Clinical Excellence Commission Research Articles

Healthcare Workers' SARS-CoV-2 Infections in Four Hospital Outbreaks during Delta Variant Prevalence in Sydney, Australia.

Healthcare workers (HCWs) are at risk of SARS-CoV-2 infections due to occupational exposure. The use of airborne personal protective equipment (PPE) significantly reduces this risk. In June 2021, an epidemic of the Delta variant began in New South Wales (NSW), Australia. Concurrent PPE guidelines, set by the Clinical Excellence Commission (CEC), restricted the use of respirators. To understand the relationship of PPE guidelines with workplace-acquired HCW SARS-CoV-2 infections in different clinical settings and to examine the relationship between rates of community transmission and workplace-acquired HCW infections during the Delta outbreak in NSW. Total SARS-CoV-2 HCW infections between 13 June and 30 October 2021 (first four months of the Delta wave) were estimated from the government COVID-19 surveillance reports and compared with the surveillance reports of community transmission. In the absence of a detailed reporting of HCW infections, open-source data including news articles, media releases, and epidemiological surveillance reports were also collected. Data were extracted on HCW cases of SARS-CoV-2 from four hospitals, including the number of HCW cases (per NSW Health definition), clinical setting, PPE guidelines, and evidence of increasing local transmission. SARS-CoV-2 infections in HCW identified as workplace-acquired infections (n = 177) and those without a known transmission source (n = 532) increased during the period of increasing community transmission (n = 75,014) in NSW. Four hospital COVID-19 clusters affecting 20 HCWs were identified between June and October 2021. HCW clusters occurred in general wards where staff were recommended to wear surgical masks. No workplace-acquired HCW infections were reported in these hospitals from critical care wards, where respirators were recommended during the same outbreak weeks. Differences in PPE policy across different wards may leave healthcare staff at risk of SARS-CoV-2 infection. During periods of high community transmission, respirators should be provided to protect hospital staff. Formal reporting of HCW infections should occur.

Preparing for the Next Pandemic: An After-Action Review of Infection Prevention and Control Audit Strategies Within Airport and Hotel Quarantine Program.

Effective infection prevention and control (IPAC) practices within the New South Wales (NSW) Airport Operations and Hotel Quarantine Program (Quarantine Program) were required to mitigate the risk of COVID-19 being transmitted to staff, other guests, contractors, and the community. The Quarantine Program relied on complex logistical arrangements and an end-to-end process that included all steps from the time travelers boarded the returning flight until completion of the quarantine period. This required compliance with relevant IPAC standards historically reserved for health care and the implementation of a quality assurance audit framework. The Clinical Excellence Commission (CEC) as the NSW Health Pillar for quality and safety and the lead in IPAC provided training and resources coupled with an IPAC quality audit framework after program commencement. This approach ensured a clear governance structure and a regular review process to minimize risk and support continuous improvement within the program.

What ‘Sparks’ Innovation in Rural Health Settings: A case study

Objective: To determine how innovation occurs and identify the factors that support innovation in a rural hospital in New South Wales, Australia. Design: Situated within a larger case study, this research collected qualitative data using semi-structured interviews. Setting: Inner regional hospital, located in a city, providing a broad range of acute and primary health services to a rural community. Participants: Hospital executives, department managers, consultant and staff specialist surgeons, physicians, nursing, nursing managers and allied health staff were recruited after a phone, personal or email approach. Main Outcome measure: Qualitative interviews (n=25) conducted in a rural hospital. Results: Fourteen innovations were identified. Factors supporting innovation were when individuals who were valued by team members had the ability to make within team innovations with ease; clinicians with ideas for improvement led innovation; external agencies- the Clinical Excellence Commission and the Agency for Clinical Innovation provided expertise, ideas, and motivation for innovation. Limiting factors included time for innovation, creative thinking, planning, and implementation. Funding, the bureaucracy and multiple points of consultation to make changes were also identified. Conclusions: Innovation occurred despite the absence of factors theory suggests are required. In rural settings, there are limited staff and resources leading to scarcity with no additional capacity in the system and innovation is a necessity. Further innovation could be unleashed if small amounts of resourcing and time were provided to staff with innovative ideas to improve services, change processes or introduce new ways of working.

Reduction of in-hospital cardiac arrest rates in intensive care-equipped New South Wales hospitals in association with implementation of Between the Flags rapid response system.

