Division Photo
Row 1: M Mahabee-Gittens, W Pomerantz, L Johnson, S Iyer
Row 2: C Dixon, T Bryzkowski, L Babcock, C Holland, A Rinderknecht, R Ruddy
Row 3: R Shapiro, J Luria, J Setlik, J Gonzalez del Rey, M Mittiga
Division Highlights
Evie Alessandrini, MD MSCE
Dr. Alessandrini's focus is on outcomes and performance measurement in pediatric emergency care. Using the infrastructure of the Pediatric Emergency Care Applied Research Network, she has just completed a 3-year HRSA funded project to create a balanced report card for EDs that care for children and this work has resulted in two publications this year. Dr. Alessandrini also served as a guest editor for the June issue of Clinical Pediatric Emergency Medicine that was focused on Improving Quality in Pediatric Emergency Care. In this issue, she co-authored manuscripts on Measuring Quality in Pediatric Emergency Care and The Acute Care Model: A New Framework for Improving Quality in Pediatric Emergency Care.
Lynn Babcock, MD
Dr. Babcock started her mentored career KL2 research project under the mentorship of Shari Wade PhD, PMR, which focuses on detecting axonal injury in children with mild traumatic brain injury through the use of advanced MRI imaging, functional outcomes and proteomics. She has developed an extensive collaborative network by becoming a member of the translational center (CCTST), the proteomics core, the neuroimaging consortium (PNRC), and the injury center (CCIC). Her key accomplishments include the 2011 Clinical and Translational Research Meeting Scholars Abstract Award for her work on post-concussion syndrome and her publication with PECARN on cervical spine injuries in children.
Terri Byczkowski, PhD
A validated measure of the quality of family-centered care in Pediatric Emergency Medicine does not currently exist. Terri Byczkowski’s research identifies and defines dimensions of family-centered care in terms of provider behaviors and system characteristics most important to them. Her research has shown that while there is overlap with existing measures of family-centered care in other venues, aspects of care unique to pediatric emergency medicine will need to be addressed.
Cinnamon Dixon, DO MPH
Dr. Dixon continued her dog bite prevention research with a study testing a video intervention in the CCHMC ED. Working with the division of Global Health and Dr. Mark Steinhoff, she also developed collaborations with a Brazilian academic institution and will initiate two projects focused on pediatric injury prevention and trauma surveillance. She had oral presentations at the World Safety Conference, Society of Academic Emergency Medicine, and Prevention of Brain Injury Among Ohio Youth Symposium; she submitted two NIH grants, and had her manuscript regarding dog bite education needs accepted for publication in Journal of Pediatrics.
Gary Geis MD, Mary Patterson, MD, MEd
Dr Geis and Patterson have continued their work in medical simulation and collaborated with several divisions on internally funded research / safety projects. In partnership with Dr. Derek Wheeler of Critical Care they were funded by AHRQ to study the development of expert skills in the recognition of sepsis which will help train more junior residents, fellows and faculty in the pediatric setting.
Michael Gittelman, MD and Wendy Pomerantz , MD MS
Dr. Gittelman has been collaborating with Wendy Pomerantz and Richard Falcone, Trauma Surgery, on developing a comprehensive injury center at CCHMC. Members from other Divisions help make up the CCIC steering committee, including: Shari Wade and Brad Kurowski in Physical Medicine and Rehabilitation, KJ Phelan in the Anderson Center for Health System Excellence and General Pediatrics, Charles Mehlman in Orthopedics and Earl Siegel of the Drug and Poison Information Center.
Jacqueline Grupp-Phelan, MD MPH
While many young patients at risk for suicide present to the ED following suicide attempts or in situations of extreme suicidal crises, other patients at risk for suicide go unrecognized, and therefore untreated, in the ED. Once discharged, 30% of suicidal adolescents return to the ED with another crisis within six months of the sentinel event. Currently, no evidence-based standards exist for appropriate screening and post-screening interventions in order to improve outcomes for patients presenting in EDs who are at elevated risk for suicidal behavior. Dr. Grupp-Phelan has finished a promising pilot study to engage youth at risk for suicide into services and is working with a multidisciplinary team to bring efficient suicide screening into the ED.
