Pediatric clinics of North America
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Pediatr. Clin. North Am. · Aug 2009
Implementing a pediatric rapid response system to improve quality and patient safety.
Life-threatening events are common in today's hospitals, where an increasing proportion of patients with urgent admission are cared for by understaffed, often inexperienced personnel. Medical errors play a key role in causing adverse events and failure to rescue deteriorating patients. ⋯ When hospital staff or family members observe warning signs and trigger timely intervention by a rapid response team, rates of cardiac arrest and mortality can be reduced. Rapid response team involvement can be used to trigger careful review of preceding events to help uncover important systems issues and allow for further improvements in patient safety.
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Pediatr. Clin. North Am. · Aug 2009
Quality improvement, clinical research, and quality improvement research--opportunities for integration.
The opportunity to mobilize linkages between quality improvement (QI) and research is at an early stage. This article describes some of the opportunities for and challenges of integrating QI and more traditional forms of clinical research to achieve broad improvements in medical care. The authors suggest that such integration would include more active experimentation in the health care delivery system and that the application of QI methods offers a rational, effective, and reasonably fast method to support the learning required to adapt new knowledge to specific practice environments and to create and test innovations needed to improve systems of care delivery.
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There is urgent need to reform health care reimbursement models, including physician compensation, to address high health care costs, despite numerous quality initiatives. Pay for performance (P4P) is a model that attempts to align financial incentives with better outcomes and value rather than the current system of rewarding volume and intensity of care delivered. ⋯ Measurement for P4P is evolving, as are the types of incentives; neither is perfect at this time. For P4P to succeed, all health care stakeholders will need to collaborate.
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Pediatr. Clin. North Am. · Jun 2009
Review Historical ArticleDelivery room management of the newborn.
Neonatal resuscitation is an attempt to facilitate the dynamic transition from fetal to neonatal physiology. This article outlines the current practices in delivery room management of the neonate. ⋯ The importance of communication with other members of the health care team and the family is discussed. Finally, future trends in neonatal resuscitation are explored.