Division of Hospital Medicine Research
Quality Improvement Highlights
Quality improvement and patient safety is an increasingly important focus area for the Division of Hospital Medicine at CHLA. DHM faculty hold several key leadership positions in the hospital that facilitates our ability to conduct scholarly initiatives. The Division also strategically participates in national multi-center collaborative efforts. Key leaders for quality improvement scholarship in the Division of Hospital Medicine include Joyce Koh, MD, Vivian Lee, MD, and Susan Wu, MD.
Ongoing:
“Project LIGHT: Learning and Implementing Guidelines for Hyperbilirubinemia Treatment.” This multicenter quality improvement project supported by the American Academy of Pediatrics (AAP) and Value in Inpatient Pediatrics Network (VIP Network) aims to optimize care for infants with neonatal hyperbilirubinemia as outlined by updated clinical guidelines released in 2022. This project’s multi-disciplinary team includes members from Emergency Medicine, nursing, and lactation support, as well as residents and fellows. (Site PIs: Dr. Jasmin Persch and Dr. Jennifer Savitz (PHM fellow 2021-2023)
“Eliminating Monitor Overuse (EMO).” Led by investigators at Children's Hospital of Philadelphia and supported by U01 awards from the National Heart, Lung, and Blood Institute (NHLBI) and the PRIS network this portfolio of projects aims to evaluate and study de-implementation strategies to reduce overuse of continuous pulse oximetry in patients hospitalized with bronchiolitis. (Site PI: Dr. Vivian Lee)
“Improving HEADSS documentation in Hospitalized Adolescents”: Given the often-fragmented care of adolescents, hospitalizations may present an opportunity to address acute, chronic, and routine health care needs. HEADSS assessments can identify outstanding needs and are encouraged in all adolescents. This quality improvement project aims to improve the completion of HEADSS, including select “critical elements,” for hospitalized adolescents at CHLA. (PIs: Dr. Vivian Lee and Dr. Kelsey Johnson)
“Improving re-labeling of inpatient metered-dose inhalers (MDIs) for home use upon discharge”: Patients are often prescribed MDIs during their hospitalization, but MDIs that are not properly labeled may be thrown away with unused doses or given to families inappropriately, without accurate instructions. This project aims to decrease waste and improve access to second MDIs for patients. (PI: Dr. Max Sokoloff)
“Implementing pharmacy-driven lab monitoring for vancomycin”: (PIs: Dr. Chien-Rong Chen (PHM fellow 2022-2024) and Dr. Daniel Diamond)
Completed/Published:
"BASiC: Better Antibiotic Selection in Children, a multicenter quality improvement initiative supported by the American Academy of Pediatric Value in Inpatient Pediatrics Network": A large multidisciplinary improvement project involving members with expertise in Emergency Medicine, Infectious Diseases, and Antibiotic Stewardship. This study aims to improve evidence-based prescribing practices to promote use of narrower spectrum antibiotics for a shorter duration for patients seen in the ED or hospitalized with CAP, SSTI, and UTI. (Site PI: Dr. Vivian Lee)
"Reducing blood cultures in hospitalized patients with CAP, SSTI, and UTI": This quality improvement project focuses on diagnostic stewardship with the aim to reduce blood culture acquisition in patients who are included in the BASiC study. (PI: Dr. Monica Mattes, PHM fellow 2020-2022)
“Project REVISE (Reducing Excessive Variability in Infant Sepsis Evaluation)”: The goals of this project are to improve the quality of care delivered to infants between the ages of 7 to 60 days, identified with a fever without a source by increasing compliance with current evidence and best practices. (Site PI: Dr. Vivian Lee) Reducing Variability in the Infant Sepsis Evaluation (REVISE): A National Quality Initiative | Pediatrics | American Academy of Pediatrics (aap.org)
"Critical Care Billing Project": Pediatric hospitalists at CHLA frequently provide critical care services to patients hospitalized on our inpatient floors. The purpose of this project is to improve hospitalists' documentation of and billing for the critical care services they provide. (PIs: Dr. Joyce Koh and Dr. Grant Christman)
"Family Centered Rounds Optimization": This observational study is assessing best practices to improve the quality and efficiency of family centered rounds and reduce variability. (PI: Dr. Susan Wu)
“Decreasing unnecessary electrolyte testing: a multicenter collaborative.” (Site PIs: Dr. Alexandra Mihalek and Dr. Maria Santos, PHM fellows 2018-2020)
Medical Education Highlights
Medical education has long been a focus area for the Division of Hospital Medicine at CHLA. DHM faculty hold leadership positions for medical student and resident education. Key leaders for medical education scholarship in DHM include Grant Christman, Mark Corden, Margaret Trost, as well as fellowship director Nam Ahuja and Meet Our Fellows | Children's Hospital Los Angeles. Hospitalists are also involved in pediatric resident projects through IMPACT.