The NSW Clinical Excellence commission introduced the 'Between the Flags' programme, in response to the death of a young patient, as a system-wide approach for early detection and management of the deteriorating patient in all NSW hospitals. The impact of BTF implementation on the 35 larger hospitals with intensive care units (ICU) has not been reported previously. To assess the impact of 'Between the Flags' (BTF), a two-tier rapid response system across 35 hospitals with an ICU in NSW, on the incidence of in-hospital cardiac arrests and the incidence and outcome of patients admitted to an ICU following cardiac arrest and rapid response team activation. This is a prospective observational study of the BTF registry (August 2010 to June 2016) and the Australian and New Zealand Intensive Care Society Adult Patient Database (January 2008 to December 2016) in 35 New South Wales public hospitals with an ICU. The primary outcome studied was the proportion of in-hospital cardiac arrests. Secondary outcomes included changes in the severity of illness and outcomes of cardiac arrest admissions to the ICU and changes in the volume of rapid response calls. The cardiac arrest rate per 1000 hospital admissions declined from 0.91 in the implementation period to 0.70. Propensity score analysis showed significant declines in ICU and hospital mortality and length of stay for cardiac arrest patients admitted to the ICU (all P < 0.001). The BTF programme was associated with a significant reduction in cardiac arrests in hospitals and ICU admissions secondary to cardiac arrests in 35 NSW hospitals with an ICU.

Personal protective equipment in the paediatric emergency department during the COVID-19 pandemic: Estimating requirements based on staff numbers and patient presentations.

ObjectiveTo estimate the personal protective equipment (PPE) required in a paediatric ED during the COVID‐19 pandemic comparing the use per patient to use per patient zone, based on the NSW Clinical Excellence Commission (CEC) guidelines in place at the time of the study.MethodsA retrospective case note review of all patients and staff present in the ED of The Children's Hospital at Westmead, Sydney, Australia in the 24 h period of Sunday 5 April 2020. The primary outcome of PPE estimates was generated from identifying the number of patient contacts and aerosol generating procedures (AGPs) performed per patient as well as the number of staff on shift.ResultsOne hundred patients attended the ED (50% of usual) and all were included in the study. For a low‐risk community environment allocating PPE per patient contact required 48 face shields, 382 surgical masks, 48 N95 masks and 430 gowns for the day, increasing to 430 face shields, 331 surgical masks, 430 N95 masks and 761 gowns in a high‐risk community environment. Allocating PPE using zoning reduces the requirement to 48 face shields, 192 surgical masks, 48 N95 masks and 204 gowns, increasing to 196 face shields, 96 surgical masks, 196 N95 masks and 292 gowns per day in a high‐risk community environment.ConclusionThis study has demonstrated the considerable requirement for PPE in a paediatric ED, which varies according to presentation type and the background prevalence of COVID‐19 in the community.

Development of the 'People-Processes-Paradigm' critical analysis tool for mortality and morbidity reviews: improving understanding of systems factors.

The impact of systems problems and human factors on delivering safe, high-quality patient care is well recognized. In the surgical setting, mortality and morbidity reviews (MMRs) are the key forum for reviewing and analysing adverse events in patient care yet there is a paucity of simple tools for undertaking such analyses. The aim of this study was to develop and pilot a new tool for analysing mortality and morbidity cases incorporating human factors and systems analysis. The published literature, professional standards, guidelines and existing audit tools for MMRs were reviewed. The 'People-Processes-Paradigm' tool was developed and pilot testing was undertaken and stakeholder feedback was obtained. Models found for undertaking systems-based analysis of adverse surgical events included the 3D model, SEIPS and the Queensland Health human error and patient safety (HEAPS) Incident Management Tool. Guidelines for standards in MMRs are provided by the Royal Australasian College of Surgeons, New South Wales Clinical Excellence Commission and Australia and New Zealand audit of surgical mortality (ANZASM). The People-Processes-Paradigm model incorporates these standards and evidence-based systems analysis tools into a single effective tool. The pilot study evaluating the use of this tool demonstrated it to be practical and easily applicable to regular use by clinicians, with the ability to be tailored to individual health service use. Improvements such as electronic format and clarification of case selection processes were recommended by users. The People-Processes-Paradigm tool has been developed for surgeons by surgeons incorporating current professional, legal and regulatory requirements in Australasia, easily transferrable to electronic platforms. This model requires further testing for validation.

