* Abbreviations: AE — : adverse event GAPPS — : Global Assessment of Pediatric Patient Safety HAC — : hospital-acquired condition SPS — : Solutions for Patient Safety Nearly 2 decades after the pervasive issue of iatrogenic harm was thrust into the public sphere by the landmark publication of To Err is Human by the National Academy of Medicine (formerly the Institute of Medicine),1 collective efforts to improve patient safety have become ubiquitous, particularly in the inpatient setting. Although researchers in several pediatric-focused multi-institutional collaboratives have begun to address this issue and have made laudable gains,2,3 there is concern that patient harm may still be a significant and underestimated reality.4–6 One potential factor behind underreporting of adverse events (AEs) is the reality that most reporting systems rely on voluntary or passive error reporting.7 Tools that use “triggers,” including some that are pediatric-specific, are used to actively detect AEs via automated processes and have been found to detect errors at a higher rate than the usual passive methods.8–10 In this issue of Pediatrics , Stockwell et al11 report the use of their Global Assessment of Pediatric Patient Safety (GAPPS) trigger tool used to measure trends in AEs over a 5-year period (from January 2007 to December 2012). The authors randomly selected and retrospectively reviewed 3790 individual patient admissions and used GAPPS to filter out AEs from 16 teaching and nonteaching children’s institutions. Their findings are sobering. A total of 414 AEs representing 19.1 out of 1000 patient … Address correspondence to Ricardo A. Quinonez, MD, Section of Pediatric Hospital Medicine, Texas Children’s Hospital, 1102 Bates Ave, FC 1860, Houston, TX 77030. E-mail: raquinon{at}texaschildrens.org