A5033105886- Clinical Reasoning and Diagnostic Skills
- Patient Safety and Medication Errors
- Emergency and Acute Care Studies
- Medical Malpractice and Liability Issues
- Sepsis Diagnosis and Treatment
- Innovations in Medical Education
- Hospital Admissions and Outcomes
- Healthcare Systems and Technology
- Cardiac, Anesthesia and Surgical Outcomes
- Family and Patient Care in Intensive Care Units
- Patient-Provider Communication in Healthcare
- Palliative Care and End-of-Life Issues
- Simulation-Based Education in Healthcare
- Trauma and Emergency Care Studies
- Health and Medical Research Impacts
- Healthcare cost, quality, practices
- Neonatal and fetal brain pathology
- Cardiac Arrest and Resuscitation
- Diversity and Career in Medicine
- Intensive Care Unit Cognitive Disorders
- Airway Management and Intubation Techniques
- Preterm Birth and Chorioamnionitis
- Complement system in diseases
- Renal Diseases and Glomerulopathies
- Artificial Intelligence in Healthcare and Education
University of Iowa
2016-2025
Boston Children's Hospital
2022-2025
Harvard University
2022-2025
Woman's Hospital
2021
National Center for Advancing Translational Sciences
2020
Johns Hopkins Medicine
2015-2019
Johns Hopkins University
2015-2019
University of Iowa Stead Family Children’s Hospital
2019
University of Iowa Hospitals and Clinics
2017
Stanford University
2015
Determine the effectiveness of a structured systems-oriented morbidity and mortality conference in improving process reviewing responding to adverse events PICU.Prospective time series analysis before after implementation conference.Single tertiary referral PICU Baltimore, MD.Thirty-three patients discussed 31 over total 20 conferences, from April 2013 March 2014.Systems-oriented incorporating elements medical incident analysis.There was significant increase meeting attendance (mean, 12 vs...
Effective interventions to prevent diagnostic error among critically ill children should be informed by prevalence and etiologies. We aimed determine the characteristics of errors identify factors associated with in patients admitted PICU.
Objectives: Poor communication during interfacility transfer to the PICU can harm critically ill children. Structured handoff prevent harm; however, landscape of referral practices across PICUs is unknown. Our objective was describe among U.S. begin identifying potential improvement opportunities. Design: Mixed methods study including a cross-sectional survey and semi-structured interviews. Setting: with greater than or equal 10 beds in 2023. Participants: Clinical/administrative leaders....
To describe diagnostic errors identified among patients discussed at a PICU morbidity and mortality conference in terms of Goldman classification, medical category, severity, preventability, contributing factors, occurrence the process.Retrospective record review agendas, patient charts, autopsy reports.Single tertiary referral Baltimore, MD.Ninety-six from November 2011 to December 2012.None.Eighty-nine 96 (93%) had least one safety event. A total 377 events were identified. Twenty (21%)...
Determine how many morbidity and mortality conferences in PICUs across the United States conform to key elements of medical incident analysis.Web-based cross-sectional survey open from March September 2013.Seventy-five with regular identified by cross-referencing publicly available databases.Multidisciplinary PICU staff who attend conference.None.Eighty-four 206 contacted had at least one respondent, a 40.8% PICU-level response rate. The mean three respondents (SD, 2.5; range, 1-13), 45 84...
Meaningful conversations about diagnostic errors require safety cultures where clinicians are comfortable discussing openly. However, clinician comfort publicly and barriers to these discussions remain unexplored. We compared clinicians' other medical identified open discussion.
<h3>Objective</h3> The objective of this study was to characterise the effects antenatal inflammatory factors and maternal therapies on neonatal hearing screen outcomes in very low birthweight infants. <h3>Methods</h3> We conducted a retrospective cohort infants <33 weeks' gestational age <1501 g birth weight prospectively enrolled between 1999 2003 for whom placental pathology, cord blood interleukin (IL) 6, IL-1ß, tumour necrosis factor-α results were available. <h3>Results</h3> Of...
Objective To determine if standardised chart review applied to records of patients discussed at a paediatric intensive care unit (PICU) morbidity and mortality conference (MMC) yields additional or different information regarding safety event occurrence characteristics. Design Retrospective record review. Setting Single tertiary referral PICU in Baltimore, Maryland, USA. Participants 96 the MMC over 14 months (November 2011–December 2012). Main outcome measures Safety events their...
