The research team estimated that 754 pediatric safety events could be avoided annually if all racial groups performed as well as the top-rated group for each type of safety event studied.
Quality and safety would improve in pediatric healthcare – for all races – if the practice of benchmarking outcomes and performance against white patients changed. Instead, investigators should consider using the best-performing group to improve healthcare disparities, according to a new Pediatrics perspective from a multi-center research team led by Children’s National Hospital.
The team examined seven pediatric safety indicators from their previous research, including postoperative infection and accidental lacerations. They determined the best-performing group was not always the white subset, but data in scientific research is often benchmarked against white patients. This can perpetuate racism and erroneously imply that white patients should define the standard for healthcare, the investigators found.
The patient benefit
The research team estimated that 754 pediatric safety events could be avoided annually if all racial groups performed as well as the top-rated group for each type of safety event studied. For some safety events, this would require benchmarking against Black, Hispanic, Asian and Pacific Islander populations.
“By looking at the data with a new lens, we believe that clinicians and researchers could make a major step forward in shrinking and eliminating disparities across pediatric healthcare,” said Kavita Parikh, M.D., MSHS, medical director of Quality & Safety Research and research director of the Division of Hospital Medicine at Children’s National. “If we can employ a more precise understanding of patient and family experience as they interact with the healthcare system, we can prevent negative outcomes that can impact entire lifetimes.”
What’s ahead
The multi-center team continues to work on ways to improve quality and safety at pediatric hospitals. With broad partnerships, the researchers hope to redesign national safety models to encourage hospitals to overcome health-equity hurdles, such as racism, language barriers and other social factors that lead to disparities.
“This call to action is not new, but it demands renewed urgency,” said Dr. Parikh, the first author of the perspective. “We propose future analyses that infuse antiracist principles with quality improvement and patient safety standards to design more effective interventions.”
A new manuscript published in the Cambridge University Press outlines 10 actionable steps that infectious diseases professionals can take to reduce their environmental impact.
The U.S. healthcare sector contributes disproportionately to greenhouse gas emissions. A new manuscript published in the Cambridge University Press outlines 10 actionable steps that infectious diseases professionals can take to reduce their environmental impact, from better waste management to promoting telehealth and advocating for hospital-wide sustainability initiatives.
Shreya Doshi, M.D., pediatric fellow at Children’s National Hospital, shares some key highlights from this manuscript below:
Q: What’s been the hold-up in the field?
A: Despite the healthcare sector’s significant contribution to greenhouse gas emissions, we are not doing enough as a community, a nation and as an industry. Much more needs to be done, and a lack of awareness is a major barrier. To truly protect children’s health and keep them out of hospitals, we must focus on reducing harm to their environment. Currently, the healthcare industry is responsible for approximately 8.5 percent of total emissions in the U.S.
Q: How will this benefit patients?
A: By adopting sustainable practices, healthcare systems can reduce pollution and its related health effects. Simultaneously, the resource-efficient use of medical supplies and medications can also lead to more cost-effective care without compromising patient safety, ultimately leading to better health outcomes.
Q: How is Children’s National leading in this space? How unique is this work?
A: This work stands out by focusing on simple, actionable steps that everyone can take, while emphasizing the leadership role that infection preventionists, antimicrobial stewards, and other ID professionals can play in advancing healthcare sustainability. We also have a hospital-wide Sustainability Council that fosters interdisciplinary collaboration. To get involved, email Sustainabilitycouncil@childrensnational.org to join!
Dr. Levitt shares insights into the program’s journey, key successes and future goals.
This September, the Colorectal and Pelvic Reconstruction Program at Children’s National proudly marks five years of commitment to patient-centered care for children and their families. Under the guidance of Division Chief Marc Levitt, M.D., the program has achieved remarkable advancements in clinical care, improving patient outcomes and enhancing family experiences.
Dr. Levitt shares insights into the program’s journey, key successes and future goals, highlighting the importance of collaboration among specialists and the continuous pursuit of innovative treatments.
Q: What was your vision for the program when it first launched? Has the vision changed?
A: When the Colorectal Program first launched, we aimed to establish a comprehensive program for colorectal patient care. This included integrating specialists across multiple disciplines, such as pediatric general surgery, urology, gynecology, gastroenterology, nursing, neurosurgery, orthopedics, pathology, radiology, anesthesia, psychology and pelvic floor therapy. Our efforts have exceeded expectations; the team has developed a cohesive and collaborative dynamic where each specialist contributes effectively to patient care. This integrated approach enhances outcomes, as patients and their families are at the center of our model, surrounded by a network of dedicated caregivers and coordinators, all focused on improving the patients’ quality of life.
Q: Can you highlight some key successes or achievements of the program?
