pathway development process (AgileMD Making a Pathway) and a brief tutorial video on using AgileMD