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Quality and Safety


Quality and Safety at Hopkins Children’s

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

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What is Pediatric Patient Safety?

The Institute of 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 10-13% of prescriptions for children are in error.  Unfortunately, since children represent only 5-10% of the patient population in the US, 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.  Children are our future, and it is vital that healthcare providers for children lead the development of reliably safer healthcare for children.  Such work has become a scientific discipline, requiring academic training, resources, and research.   

The Division of Quality and Safety

The 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 U.S. 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 healthcare 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 healthcare, her efforts to solve these safety defects have changed medicine with respect to pediatric healthcare quality and safety.

In 2003, Miller launched this division and then developed it to its present status with three additional full time faculty, two of whom are seeking formal PhD training under her mentorship.  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 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 NIH-sponsored KL-2 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.

NACHRI & Quality Transformation

Nationally, Miller’s pioneering work as a researcher and ‘hands on’ leader for pediatric patient safety and healthcare quality fueled her selection from a national search to serve the national and international role of Vice President, Quality Transformation, at the National Association of Children’s Hospitals and Related Institutions (NACHRI) since 2007.  NACHRI is an association of children’s hospitals with 218 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 healthcare quality and safety, best exemplified by the over 60 Pediatric Intensive Care Units (PICUs) working with NACHRI to eliminate catheter-associated blood stream infections.  Her NACHRI 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 at Johns Hopkins University but also NACHRI 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.