Partnering to Improve Care at the Liberty Campus
The expanded Liberty campus opened in August of 2015. During the successful first year, Hospital Medicine led the way in providing high quality, family-centered safe care to a growing number of patients and their families. To meet the demands of this new campus, Hospital Medicine has developed an innovative model for care to meet the needs of patients of higher acuity and complexity, that includes residents, nurse practitioners, and telemedicine-facilitated co-management of high acuity patients with the Division of Critical Care Medicine
. Hospital Medicine physicians and nurses have also partnered with the Division of General and Thoracic Surgery
, the Cancer and Blood Diseases Institute
and multiple divisions within the department of pediatrics to provide services at Liberty for patients requiring specialty care. This has resulted in growth in the number of patients receiving care at the Liberty campus and allowed more families the convenience of staying closer to home while still accessing the world-class clinical services of Cincinnati Children's Hospital Medical Center.
Reducing Length of Stay After Scoliosis Surgery
Dr. Blair Simpson, MD
, co-led a multidisciplinary team representing the Divisions of Orthopaedics
and Hospital Medicine, as well as a A3N inpatient unit to standardize care for adolescents following corrective surgery for idiopathic scoliosis. The team created a standardized post-operative care algorithm that built upon prior Hospital Medicine partnerships focusing on standardized approaches to respiratory care, urinary retention, venous thromboembolism risk assessment, and surgical infection prevention. Implementation of the post-operative algorithm reduced the length of stay from 3.7 to 3.0 days, which translates into a substantive cost savings for patients and the health system. Work is ongoing to spread this phase-based framework to other orthopaedic conditions as well as other surgical conditions across the institution.
Family Engagement and Partnership in Research
Patients and families can provide meaningful contributions throughout the research process. Most studies have focused on engaging parents of children with chronic illness. No studies have documented the feasibility or acceptability of family engagement of acutely ill children in research. Hospital Medicine faculty, including Drs. Samir S. Shah, Jeffrey Simmons, Andrew Beck, Katherine Auger, Angela Statile, and Christine White, partnered with the Department of Patient Services colleagues to pioneer a novel approach of serial, short-term focused engagement of families of children hospitalized with acute illnesses such as pneumonia, dehydration, and seizures. This approach allowed integration of the invaluable perspectives of families into research questions, intervention design, and outcome measurement in the Hospital-to-Home Outcomes (H2O) study which seeks to improve patient outcomes and reduce hospital readmissions. A grant from the Patient-Centered Outcomes Research Institute (PCORI) supports this work.
Detecting medical errors is important for identifying causative factors and measuring the effectiveness of prevention strategies. In the patient and family–centered I-PASS study, Dr. Jennifer O’Toole and colleagues found that including families in safety reporting increased overall error and adverse event detection, a finding that represents an important safety innovation. Families may identify otherwise unrecognized errors, providing new opportunities for prevention. A grant from the PCORI supports this work.
Children with developmental disabilities, or who require medical technology such as feeding tubes or tracheostomies, are at increased risk of emergency department visits, hospitalization and long stays once hospitalized. These children’s families not only are experts in their children and their children’s illnesses, but they also acquire substantial experience in how hospital care works. Unfortunately, the system of care in the hospital is not designed to fully benefit from these families’ expertise with resulting inefficiencies, confusion and error. Drs. Patrick Brady, Samir S. Shah and colleagues have partnered with families of children with medical complexity to better understand families’ experience and then co-design interventions to improve hospital care, experience and patient safety. A grant from the Agency for Healthcare Research and Quality supports this work.
Advancing Scientific Scholarship Nationally
Hospital Medicine faculty play an instrumental role in advancing scientific scholarship through leadership roles in leading scientific journals. Drs. Katherine Auger, MD, MSc
, and Erin Shaughnessy, MD, MSHCM, joined the editorial boards of the American Academy of Pediatrics
flagship research journals, The Journal of Pediatrics
and Hospital Pediatrics
, respectively. The Journal of Hospital Medicine
, the official journal of the >15,000 member Society of Hospital Medicine
selected Dr. Joanna Thomson, MD, MPH
, as associate editor and promoted Dr. Samir S. Shah, MD, MSCE
, to senior deputy editor. The Journal of Clinical Ethics
, a journal written by and for physicians, nurses, attorneys, ethicists, and others whose decisions directly affect patients selected Dr. Armand Antommaria, MD, PhD, FAAP
, to the editorial board.
Safety Accreditation and Regulatory Readiness
In July, Dr. Jeffrey Simmons, MD, MSc
, became the institutional safety officer as well as the executive co-lead with Dr. Mary Sitterding from the Department of Patient Services. With an integrated mission of being Always Ready, Always Safe, and guided by both the care and people pillars of SP20, he will partner with medical and patient services operational leaders to reduce events of serious harm to patients and staff, and help improve our learning system to support regulatory readiness. In addition, he will partner with faculty in the James M. Anderson Center for Health Systems Excellence
to further develop Cincinnati Children's portfolio of safety-related research to expand the impact of the great work done here to improve patient and staff safety.
Excellence of Division Faculty and Trainees
Dr. Laura Brower, MD, received a Novice Research Award from the Gerber Foundation to implement a novel evidence-based pathway for the care of young infants with fever with a particular focus on standardizing the assessment for herpes simplex virus, an uncommon but serious infection that can cause neurologic disability or death.