Medication Risk Management: A Subjective Review of Present Scenario

Historically, the FDA has interpreted the requirement that a drug must be “safe” to mean that the benefits of a drug outweigh its risks. The determination was made on a “categorical” basis, where the totality of risks was weighted against the totality of benefits when considered for the purposes outlined in the drug product’s labeling. If a drug did not meet this criterion, it was not approved or its label was rewritten to narrow the conditions for use. This logic was endemic in the FDA for most of the 20th century. On average, two to four drugs over each 5-year period were withdrawn from the marketplace after post-marketing surveillance data uncovered new risks. Similarly, on occasion, the FDA would require some special “tool” or intervention to improve a product’s safety profile. Harm associated with medication remains the second most common type of incident in hospitals, as reported by the Clinical Excellence Commission. Health services actively review medication safety. The vast majority of medication errors result in no injury. A minor injury may result, for example, in a patient needing an increased level of monitoring. Even if incidents result in minor injury, managers and staff still take any errors very seriously, reviewing the actions around the incident and making improvements as a result. FDA’s new concepts for risk management amount to a “cultural shift” in the logic of drug approval and the FDA’s role. The key events that led to this change can be traced to a series of reports that highlighted the need for improved medical safety. In 1999, the IOM released a report entitled, “To Err is Human.” This report reviewed the nature and cause of medication errors, estimating that up to 98,000 people died each year due to these errors. In their assessment the IOM included both adverse drug reactions and human errors in drug administration. The report captured the attention of news reporters and the government. Headlines proclaimed alarm at the larger number of fatalities caused by medical errors. Consequently, there was a government-wide initiative started to develop methods and institute procedures to reduce medical errors. Statements made by FDA officials regarding some of these withdrawals suggested that the FDA no longer believed that passive oversight and re-labeling drugs with new warnings was sufficient. Furthermore, the FDA no longer believed that it was sufficient to identify safe conditions of use in the label and that healthcare professionals and patients had to comply with advocated directions of use for the drug to remain on the market.

Medication Risk Management.

Historically, the FDA has interpreted the requirement that a drug must be "safe" to mean that the benefits of a drug outweigh its risks. The determination was made on a "categorical" basis, where the totality of risks was weighted against the totality of benefits when considered for the purposes outlined in the drug product's labeling. If a drug did not meet this criterion, it was not approved or its label was rewritten to narrow the conditions for use. This logic was endemic in the FDA for most of the 20th century. On average, two to four drugs over each 5-year period were withdrawn from the marketplace after post-marketing surveillance data uncovered new risks. Similarly, on occasion, the FDA would require some special "tool" or intervention to improve a product's safety profile. Harm associated with medication remains the second most common type of incident in hospitals, as reported by the Clinical Excellence Commission. Health services actively review medication safety. The vast majority of medication errors result in no injury. A minor injury may result, for example, in a patient needing an increased level of monitoring. Even if incidents result in minor injury, managers and staff still take any errors very seriously, reviewing the actions around the incident and making improvements as a result. FDA's new concepts for risk management amount to a "cultural shift" in the logic of drug approval and the FDA's role. The key events that led to this change can be traced to a series of reports that highlighted the need for improved medical safety. In 1999, the IOM released a report entitled, "To Err is Human." This report reviewed the nature and cause of medication errors, estimating that up to 98,000 people died each year due to these errors. In their assessment, the IOM included both adverse drug reactions and human errors in drug administration. The report captured the attention of news reporters and the government. Headlines proclaimed alarm at the larger number of fatalities caused by medical errors. Consequently, there was a government-wide initiative started to develop methods and institute procedures to reduce medical errors. Statements made by FDA officials regarding some of these withdrawals suggested that the FDA no longer believed that passive oversight and re-labeling drugs with new warnings was sufficient. Furthermore, the FDA no longer believed that it was sufficient to identify safe conditions of use in the label and that healthcare professionals and patients had to comply with advocated directions of use for the drug to remain on the market.