Carolyn Holland, MD MEd
Dr. Holland's focus is on adolescent health and sexually transmitted infections. She recently presented results demonstrating differences in STI testing rates among pediatric ED patients. Additionally, she is a Co-Investigator on the Outcomes Research Grant with Dr. Reed to improve results notification and partner notification and treatment among STI positive adolescents in the ED setting. She is collaborating with Dr. Michael Lyons of the University Of Cincinnati Department of Emergency Medicine on a retrospective review of missed opportunities for earlier HIV diagnosis among adolescent ED patients. Finally, she and Dr. Joyce Lippe recently received a grant to begin an expanded HIV testing program in the ED at CCHMC.
Srikant Iyer, MD, MPH
Dr. Iyer has focused on process and systems improvement over the past year. On a local level, he has worked to improve acute ED pain management resulting in a pain management report being published in the inaugural "Quality Reports" section in Pediatrics. This academic year he led and completed an improvement initiative in the ED fast track, On a national level, he has worked to improve outcomes of children with hypoplastic left heart syndrome, with several manuscripts published over this past year.
Benjamin Kerrey, MD
Dr. Kerrey and his team have completed an initial review of the process and outcomes of Rapid Sequence Intubation (RSI) in our ED, noting higher than reported adverse effects. They have refined a process of case identification, video review, and serial simulation to assess and improve systems of care in the trauma bay. The team is now planning to apply a version of that process to improve the performance of RSI in the ED.
Melinda Mahabee-Gittens, MD MS
Melinda Mahabee-Gittens' research centers on developing and evaluating the efficacy of PED-based youth tobacco prevention interventions and adult tobacco cessation interventions. Most recently, she has been completing work on an NIH-funded study that involves the complex analysis of a large secondary dataset to explore how race/ethnicity affects family factors that contribute to adolescent's smoking initiation and progression over time. She is also developing research strategies to seamlessly incorporate tobacco screening and cessation counseling into the pediatric healthcare system.
Jennifer Reed, MD
Over the past fiscal year, Dr. Reed received a BIRCWH (Building Interdisciplinary Research Careers in Women's Health) K12 grant as well as an institutional Place Outcomes Award grant to execute a quality improvement research project to improve results notification and partner notification and treatment among STI positive adolescents in the ED setting. This project is a collaborative effort with Adolescent Gynecology (Jill Huppert, MD), University Hospital Division of Emergency Medicine (Carolyn Holland, MD) and the Anderson Center for Health Systems Excellence (Evaline Alessandrini, MD, MSCE).
Richard Ruddy, MD
Dr. Ruddy has been the site PI in the Pediatric Emergency Care Applied Research Network (PECARN) for CCHMC since the network’s beginning in 2001. This academic year several primary study papers have been published including work on cervical spine injury (Babcock, Reeves), Head Injury (Glass), Quality Measures (Alessandrini, Ruddy). Other studies in the initial completion phase include the Decision rule for Intra-Abdominal Injuries where presentations and papers are submitted (Kerrey). CCHMC is the leading site enrolling febrile infants in the Biosignature Study assessing RNA against type of infection. Dr. Ruddy remains an active investigator within the Quality Measures, Safety and the Respiratory / Asthma Work Groups. He is the new PI for a three-hospital node in the network funded with an EMSC Network Development Demonstration Project with Medical College of Wisconsin and Washington University School of Medicine (anticipated $2.5 million over 4 years).
Daniel Schumacher, MD
Dr. Schumacher is just completing a project in which he conducted cognitive interviews with pediatric residents at CCHMC and Dayton Children's to determine how they understand, interpret, and respond to the Pediatrics Milestones. The Milestones are documents that are being developed through a collaborative effort of the ACGME and ABP and will take the next steps in GME outcomes assessment in pediatrics. Preliminary data from this study was presented as platform presentations at the Association of Pediatric Program Directors (APPD) and Pediatric Academic Societies meetings and poster presentations at the APPD and ACGME meetings earlier this year.
