2023 Department of Pediatrics Academic Annual Report

PEDIATRIC VASCULAR ACCESS Erin Shaughnessy, M.D., MSHCM, continues research related to best practices for vascular access in hospitalized children, building on the miniMAGIC (Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics) guideline published in Pediatrics in 2020. One evidence gap noted in the miniMAGIC guideline is efficacy of midline catheters in pediatrics. Dr. Shaughnessy and colleagues published a scoping review of midline catheter use in pediatrics last year and presented this work at a clinical symposium at the Pediatric Hospital Medicine meeting in Philadelphia in 2023. Another area of interest is the appropriate use of peripherally inserted central catheters (PICCs) in hospitalized infants and children. Dr. Shaughnessy and colleagues recently completed a multisite retrospective cohort study of PICC use and outcomes in hospitalized infants and children, which shows large variation between sites and potential areas for improvement. TELEHEALTH Marie Pfarr, M.D., MSc, is leading a study examining telemedicine use in Children with Medical Complexity (CMC). Specifically, she is interested in identifying patient-level factors associated with telemedicine use in CMC and a qualitative study understanding the perceived advantages, disadvantages and barriers of telemedicine use in CMC from the perspective of caregivers. MEDICAL EDUCATION Stephanie Berger, M.D., and Cassi Smola, M.D., are co-investigators in an Open Notes study evaluating curriculum needs for medical students with medical records newly available to patients via the patient portal. Ryan Flaherty, D.O., current pediatric hospital medicine fellow, is working with Stephanie Berger, M.D, to evaluate the pediatric clinical clerkship for third-year medical students and change the parallel curricula to use entrustable professional activities (EPAs) as a framework to teach pediatric medicine. Dr. Flaherty is also working with Drs. James Willig and Winter Williams at the UAB medical school to evaluate the mid-rotation feedback form regarding medical student proficiency with EPAs and determine if this form correlates with OSCE performance, possibly allowing for early intervention. FEATURED QUALITY-IMPROVEMENT INITIATIVES Children’s of Alabama has seen significant surges of inpatient volume over the past two years that have resulted in diversion of patients to other hospitals or boarding admitted patients in the Emergency Room. Both situations result in subpar care for ill children. To help avoid this situation, the Pediatric Hospital Medicine division has partnered with colleagues across Children’s Hospital to improve patient throughput. Meghan Harrison, M.D., mentored by Dr. Shaughnessy, has led an initiative to improve discharge efficiency. The entire division has lent support through changing workflows to support early discharge as well as discharge at any hour that a patient is medically ready. The task force has seen sustained improvement in the percent of patients discharged in off-peak hours, defined as 5 p.m. to 11 a.m. By smoothing out discharges away from peak times, the hospital avoids bottlenecks to better serve patients. Balancing measures of length of stay and percent of re-admissions have remained steady. Next steps for the work include spreading standardized discharge criteria for common diagnoses as well as collaborating with nursing colleagues to improve time from discharge order to patient exit. Mary Orr, M.D., MPH, DTM&H, leads a multidisciplinary group dedicated to quality improvement in bronchiolitis with representatives from the physicians in the emergency department, PICU, SCU and Dearth nursing leadership, and respiratory therapy leadership. Multiple metrics are monitored monthly and compared to national benchmarks with ongoing audit and feedback. The group has achieved sustained reductions in length of stay, rates of high-flow initiation, time spent on high flow and albuterol use, many of which are included on our division’s safety dashboard. Erinn Schmit, M.D., M.Ed., continues as the chair of the Safe Sleep Task Force at Children’s of Alabama. This multidisciplinary task force has worked to improve practices at Children’s of Alabama and to educate parents and staff on the importance of safe sleep recommendations for infants. The task force has received both grant and donor funding to purchase sleep sacks as a discharge gift for all admitted infants and to purchase crib caddies to keep extraneous care items out of cribs. Michelle Veters, M.D., is the site leader for the American Academy of Pediatrics (AAP) Value in Inpatient Pediatrics (VIP) quality improvement collaborative’s new initiative to standardize care of neonatal hyperbilirubinemia. The effort is named Learning and Implementing Guidelines for Hyperbilirubinemia Treatment (LIGHT) and involves multiple children’s hospitals across the United States. Dr. Veters’ team includes Drs. Mary Orr, Jordan Lim and Elizabeth Mertens. Recently, the team implemented a new evidence-based order set for care of infants with hyperbilirubinemia. FEATURED CLINICAL INNOVATION Marie Pfarr, M.D., MSc, is leading a new complex care service at Children’s of Alabama. The inpatient care team was launched in October 2023, with plans to start an outpatient consultation and co-management clinic in April 2024. The service aims to enhance coordination and the overall care experience for highly complex pediatric patients. Stakeholders include families, clinicians and many allied health professionals.

2023 PUBLICATIONS HIGH-IMPACT PUBLICATIONS

J Pediatr. 2023 Apr 4;113407. Prevalence of Invasive Bacterial Infection in Hypothermic Young Infants: A Multisite Study. Jennifer L Raffaele, Meenu Sharma, Stephanie Berger, Meredith Mitchell, Clifton Lee, John Morrison, Madhuri Prasad, Monica D Combs, Kira Molas-Torreblanca, Julie K Wood, Annalise Van Meurs, Kathryn Westphal, Ali Sawani, Sumeet L Banker, Jennifer Lee, Coleton King, Elizabeth E Halvorson, Nicholas M Potisek; Hypothermic Young Infant Research Collaborative.

2023 Academic Annual Report

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