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Quality and Safety

This team of diverse professionals is needed to provide high quality and safe health careThe goal of the Division of Pediatric Quality & Safety, led by pediatrician Marlene Miller, front, is to prevent medical errors and ensure the highest quality of care to all patients at each visit.

In the coming decades, Johns Hopkins Children’s Center will lead a radical transformation of modern medicine. Our researchers have learned that providing high quality and safe health care requires consciously built smart health care 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, at the 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 by our Eudowood Division of Pediatric Quality and Safety, a leader across the United States in the scientific study of patient safety and the development of new systems of care with proven better outcomes for children.

What is pediatric patient safety?

The National Academies of Sciences, Engineering and 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 percent to 13 percent of prescriptions for children are in error. Unfortunately, since children represent only 5 percent to 10 percent of the patient population in the United States, 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. It is vital that health care providers for children lead the development of reliably safer health care for children. Such work has become a scientific discipline, requiring academic training, resources and research.   

The Eudowood Division of Pediatric Quality and Safety

The Eudowood 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 United States 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 health care 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 health care, her efforts to solve these safety defects have changed medicine.

In 2003, Miller launched this division and then developed it to its present status with three additional full-time faculty.  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 Quality and Safety 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 National Institutes of Health (NIH)-sponsored KL2 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.

CHA and Quality Transformation

Nationally, Miller’s pioneering work as a researcher and hands-on leader for pediatric patient safety and health care quality fueled her being named after a national search in 2007 to serve the national and international role of vice president of quality transformation at the Children's Hospital Association (CHA).  CHA is an association of children’s hospitals with 220 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 health care quality and safety, best exemplified by the over 60 pediatric intensive care units (PICUs) working with CHA to eliminate catheter-associated blood stream infections. Her CHA 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 but also CHA 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.

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