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What’s New in Pediatric Orthopaedic Quality, Safety, and Value? A Systematic Review With Results of the 2016 POSNA Quality, Safety, and Value Initiative (QSVI) Challenge

Miller, Daniel J. MD*; Cahill, Patrick J. MD; Janicki, Joseph A. MD; Stephenson, Lindsay P. MD§; Choi, Paul D. MD

doi: 10.1097/BPO.0000000000001241
Selected Topics

Background: Enhancing the safety, quality, and value of care provided is a point of emphasis for modern health care systems. We performed a review of recent literature to highlight those efforts relevant to pediatric musculoskeletal care.

Methods: We searched the PubMed database for all papers related to quality improvement, patient safety, and/or value in pediatric orthopaedics published from October 1, 2012 to October 31, 2017, yielding 193 papers.

Results: A total of 36 papers were selected for review based upon new findings. Papers were selected based on significant contributions in the following categories: casting safety, antibiotic stewardship/infection prevention, perioperative care pathways, blood conservation, venous thromboembolic disease prevention, and imaging safety/appropriateness.

Conclusions: There have been numerous advances in safety, quality, and value in pediatric orthopaedic care. Quality improvement efforts emphasizing provider education and safety monitoring can lead to a decrease in cast-related complications. Perioperative care pathways and bundles are associated with a decrease risk of surgical site infection and decreased length of stay in pediatric spinal deformity surgery. Increased scrutiny has been placed on the value of routine follow-up radiographs in pediatric fracture and spinal deformity care.

Level of Evidence: Level 4—literature review.

*Division of Orthopaedic Surgery, Gillette Children’s Specialty Healthcare, St. Paul, MN

Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA

Division of Orthopaedic Surgery, Ann and Robert H. Lurie Children’s Hospital, Northwestern University, Chicago, IL

§Division of Orthopaedic Surgery, Shriner’s Hospital for Children, Houston, TX

Division of Orthopaedic Surgery, Shriner’s Hospital for Children, Pasadena, CA

This work was not supported by funding.

The authors declare no conflicts of interest.

Reprints: Daniel J. Miller, MD, Gillette Children’s Specialty Healthcare, 200 University Avenue East, St. Paul, MN 55101. E-mail:

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