"Point-of-Care Ultrasound (POCUS) Training in Pediatric Hospital Medicine Fellowship: AA National Needs Assessment." The objective of this survey is to learn about the current state of point-of-care ultrasound training in the Pediatric Hospital Medicine fellowship and to better characterize the interest in and any barriers to such training during fellowship. The information gathered from this study will be used to inform the development of a PHM-specific POCUS curriculum. (Dr. Anna Egan, PHM fellow 2021-2023)
Completed/Published:
"Triaging Referrals as the Medical Control Officer (MCO): A Curriculum for Pediatric Hospital Medicine Fellows." This multisite educational intervention pilot and feasibility study aims to create, develop, and implement an effective phone triage curriculum for Pediatric Hospital Medicine fellowships. Our primary objective is to evaluate PHM fellows' self-efficacy after an educational intervention focused on advanced communication skills and patient safety during mock interfacility transfer telephone calls. (PI: Dr. Kira Molas-Torreblanca, past PHM Fellowship Director)
"Survey of COMSEP membership: How are pediatric hospital medicine sub-specialty core competencies incorporated into medical student-level training?": A national survey conducted via the Council on Medical Student Education for Pediatrics (COMSEP) to report proportions of clerkships that incorporate PHM core competencies. Demographic factors between institutions that incorporated these competencies were compared to those that do not. (PI: Dr. Fatuma Barqadle)
Clinical Research Highlights
Clinical research in the Division of Hospital Medicine capitalizes upon the robust patient population at Children’s Hospital Los Angeles. DHM faculty hold several key leadership positions that facilitate our ability to conduct clinical research. Key focus areas include participation in multicenter collaborative research for care of common inpatient conditions, care of children with medical complexity, and health equity/advocacy work. Key leaders for clinical research scholarship in the Division of Hospital Medicine include Dr. Nam Ahuja, Dr. Angela Choe, Dr. Kim Petko, Dr. Tamara Simon, and Dr. Susan Wu.