Safety of concomitant treatment with Non-Vitamin K Oral Anticoagulants and SSRI/SNRI antidepressants

Introduction: Warfarin has been considered as a “gold standard” in the prevention and treatment of thromboembolic events since 1954. Since the introduction of direct oral anticoagulants in the last few years (NOAC-Non-Vitamin K antagonist Oral Anticoagulants) prescriptions volume for apixaban, edoxaban, dabigatran and rivaroxaban have been gradually surpassing warfarin. The benefits include: anticoagulation from day one, fixed daily dosing, elimination for the need of international normalised ratio (INR) monitoring, fewer interactions with food and co-administered medicines with reduced risk of bleeding and better overall life quality. Objectives: Assessing evidence for the safe use of Non-vitamin K Oral Anticoagulants (NOAC) with Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Noradrenaline Reuptake Inhibitors (SNRI). Method: Review of literature published between 2014 and 2016 was made using the key words: Selective Serotonin Reuptake Inhibitor, Serotonin and Noradrenaline Reuptake Inhibitors, apixaban, dabigatran, edoxaban, rivaroxaban, bleeding, interaction, depression with time description from 2014 to 2018. Evidence within the literature was then compared with guidelines from the National Institute for Health and Care Excellence (UK), British National Formulary (UK), Clinical Excellence Commission (Australia), Thrombophilia and Anticoagulation Clinic (USA) and Summaries of Product Characteristics (SPC). Results: 1. Serotonin plays a critical role in maintaining homeostasis. Use of SSRI/SNRI compromises its platelet reuptake increasing risk of bleeding. 2. Increased tolerability and safety of NOAC over Warfarin, although caution is advised when NOAC is used with SSRI/SNRI with less evidence suggesting pharmacodynamic interactions. 3. It is not recommended to use NOAC with strong CYP and P-gp inhibitors. Conclusions: With limited literature evidence, caution is advised when co-prescribed NOACs with SSRI/SNRI, especially with other cofactors and interacting medicines further increasing risk of bleeding. Keywords: SSRI, SNRI, NOAC, risk of bleeding, drug interactions

“In Safe Hands” – A costly integrated care program with limited benefits in stroke unit care

Given reported favourable outcomes of accountable care unit models of health care delivery (Taylor et al., 2017; Stein et al., 2015; Kara et al., 2015), the Clinical Excellence Commission of NSW has embraced “In Safe Hands” (ISH) to enhance coordination of care. ISH embraces the structured interdisciplinary bedside round (SIBR) component, for which reported outcomes include reduced length of stay (Taylor et al., 2017; Stein et al., 2015; Kara et al., 2015), possible reduction in overall costs of care (Kara et al., 2015), and enhanced patient and staff satisfaction (O’Leary et al., 2011). It is not yet clear whether the benefits of such a model are translatable to the Australian Health Care System (Hunyh et al., 2016) and/or established units with an already strong multi-disciplinary approach to patient care. The purpose of this prospective cohort study of 200 participants was to assess the effect(s) of implementation of ISH in a stroke unit of a tertiary hospital in Sydney, Australia.Data on length of stay, re-admission rates, adverse events, as well as patient and nursing satisfaction, were collected pre and post implementation.There was no significant difference in length of stay in median days (5 (IQR 2–7) versus 4 (IQR 2–6), P = 0.55) or incidence of adverse events (10% versus 12%, P = 0.82). Stroke outcome disability scores were not affected by the intervention. There were no significant differences overall in reported patient and nursing satisfaction. Implementation of the ISH program cost approximately AUD$ 1805/week (USD$ 1365) in wages.The ISH program was a costly intervention of limited benefit in a well-established acute stroke unit. We here discuss potential reasons for the failure of this intervention to achieve its primary aim in this setting.

NSW ambulance - Make ready model environmental cleaning: The fight against healthcare associated infections

Introduction: The NSW Ambulance Make Ready Model (MRM) is an innovative ambulance environmental cleaning solution that has been implemented into nine ambulance superstations throughout the Sydney Metropolitan Area. This new way of conducting business has provided a platform to introduce refreshed standards for environmental cleaning specifically for the ambulance. Dedicated logistics staff clean ambulances using evidence-based cleaning practices to achieve hygiene standards in accordance to both the Clinical Excellence Commission and Centre for Disease Control & Prevention assessment guidelines for a health environment.

