more common practice with the emergence of Accountable Care Many of these quality metrics should be subanalyzed by patient characteristics such as insurance status or ethnicity to assure equitability of care In this new edition, goals of emergency care will stress many of these quality domains for each chapter In order to provide high-quality care for children, EDs must adopt the principles of high-reliability organizations and acknowledge that providers are human beings who may fail to consistently communicate well and are at risk for cognitive errors, especially in a stressful environment A brief discussion of these issues and how this textbook can be used to aid the clinician follows High Reliability and Patient Safety KEY POINTS Clinicians are human beings who will always make mistakes; everyone must be aware of this and accept suggestions from or seek colleagues’ assistance and defer to the person with the most expertise Report and take action on near miss events—this will prevent future errors A standardized, structured approach to case review is important for a learning system and promotes a supportive culture High-reliability organizations are ones that operate under trying conditions yet manage to have relatively low frequency of safety events The ED environment, by nature, is perpetually operating under challenging conditions with no regulation of patient arrival or acuity and frequent workflow interruptions Furthermore, children add unique challenges such as the lack of standardization of dosing and equipment, the inability of young or disabled children to communicate their complaints, and unique developmental and physical characteristics that may affect diagnostic and treatment strategies To provide high-quality care for children in EDs, the principles of highreliability organizations must be embraced ( Table 1.3 ) Such organizations