Ongoing:
Common inpatient conditions
“Parent perspectives on shared decision making with implementation of the 2021 AAP febrile infant clinical practice guidelines.” This qualitative work studies parent perspectives on shared decision making for management decisions in the new febrile infant guidelines, for both English speaking and limited English proficiency families. (Dr. Jennifer Savitz, PHM Fellow 2021-2023)
Children with medical complexity
“Factors associated with health-related quality of life in caregivers of children with tracheostomy”. This study surveys longitudinal quality of life of caregivers of children with tracheostomy, and associations of factors such as home healthcare and discrimination in the healthcare setting with quality of life. (Dr. Natalia Sidhu, PHM Fellow 2021-2023)
Bronchiolitis management in congenital heart disease (PI: Nam Ahuja)
"Cerebrospinal Fluid (CSF) Shunt Infection Prevention in PHIS+": Retrospective observational cohort studies examining detailed clinical data from chart review as well as the PHIS+ database to better understand the effectiveness of intrathecal antibiotics and antibiotic impregnated shunt catheters in preventing post-surgical CSF shunt infection. (PI: Dr. Tamara Simon)
"Novel Biomarker Investigation for Patients Undergoing CSF Shunt Infection Treatment": A prospective observational study with hydrocephalus patients undergoing CSF shunt surgery to better understand the evolution of CSF microbiota in CSF shunt infection. These analyses will evaluate how proposed biomarkers can inform management and treatment of CSF shunt infection. (PI: Dr. Tamara Simon)
Developing an Innovative Decision Support Tool for Pediatric Neuromuscular Scoliosis (RePORT ⟩ RePORTER (nih.gov)
Rural-Urban disparities in care for children with medical complexity. (NIH R01 Page | Leyenaar Lab (dartmouth.edu)
"Diagnosis and Treatment Patterns for Suspected Bacterial Tracheostomy-Associated INfections (bTRAINs)": A prospective study to describe diagnostic and antibiotic treatment patterns and clinical outcomes in children with tracheostomy being evaluated with bTRAINS. This observational study will follow patients with tracheostomy and associate diagnostic patterns with the primary outcome of bTRAIN treatment. (PI: Dr. Christopher Russell)
Health Equity/Advocacy/Communication
“Patient and Family Centered I-PASS LISTEN (Language, Inclusion, Safety, and Teamwork for Equity Now) Study”: A multi-site step-wedged randomized control trial to evaluate the impact of an intervention to improve communication between medical teams and hospitalized patients and families who speak languages other than English. (PI: Dr. Angela Choe and Dr. Susan Wu)
“Understanding and improving provider communication with hospitalized pediatric patients with language preference other than English”: A single center effort that used participatory method called group level assessment followed by direct observation to assess provider perspectives and practices around communication with patients with limited English proficiency that led to an interdisciplinary quality improvement effort to improve written discharge instructions for hospitalized children with LEP (PI: Dr. Angela Choe)
Completed/Published:
Common inpatient conditions
"Prospective Cohort Study of Severe Bronchiolitis and Risk of Recurrent Wheezing": The 35th Multicenter Airway Research Collaboration (MARC-35) study is a NIH-funded, 17-center prospective cohort study to consider the association between several factors (e.g., infectious etiology, vitamin D levels, and the subsequent development of recurrent wheezing by age 3 years.) (Site PI: Dr. Susan Wu)
"Opportunistic immunization: Variation in policies and practices for vaccination of hospitalized adolescents": A multicenter retrospective observational survey study to assess current immunization policies/practices in an effort to understand variations amongst children's hospitals in the rates of inpatient vaccines delivers and any disparities in practice between inpatient vaccination and inpatient influenza/childhood vaccination. (PI: Dr. Alexandra Mihalek, PHM Fellow 2018-2020)
"Socially assistive robots (SAR) using empathy to reduce children's pain during peripheral IV placement": For this study, we propose using a humanoid robot, together with already in use distraction techniques employed by the CHLA Child Life group, to reduce anxiety and pain perception in children receiving PIV placement prior to radiology studies. (PI: Dr. Margaret Trost)
Evaluating outcomes of patients with third-generation cephalosporin-resistant UTIs who are treated with discordant antibiotics: a multicenter retrospective cohort study looking at initial clinical response, escalation of care, and duration of parenteral therapy for patients with resistant UTIs. (Site PI: Dr. Vivian Lee)
Children with medical complexity
"Comparing outcomes of technology dependent children in children's hospitals versus non-children's hospitals": A multicenter retrospective cross-sectional study using Kids' Inpatient Database from 2012. This study compares the care of technology dependent pediatric inpatients at children's versus non-children's hospitals to identify if certain patients would benefit from the regionalization of inpatient care and if others would receive similar quality of care closer to home. (PI: Dr. Namrata Ahuja; PHM Fellow 2015-2018)