Dr. Catherine Forster, MD, elected president of the fellows and junior section of the Society for Pediatric Research (SPR). She also co-chairs the SPR mentoring committee, and in this role, advocates for the needs of young investigators. The SPR fosters the research and career development of investigators engaged in creating new knowledge that advances the health and well-being of children. Dr. Forster is the recipient of two prestigious grants. The New Investigator Scholars Award from the University of Cincinnati Center for Environmental Genetics supports her work following molecular changes in bacteria from the urine of children who require clean, intermittent bladder catheterization to document the association of antibiotic use with these genetic changes. The Novice Research Award from the Gerber Foundation will allow her to investigate the association between a specific immune deficiency in the genitourinary tract and recurrent urinary tract infections in children.
Dr. Erik Hoefgen, MD, gave the American Academy of Pediatric Presidential Plenary presentation at the annual meeting of the Pediatric Academic Societies. His presentation provided insight on healthcare utilization for children with chronic illnesses such as diabetes, depression, and asthma.
Dr. Anita Shah, DO, received the Presidential Scholarship Award for Child Health Policy from AcademyHealth, a leading national voice in health policy and healthcare financing. She also received a Young Investigator Award from the Academic Pediatric Association to study how resilience may modify the effect of parental adverse childhood experiences on outcomes such as the parent’s ability to cope with the stress of their child’s hospitalization and subsequent healthcare utilization.
Current and former fellows. Drs. Catherine Forster, Katherine Auger, MD, MSc, and Amanda Schondelmeyer, MD, received loan repayment Awards from the National Institutes of Health (NIH). These awards support exceptional young investigators engaged in research that supports the NIH mission.
The Division of Hospital Medicine faculty and fellows received the prestigious 2015-2016 Division Teaching Award from the graduating senior resident class for the Division’s excellence in and commitment to resident education.
Dr. Katherine Auger received the 2016 Nemours Child Health Service Research Award from AcademyHealth. This award recognizes a body of scientific work from emerging scholars in the field of child health services research. AcademyHealth focuses on advancing the fields of health services research and health policy through the transfer of relevant information across the research and policy arenas.
Dr. Andrew Beck, MD, MPH, received recognition as part of the Forty Under 40 Class of 2016 by the Cincinnati Business Courier. This annual award program recognizes young professionals in Ohio, Kentucky, and the Indiana Tri-State area who have reached major milestones in their careers, and who also made significant contributions to the community.
Dr. Patrick Brady, MD, MSc, received the Cincinnati Children's Junior Faculty Clinical Care Achievement Award for his leading role in improving patient safety and engaging families in initiatives to improve hospital care. His appointment as a core faculty member of the new Academic Pediatric Association’s Quality and Safety Improvement Scholars Program recognized his national expertise in patient safety. Dr. Brady also received the Best Faculty Oral Abstract Award from the Academy for Healthcare Improvement for his work titled “Developing an end-user designed data display for oxygen trends: an ethnographic study.”
Dr. Craig Gosdin, MD, MSHA, received the honor of identifying and presenting the top articles in the field at Pediatric Hospital Medicine (PHM), an annual international scientific meeting jointly sponsored by the American Academy of Pediatrics, the Academic Pediatric Association, and the Society of Hospital Medicine.
Dr. Karen Jerardi, MD, MEd, is leading the national group of PHM fellowship directors in the development and dissemination of a standardized fellowship curriculum. This curriculum is already utilized in the subspecialty certification application process with the American Board of Pediatrics and American Board of Medical Specialties. Moving forward, this curriculum will be the standard used for Accreditation Council for Graduate Medical Education (ACGME) accreditation of pediatric hospital medicine fellowships nationwide.
Dr. Jennifer O’Toole, MD, MEd, and colleagues received the 2015 Pediatric Hospital Medicine Award for the Best Paper in Quality and Patient Safety at the 2015 annual Pediatric Hospital Medicine Meeting. This award presented jointly by the American Academy of Pediatrics, the Academic Pediatric Association, and the Society for Hospital Medicine. Dr. O’Toole and colleagues demonstrated that implementing a systematic approach to patient hand-offs (i.e, when one physician assumes the care of a patient from another physician) reduces preventable errors by one-third.
Dr. Samir S. Shah, MD, MSCE, received the 2015 Pediatric Hospital Medicine Award for Research Excellence. This inaugural award presented jointly by the American Academy of Pediatrics, the Academic Pediatric Association, and the Society for Hospital Medicine to recognize Dr. Shah’s important research contributions on childhood pneumonia and systems of hospital care. Dr. Shah is also co-editor of The Philadelphia Guide: Inpatient Pediatrics, 2nd edition (McGraw-Hill Professional, 2016, ISBN-13: 978-0071829212), a handbook that provides practical guidance to improve the care of hospitalized children.
Dr. Brian Volck, MD, is author of Attending Others: A Doctor’s Education in Bodies and Words (Cascade Books, 2016, ISBN-13: 978-1620327289). Attending Others is a highly personal account of what Dr. Volck learned about medicine after he completed his formal education. He recounts how through his own experiences, he learned to listen to children unable to talk, to assist in healing when cure is impossible, and to love those whose life and experiences are radically different from his own.