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Today's physician must not only be aware of continuous change in health care, but be involved in that change itself with the goal of continuous improvement. A commitment to improvement involves the setting of goals as well as the ability to recognize the difference between improvement and mere change. With a commitment to quality in mind, it is also essential to recognize what portions of process interfere with improvement, and development team methods to change and overcome those limitations., Physicians must be ready to assume an active role in the design, implementation, and improvement of emerging models of health care delivery. Knowledge and skill in continuous improvement prepare them to engage seriously in the processes of change, on the basis of the same scientific principles they always have relied on in the use of evidence to improve outcomes. This includes include the ability to 1) identify the health needs of the individuals and communities for which they provide health services; 2) assess the impact of current practice with appropriate outcome measures; 3) discover what in the process of health care may be contributing to less than desired outcomes; 4) design and test interventions to change the process of care to improve outcomes; 5) act as an effective member of the interdisciplinary team required to complete these tasks; and 6) consider ethical principles and professional values when making decisions about change in health services delivery. Graduate medical education presents special opportunities and challenges for learning about continuous improvement. Early experiences at Rainbow Babies and Children's Hospital in Cleveland and Children's Hospital in Boston suggest how we might prepare pediatricians and other physicians to create positive change and continually improve health care. Pediatrics 1998;101:768-774; managed care, graduate medical education, total quality management., ABBREVIATIONS. PDSA, Plan-Do-Study-Act (cycle); GME, graduate medical education; MDI, metered-dose inhaler. When young physicians earn their medical degrees, they also earn a special responsibility for the health of patients, families, [...]

The Rochester criteria for the evaluation of infants with fever may accurately identify infants who are unlikely to have serious bacterial infections (SBI). The Rochester criteria, also called the low-risk criteria, relies upon physical examination, patient history, and laboratory test results. Researchers studied 1005 healthy-looking infants with fevers who were two months old or younger. Of these patients, 511 satisfied the low-risk criteria while 494 did not. Laboratory testing identified SBI in 1% of infants categorized as low-risk. Twelve percent of infants who were not categorized as low-risk were diagnosed with SBI. Almost 99% of infants identified as being at low-risk will not have SBI. Based upon these findings, infants with fever who are two months old or younger and fit the low-risk criteria should be managed by observation only.