Timely diagnosis of pediatric sepsis remains elusive. We estimated the risk potentially missed in US emergency departments (EDs) and determined factors associated with its occurrence.In a retrospective study linked inpatient ED records from four states using administrative data (excluding 40% missing identifiers), we identified children admitted severe and/or septic shock who had at least one treat-and-release visit 7 days prior to admission. An expert panel rated likelihood each being...
OBJECTIVES: For patients requiring transfer to a higher level of care, excellent interfacility communication is essential. Our objective was characterize verbal handoffs for urgent transfers children the PICU and compare these characteristics with known elements high-quality intrahospital shift-to-shift handoffs. DESIGN: Mixed methods retrospective study audio-recorded referral calls between referring clinicians receiving physicians transfers. SETTING: Academic tertiary PICU. PATIENTS:...
Diagnostic errors can harm critically ill children. However, we know little about their prevalence in PICUs and factors associated with error. The objective of this pilot study was to determine feasibility record review identify patient, provider, work system diagnostic during the first 12 hours after PICU admission.Pilot retrospective cohort structured using a tool (Safer Dx instrument) error.Academic tertiary referral PICU.Patients 0-17 years old admitted nonelectively PICU.None.Four 50...
The traditional morbidity and mortality conference (MMC) was originally pioneered in the early 20th century as a way to evaluate clinical practice1 adopted for hospitals by American College of Surgeons 1916. Throughout years, it has provided education trainees2 served forum discuss challenging cases attending physicians. However, MMCs frequently involved assignments blame, “Monday morning quarterbacking,” did not address systemic issues. Furthermore, they excluded nurses allied medical...
Introduction: To prevent transmission of severe acute respiratory syndrome coronavirus 2 to healthcare workers, we must quickly implement workflow modifications in the pediatric intensive care unit (PICU). Our objective was rapidly train interdisciplinary PICU teams safely perform endotracheal intubations children with suspected or confirmed disease 2019 using a structured simulation education program. Methods: We conducted quality improvement study tertiary referral PICU. After developing...
Febrile seizures are usually considered relatively benign. Although some cases of sudden unexplained death in childhood (SUDC) have a history febrile seizures, no documented case seizure-induced has been reported. Here we describe child with complex who died suddenly and unexpectedly after suspected seizure while bed at night during the beginning phases sleep. She was resuscitated pronounced brain dead two days later our regional medical center. Autopsy revealed multiorgan effects...
Purpose/Problem: Implicit biases of physicians can negatively impact the diagnosis and treatment patients based on demographics social characteristics.In an examination setting, these may result in different responses to vignette-based multiple-choice items if patient characteristics are mentioned.The present study investigates extent which varying results response distributions USMLE Step 3 exam.Description Program, Assessment, or Study: A convenience set 20 had variants created where race...
Objectives: This study aimed to identify the prevalence of and factors associated with diagnostic uncertainty when critically ill children are admitted PICU. Understanding is necessary develop effective strategies reduce errors in Design: Multicenter retrospective cohort structured medical record review by trained clinicians using a standardized instrument narrative clinical notes. Diagnoses were compared across time from PICU admission hospital discharge. Generalized linear mixed models...
Objectives: To determine the perceptions of current pediatric critical care medicine fellows and junior faculty regarding extent quality career development support received during fellowship training. Design: Web-based cross-sectional survey open from September to November 2015. Setting: Accreditation Council for Graduate Medical Education-accredited programs. Subjects: Pediatric (second yr or higher) (within 5 completing a program). Interventions: None. Measurements Main Results: There were...
Background:The prevailing theory regarding disparities in diagnostic errors primary care suggests implicit bias, and clinical reasoning as the major causal factors.This view is limited to physician-related factors, excludes patient, system, policy well their interdependencies.Furthermore, we have yet ascertain views of ethnic minority patients on contributors errors, specifically communication failures within process.Methods: In 2019, authors performed four focus groups adult Latino...
Multidisciplinary PICU teams must effectively share information while caring for critically ill children. Clinical documentation helps clinicians develop a shared understanding of the patient's diagnosis, which informs decision-making. However, diagnosis-related in is understudied, thus limiting insights into how pediatric intensivists convey their diagnostic reasoning. Our objective was to describe critical care document patients' diagnoses at admission.Retrospective mixed methods study...