665 - How Clean are We? Impact of Education on Cleaning Outcomes in the Pediatric BMT Setting

Topic Significance & Study Purpose/Background/Rationale: Infections continue to be the largest cause of morbidity and mortality in the blood and marrow transplantation (BMT) setting. Immunosuppression from conditioning regimens and delayed immune recovery make the patient vulnerable to both opportunistic infections and healthcare associated infections (HCAIs). Therefore, infection prevention strategies are essential to help minimize their incidence. Working towards reducing HCAIs, the state of New South Wales (NSW) in Australia released a Health Policy Directive (HPD) standardising environmental cleaning across all public health hospitals, including “extreme risk” areas like pediatric BMT units. We utilized the Clinical Excellence Commission (CEC) audit tool as defined in the HPD to ensure defined acceptable quality levels (AQL) were achieved. Based on these guidelines preventative interventions were put in place to aid the reduction of HCAIs in the BMT setting. Methods, Intervention, & Analysis: In 2013, trained personnel commenced inspections of BMT rooms both internally and externally, as per the CEC audit tool. Mandatory audits and their frequency were commenced as defined in the HPD. A time in motion study was also initiated to observe cleaning of BMT rooms in real time. Standard operating procedures were reviewed and practical teaching sessions using simulation training (SIM), were rolled out to cover the step-by-step instructions of cleaning a BMT room to domestic service personnel, including the use of personal protective equipment (PPE). Findings & Interpretation: External auditing demonstrated improvement in the AQL for environmental cleaning from 60% compliance in 2013 to 95% compliance in 2016. By the use of education in the form of SIM training, improvement in the standard of cleaning and disinfection of the BMT rooms was able to be demonstrated. Discussion & Implications: By implementing continued education sessions every 6 months alongside regular auditing, the unit will maintain a high level of environmental cleaning standards to minimize HCAIs in the pediatric BMT patient.

Between the flags: implementing a safety-net system at scale to recognise and manage deteriorating patients in the New South Wales Public Health System.

In 2005, the Clinical Excellence Commission (CEC) found that unrecognised patient deterioration remained an important problem in New South Wales (NSW) public hospitals. The challenge was to design and implement an effective and sustainable safety-net system in all 225 NSW public hospitals. The CEC's system was designed in collaboration with a broad coalition of partners, including clinicians, managers, system administrators and collaborating agencies. A five-element system comprising governance, standard calling criteria in standard observation charts, two-level clinical emergency response systems (CERS) in each facility, an education programme and evaluation, was designed for state-wide implementation. This system was called 'Between the Flags' (BTF). Implementation was led by the CEC on behalf of a NSW coalition, and commenced in January 2010 with the implementation of the Standard Adult General Observation Chart, awareness training for all staff and a CERS in each facility. Since the introduction of BTF, the cardiac arrest rate has declined by 42% (P < 0.05) and the Rapid Response rate has increased by 135.9% (P < 0.05) in NSW. The strength of staff support for BTF has grown with the proportion of respondents strongly agreeing that BTF has benefitted patient safety more than doubling from 21% to 44%, and overall agreement rising from 68% to 82% between 2010 and 2012. Key success factors are a focus on governance, standardisation of observation charts and striking the right balance between a rule-based approach and individual clinical judgement.

Implementing the Clinical Excellence Commission (CEC) criteria lead urinary catheter removal protocol in a major rural facility

Implementing the Clinical Excellence Commission (CEC) criteria lead urinary catheter removal protocol in a major rural facility

ISQUA16-2904“BEYOND PROJECTS” – A SYSTEMIC APPROACH TO IMPROVING QUALITY, PATIENT-FOCUSSED CARE

To develop, implement and evaluate a system-wide Challenge with the aim of improving safety and quality. The Clinical Excellence Commission (New South Wales (NSW), Australia) developed a Challenge for health care services based on the available evidence about crucial organizational attributes. Work on ‘the Challenge’ was undertaken with the aim of achieving long-term systemic and organizational improvements in safety and quality in health care [1 …

A pilot programme of clinical practice improvement for future consultant doctors.

