Creating Unit-Based Patient Safety Walk-Rounds in a Pediatric Emergency Department

We describe how a new program of unit-based patient safety walk-rounds (PSW), where staff participate in quality improvement monitoring and discuss patient safety issues, was developed and conducted, share our tools, and report preliminary results. Over the first 9 months, 20 unit-based PSW involving 99 staff members occurred, including 30% on weekends, 40% during the evening, and 25% during the overnight shifts. Several systems issues were identified using 6 quality improvement tools and acted upon including creation of educational programs, collaboration with multiple departments external to the emergency department, changes in computerized physician order sets, and institution of multidisciplinary bedside rounds. The number of medication “near-miss” incident reports during this period increased by 44% compared with the 24 months before beginning this program. Through unit-based PSW, clinical, administrative, and ancillary support staff have successfully worked together to improve safety and quality of care and awareness of patient safety in a children's hospital emergency department.