1. Dickinson, Chris J. MD

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In 2011, a group of children's hospitals in Ohio that had joined forces to improve safety and reduce harm expanded their network to include other hospitals from other states. The network has now expanded to 130+ children's hospitals in the United States and Canada. This collaboration, called the Solutions for Patient Safety (SPS), is funded by the Centers for Medicare & Medicaid Services (CMS) as a Hospital Engagement Network (HEN). It has been one of the most successful HENs funded by CMS. The SPS's goals are lofty: a 40% reduction in harm events such as falls, pressure injuries, or infections such as surgical site infections and a 50% reduction in serious safety events. The results have been impressive, with 9371 children saved from serious harm and more than $151 million saved in 2017. SPS bundles specific to the care of children have been developed and proven to be quite effective when done in a highly reliable manner. Since all of the harm events or health care-acquired conditions measured by SPS have adult counterparts, many of the bundles were adapted from the adult literature where the pediatric literature was scant. This past year SPS added a goal to improve staff safety, with a 25% reduction in employee harm as measured by the Days Away Restricted or Transferred (DART) metric, suggesting that a safe patient handling effort would need to be implemented in SPS-participating children's hospitals.


When health care professionals think of harm prevention to children, mobility and safe patient handling programs do not immediately come to mind. However, as is the case with adults, hospitalized children on prolonged bed rest do become deconditioned. Children will lose neurodevelopmental milestones, become weaker, and suffer many of the same immobility complications as do adults. While it is true that the child's ability to recover can be much faster than an adult, the complications of immobility can be seen in the interim. These complications include pressure injuries, ventilator-associated pneumonia, falls, venous thromboembolism events, prolonged hospitalization, and readmissions. In addition, the obesity epidemic has affected pediatric units such that it is no longer surprising to see a patient weighing in excess of 100 kg on a pediatric unit. Finally, many children's hospitals have also expanded their age ranges by caring for adolescents and young adults well into their 20s and 30s with chronic congenital conditions that cannot be easily cared for on adult units.


There is now a national imperative to reduce harm to patients and staff and reduce the debilitating effects of immobility on pediatric units. But how to do this? There is a paucity of pediatric literature. Adopting an "off-the-shelf" adult mobility program will not necessarily work in pediatrics. But to not use the extensive experience and published data of adult colleagues would also seem inefficient. This was the approach taken by the following authors where they successfully modified an adult-based mobility program in use at Michigan Medicine for pediatrics. This approach has several advantages. First, the IT and other data resources needed to implement a modified adult program for pediatrics are far fewer than that of a de novo pediatric program. This allows the program to be implemented much more quickly and efficiently. Second, one should remember that the vast majority of hospitalized children are not cared for in freestanding children's hospitals but rather in children's hospitals or units as part of a larger health system. Resources for a pediatric mobility program, such as staff education, equipment, IT, and data collection, will be much more efficiently utilized if the program is similar to the adult program. This is particularly true for smaller pediatric units where the staff might also be caring for adults. Third, this program will be able to leverage the existing in-house expertise from the adult nursing colleagues.


In the following articles, the reader will find one approach that a children's hospital within a larger academic health system pursued to develop a safe patient handling and mobility program. Obviously, children have unique needs that the authors of the 3 articles sought to meet. First, there is the challenge of developmental changes that occur with various age groups. Owens and Tapley describe the development of standardized mobility assessment tools for various age groups of children at different developmental mileposts. Second, layered onto the age diversity are the various medical needs of a child in an intensive care unit (ICU) setting. Van Damme and colleagues describe an innovative approach to the development of medical criteria to safely mobilize critically ill children in an ICU. The last question is how to mobilize a child safely. Parchem, Peck, and Tales answer this question and list the equipment and staff needed to mobilize a child. Their article describes the need to engage an entire team of nurses, physical and occupational therapists, families, rehabilitation engineers, child life therapists, and speech and language pathologists to mobilize even the sickest child. It is hoped that the reader will look at pediatric mobility through a different lens after reviewing this work.


-Chris J. Dickinson, MD