To provide junior doctors with tools to improve patient care in their workplace, a partnership was developed between the Clinical Excellence Commission (CEC) and the Royal Australasian College of Physicians (RACP) to help trainee consultants carry out clinical practice improvement (CPI) projects during clinical work. Based on a patient-care problem they wished to resolve, trainee consultants attended a 2-day face-to-face workshop to learn quality-improvement methods, describe their proposals and refine them using CPI methodology. They were provided with continuing supervision, participated in a mid-point review and were responsible for driving their projects. Trainee consultants attended a 2-day face-to-face workshop to learn quality-improvement methods RESULTS: Examples of five projects are: reducing mislabelled specimens leaving an emergency department, from 82 in the baseline period to 18 following the intervention; creating a multidisciplinary team to reduce hypoglycaemic episodes on a diabetic ward, from 23 episodes at baseline to three episodes over the same time period after the intervention; establishing an acute paediatric review clinic that reduced avoidable admissions of pneumonia by 74percent; providing 100percent of patients in a palliative care unit with an effective pain-management plan; developing an education package to increase staff confidence in recognising and responding to anaphylaxis in children, producing an increase in confidence from 51percent at baseline to 100percent after the intervention. Involving a learned college such as the RACP in patient-care improvement, with educational input from a partner organisation, shows how junior staff can become effective leaders in improving patient care.

How should we deal with missed test results and pending results at discharge?

The failure to follow-up test results is an area of patient safety risk which can have major consequences for the quality of care, potentially leading to missed diagnoses and sub-optimal patient outcomes. Previous research has shown that pathology and imaging test results fail to be followed up in 20–62% of inpatients, and in up to 75% of patients treated in an emergency department.1 An investigation of reported clinical incidents undertaken by the NSW Clinical Excellence Commission in 2012 revealed that 11% (3/27) of incidents resulting in serious harm (e.g., patient death) and 32% (24/75) of incidents with major consequences for patients were related to poor test result follow-up. Health information technology (IT) has a key role to play in the communication and follow-up of test results.1 Effective solutions must engage all stakeholders to arrive at decisions about who needs to receive the test results, how and when the results are communicated, and how they are acknowledged and acted upon. Reference1.Georgiou A, Lymer S, Forster M, et al. Lessons learned from the introduction of an electronic safety net to enhance test result management in an Australian mothers' hospital. J Am Med Inform Assoc 2014; 21: 1104–8.

Editorial: Interruptions and medication: Is 'Do not disturb' the answer?

Abstract

Root cause analysis of critical events in neurosurgery, New South Wales.

Adverse events reportedly occur in 5% to 10% of health care episodes. Not all adverse events are the result of error; they may arise from systemic faults in the delivery of health care. Catastrophic events are not only physically devastating to patients, but they also attract medical liability and increase health care costs. Root cause analysis (RCA) has become a key tool for health care services to understand those adverse events. This study is a review of all the RCA case reports involving neurosurgical patients in New South Wales between 2008 and 2013. The case reports and data were obtained from the Clinical Excellence Commission database. The data was then categorized by the root causes identified and the recommendations suggested by the RCA committees. Thirty-two case reports were identified in the RCA database. Breaches in policy account for the majority of root causes identified, for example, delays in transfer of patients or wrong-site surgery, which always involved poor adherence to correct patient and site identification procedures. The RCA committees' recommendations included education for staff, and improvements in rostering and procedural guidelines. RCAs have improved the patient safety profile; however, the RCA committees have no power to enforce any recommendation or ensure compliance. A single RCA may provide little learning beyond the unit and staff involved. However, through aggregation of RCA data and dissemination strategies, health care workers can learn from adverse events and prevent future events from occurring.

A multi-tiered approach to safety education

The World Health Organization has recognised that patient safety education should begin at the undergraduate level. This should not just be for medical students, but for all students in the health professions. Although all students in the health professions should receive a basic grounding in patient safety, there is also a need to develop future leaders in this field. As a result of widespread early student exposure, some students may become interested in learning more. It follows that a postgraduate approach is also needed. The New South Wales Clinical Excellence Commission (CEC) has initiated a tiered approach to patient safety education by providing patient safety teaching in medical, nursing and allied health schools. Teaching is provided in cooperation with the host university, and is interactive, using a mixture of interactive lectures, video clips, films and break-out groups to discuss scenarios and feedback from students to their peers about the concepts they have discussed. For medical graduates, the CEC has initiated patient safety teaching in the early postgraduate years, and provides an elective in patient safety for trainee doctor specialists as part of their accredited training. This process helps to identify and mentor future medical leaders in this field. In addition to teaching the core principles of patient safety to a wide range of students in the health professions, an approach for developing future leaders will provide additional opportunities for motivated students and create opportunities for continuing development in the early postgraduate years and beyond.