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Quality improvement and crisis resource management in pediatric resuscitation

Myers, Sage R.a , c; Donoghue, Aaron J.a , b , c

Current Opinion in Pediatrics: June 2019 - Volume 31 - Issue 3 - p 297–305
doi: 10.1097/MOP.0000000000000772
EMERGENCY AND CRITICAL CARE MEDICINE: Edited by Jean E. Klig and Clifford W. Bogue

Purpose of review The pediatric resuscitation environment is a high-stakes, environment in which a multidisciplinary team must work together with patient outcomes dependent, at least in part, on the performance of that team. Given constraints of the environment and the nature of these events, quality improvement work in pediatric resuscitation can be challenging. Ongoing collection of accurate and reliable data on team performance is necessary to inform and evaluate change.

Recent findings Despite the relative difficulty of quality improvement analysis and intervention implementation in the resuscitation environment, these efforts can have significant impact on patient outcomes. Although there are barriers to accurate data collection in real-life resuscitation, team performance of both technical and nontechnical skills can be reliably measured in video-based quality improvement programs. Training of nontechnical skills, using crisis resource management principles, can improve care delivery in resuscitation.

Summary Striving toward a learning healthcare system model in resuscitation care delivery can allow for efficient performance improvement. Given the possible impacts on mortality and quality of life of care delivered in the resuscitation environment, all providers who could possibly face a resuscitation event – no matter how rare – should consider how they are evaluating the quality of their care delivery in this arena.

aDivision of Emergency Medicine

bDivision of Critical Care, Children's Hospital of Philadelphia

cPerelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA

Correspondence to Sage R. Myers, MD, MSCE, Division of Emergency Medicine, Children's Hospital of Philadelphia, 3501 Civic Center Blvd, CTRB, 2nd Floor, EM Offices, Philadelphia, PA 19104, USA. Tel: +1 267 426 7939; fax: +1 215 590 4454; e-mail:

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