Richard Strait, MD
Dr. Strait continues to research the immunology surrounding antibody mediated disease with focus on transfusion related acute lung injury, anaphylaxis and various immunoglobulin isotypes roles in prevention of disease. Recent publications (see below) have been in collaboration with various other investigators outside of Emergency Medicine.
Nathan TImm, MD
Dr. Timm had eight manuscripts accepted for publication with emphasis in three areas - clinical practice, ED utilization and disaster preparedness. Clinical practice studies included work with adolescent male STIs and pediatric pneumothorax. ED utilization projects included ED left without being seen population, pregnant teens, adult PED visits and ED crowding impact on clinical care in febrile neonates. Finally, his disaster preparedness work described our hospital emergency management model at CCHMC.
Significant Accomplishments
Research
The Division of Emergency Medicine exceeded funding goals by submitting 23 grants as a primary site and seven as a subrecipient and obtaining four more via new faculty and industry. Cincinnati Children’s became a principal investigator within the national Pediatric Emergency Care Research Network (PECARN) along with partners St. Louis Children’s Hospital and Children’s Hospital of Wisconsin. Research stakeholders led by Jacqueline Grupp-Phelan, MD, MPH, held a research retreat resulting in a mandate for an improved mentoring plan and restructuring of institutional investment.
In clinical research, Lynn Babcock, MD, MPH, and Scott Reeves, MD, were authors on the landmark PECARN study on cervical spine injury, “Factors Associated with Cervical Spine Injury in Children after Blunt Trauma” (Annals of Emergency Medicine, Oct. 2010). Benjamin Kerrey, MD, Matthew Mittiga, MD, and Andrea Rinderknecht, MD, presented innovative work on resuscitation procedures, while Babcock presented pioneering work on mild traumatic brain injury. Gary Geis, MD, Derek Wheeler, MD, and Mary Patterson, MD, MEd, were funded by the Agency for Healthcare Research and Quality to develop expertise in sepsis identification through use of simulation.
In prevention research,a team directed by Grupp-Phelan led the division with funded grants and continues to publish important work in mental health screening, smoking prevention , cultural issues across ethnic groups and injury control.
In quality research, a team led by Evaline Alessandrini, MD, MSCE, and Reeves, presented work at the Pediatric Academic Societies conference, published in the first issue of Pediatrics devoted to quality (Iyer et al: “Use of quality improvement methods to improve timeliness of analgesic delivery”) and published two papers in the “Quality in Pediatric Emergency Medicine” issue of Clinical Pediatric Emergency Medicine (June 2011). Two division members (Holly Brodzinski, MD, and Jennifer Reed, MD) received Place Awards for institutional outcomes research. The first paper on quality measures in pediatric emergency medicine from Alessandrini’s EMSC grant was published in the May issue of Academic Emergency Medicine.
In educational research, Javier Gonzalez del Rey, MD, MEd, received funding on two grants to expand the primary care residency and hand-offs by pediatric residents. Faculty contributed to several excellent papers and to Fleisher and Ludwig’s5-Minute Pediatric Emergency Medicine Consult.
Clinical Program
Joseph Luria, MD, led a newly assembled clinical leadership team of physicians and APNs through a year of leadership development along with Scott Steel from the Education and Learning Department. This resulted in restructuring of administrators on call, improvements in clinical scheduling and new improvement teams, including a multidisciplinary team for patient experience. Faculty trained in improvement science – Brodzinski and Alessandrini – completed projects in management of abscesses with sedation and timely administration of antibiotics to febrile neutropenic patients. A multidisciplinary team focused on the care of acute pain significantly improved pain reassessment in acute fracture patients. Srikant Iyer MD, MPH, led a team that increased efficiency and productivity of our fast-track area. Our safety team has reduced the number of medication errors and there have been no serious safety events for 1,342 days through June 30, 2011. This was accomplished while treating more than 146,000 patients at two emergency departments and three urgent care sites.
Education and Faculty Development
Through the leadership of Javier Gonzalez del Rey, MD, MEd, the division held two half-day faculty development workshops that trained faculty on improvement science, budget development, clinical communication skills and conflict prevention and resolution.
