Quality and Safety at Hopkins Children’s
In
the coming decades, Hopkins Children’s will lead a radical transformation of
modern medicine. Our researchers have learned that providing high quality and
safe healthcare requires consciously built smart healthcare systems. Such work
requires maximal use of information technology and human factors engineering, the
discipline of applying what is known about human capabilities and limitations
to the design of products, processes, systems, and work environments. Identifying a new therapy is but a
fraction of the work needed to ensure that the right patients receive that
therapy at the right time, right dose and for the right reasons every time. This requires system redesign with a focus on
patient safety.
Looking at each child as
a unique individual – with a unique genetic makeup, living in and influenced by
a unique environment – our goal is to prevent harmful medical errors and ensure
reliable, high quality care to all patients at every visit. One of the most brilliant illustrations of
this vision is the bold work being done now in by our Division
of Quality and Safety, a leader across the US in the
scientific study of patient safety and the development of new systems of care
with proven better outcomes for children.
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What is Pediatric Patient
Safety?
The Institute of Medicine estimated in 1999 that nearly 100,000 Americans experience a
medical error each year. For children,
the risks of medical care are significantly increased by their dependency on
adults for care and the critical need to quantify medications, fluid, and
equipment based on body size. For
example, given the propensity for mathematical errors in these body size-based
calculations, some studies estimate that 10-13% of prescriptions for children
are in error. Unfortunately, since
children represent only 5-10% of the patient population in the US, most commercially-developed
solutions to prevent medical errors are not developed to lower the risk for pediatric
medical errors.
Moreover, while the last
decade has seen a significant increase in safety-oriented activities by
accrediting agencies, states, and others, evidence that these activities have
truly decreased rates of medical errors is still missing. Although the science of measuring and
improving safety is growing rapidly, clearly more needs to be done,
particularly for the most vulnerable population, our children. Children
are our future, and it is vital that healthcare providers for children lead the
development of reliably safer healthcare for children. Such work has become a scientific discipline,
requiring academic training, resources, and research.
The Division of Quality and Safety
The Division of
Quality and Safety in the Department of Pediatrics at Johns Hopkins University
School of Medicine is one of the first academic divisions in the U.S. to
scientifically evaluate and elucidate patient safety risks for children. Division Director, Marlene R. Miller, M.D., is a pioneer in pediatric patient safety and healthcare quality through her
work in advancing this scientific field of research, developing programs
internally and nationally, and advocating tirelessly for pediatric patient
safety at the national level. As a
national leader in identifying, analyzing and learning from safety defects in
pediatric healthcare, her efforts to solve these safety defects have changed
medicine with respect to pediatric healthcare quality and safety.
In 2003, Miller launched this division and then developed it to its present status with three
additional full time faculty, two of whom are seeking formal PhD training under
her mentorship. With Miller’s
guidance, multiple additional faculty throughout the Department of Pediatrics are
broadening their careers by focusing on identifying and solving patient safety
risks for children in their clinical areas. David Bundy, M.D., a general pediatrician and one of Miller’s first
recruits to the Division, has received funding from a variety of sources,
including the Robert Wood Johnson Foundation, to investigate the quality and
safety or medical care provided to children with chronic conditions, including
sickle cell disease. While Johns Hopkins
has historically conducted pioneering basic and clinical research in sickle
cell disease, the potential benefits of this early work will not be truly realized
until the resulting medical discoveries can be used safely and reliably for all
children with sickle cell disease.Bundy, under Miller’s guidance, is working to connect these new discoveries to improved health for children in
Baltimore and beyond. Michael Rinke, M.D., was recently awarded a NIH-sponsored KL-2 grant to investigate prevention strategies for pediatric central
line infections in the outpatient setting. Working with Miller and a
multidisciplinary team of nurses, doctors and technicians, Rinke’s projects
aim to eliminate these serious infections in a particularly vulnerable
population: pediatric oncology patients.
NACHRI & Quality Transformation
Nationally, Miller’s pioneering work as a researcher and ‘hands on’ leader for pediatric
patient safety and healthcare quality fueled her selection from a national
search to serve the national and international role of Vice President, Quality
Transformation, at the National Association of Children’s Hospitals and Related Institutions (NACHRI) since 2007. NACHRI
is an association of children’s hospitals with 218 members in the United
States, Canada, Australia, the United Kingdom, Italy, China, Mexico, and Puerto
Rico. Her key activities include
developing and chairing efforts involving multiple children’s institutions to
improve healthcare quality and safety, best exemplified by the over 60
Pediatric Intensive Care Units (PICUs) working with NACHRI to eliminate
catheter-associated blood stream infections.
Her NACHRI quality transformation collaborative efforts now involve 67
PICUs, 28 pediatric hematology-oncology divisions, 22 pediatric emergency departments,
and 30 pediatric nephrology divisions. The work of Miller and her staff has been chosen by the American
Board of Pediatrics as one of only four highest quality pediatric quality
improvement efforts across the country after a comprehensive national
search. Most recently, under Miller’s leadership and national role, the Division has submitted an
application to the Department of Health and Human Services as a formal Center
of Excellence in Pediatric Quality and Patient Safety. This brings to bear the expertise she has developed
and fostered, not only in the School of Medicine and the Bloomberg School of
Public Health at Johns Hopkins University but also NACHRI and the more than 20
other national organizations that partnered with Dr. Miller in this application
to become a national resource for identifying and solving quality and safety
problems for children.