A: The creation of our integrated colorectal care program at Children’s National has been a significant success, bolstered by strong institutional support. While this model requires considerable effort, it ultimately attracts patients and leads to outstanding outcomes. We’ve received patient inquiries from 48 states (AK,AL, AR, AZ, CA, CO, CT, D.C., DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, TN, TX, UT, VA, VT, WA, WI, WV) and 68 countries (Australia, Bahamas, Bangladesh, Bulgaria, Canada, Chile, Croatia, Cyprus, Dominican Republic, Ecuador, Egypt, England, Ethiopia, France, Germany, Greece, Guatemala, Haiti, Hong Kong, India, Ireland, Israel, Jamaica, Jordan, Kazakhstan, Kenya, Kuwait, Lithuania, Maldives, Mauritania, Mexico, Monaco, Morocco, Myanmar, The Netherlands, New Zealand, Nepal, Nigeria, Northern Ireland, Norway, Oman, Palestine, Pakistan, Paraguay, Papua New Guinea, Peru, Philippines, Portugal, Romania, Russia, Saint Lucia, Saudi Arabia, Scotland, Serbia, Singapore, Slovakia, Slovenia, Spain, Sri Lanka, South Korea, St. Kitts & Nevis, Sudan, Sweden, Ukraine, Uzbekistan, United Arab Emirates, Venezuela, Wales).
Some key successes include the development of innovative surgical procedures for conditions such as imperforate anus and anorectal malformations, advanced repair techniques for cloacal malformations, integrated care strategies for colonic dysmotility, and novel approaches for the newborn care of patients with cloacal exstrophy. All these new approaches were developed at Children’s National over the past five years.
In addition to clinical innovations, we have significantly enhanced our academic environment. Over the last five years, our team has authored more than one hundred articles and three well-regarded books, helping health care professionals around the world improve the care they provide to their patients. We have also trained surgical fellows and nurses in colorectal care and welcomed clinicians from over 30 countries for specialized training. This outreach is especially fulfilling, as it enables us to influence the care of children around the globe whom we may never meet, by sharing valuable skills and knowledge with these practitioners.
Q: Can you share examples of particularly challenging cases or high-profile cases that have influenced the program’s clinical approach?
A: The way we care for a patient with a cloaca is unique – the entire team joins together in the operating room to assess the anatomy, and every member then gives their thoughts on how to approach the reconstruction. The very next day we perform that surgery, with the understanding of the anatomy in mind, and what plays out in that operating room is quite magical. This collaborative approach frequently leads to exceptional outcomes, as our diverse ideas come together to form a cohesive plan. Through this teamwork, we have developed creative ways to solve complex anatomical problems that no one individual surgeon would have thought of on their own.
Q: How have patient outcomes improved over time?
A: We have optimized the collaborative experience so that patients only need a single visit to see all the specialists they require. Our outcomes for complex colorectal surgeries have significantly improved, particularly for conditions like cloaca, Hirschsprung disease and anorectal malformations. Advances in surgical techniques and enhancements in nursing care have led to dramatically better results. We have reduced, and in some cases eliminated, complications from these surgeries, while also seeing improvements in bowel continence and kidney health. Our nursing teams — outpatient, operating room and inpatient — play a crucial role, offering unique insights into pre- and post-operative care that are vital for achieving successful outcomes.
Q: What have been the biggest challenges or barriers faced by the program and how have you addressed these challenges?
A: One of the biggest challenges we face is ensuring that patients can get to us. Many patients encounter obstacles with insurance companies that restrict travel outside their network, or they deal with the difficulties of traveling from far away for their surgery. We have worked diligently to address these issues by improving our insurance approval process and making families comfortable during their stay in Washington, D.C., including assistance with accommodations, necessary medical supplies, etc. If we can remove these barriers, we can care for more patients and make the experience easier for them and their families.
Q: How does the colorectal program collaborate with other departments or services? How has the program integrated from various specialties (e.g., urology, gynecology, GI) to enhance patient care?
A: We have specialists who are fully integrated in their roles on the colorectal and pelvic reconstruction team. General pediatric surgeons, urologists, gynecologists and gastroenterologists work both in the colorectal program and in their home program in a uniquely integrated fashion. For example, our urologists each spend half of their time in general urology and the other half in colorectal, handling the urologic aspects of colorectal patients’ care. In this way collaboration is enhanced and encouraged.
Q: What are the future goals or plans for the colorectal program?
A: Our future goals for the colorectal program are focused on expanding our impact and enhancing patient care. First and foremost, we aim to help as many patients as possible. We plan to collaborate with other colorectal centers worldwide to share knowledge and best practices. Training surgeons and nurses remains a priority, as we want to equip as many healthcare professionals as possible with the skills needed in this field. Additionally, we are committed to traveling to the developing world to provide care for children who cannot access services at Children’s National. Finally, we intend to enhance our research efforts, leveraging basic science to investigate and address conditions related to the colon, ultimately seeking to reduce or eliminate associated illnesses.
https://innovationdistrict.childrensnational.org/wp-content/uploads/2024/09/Levitt-and-baby-feature.jpg300400Innovation Districthttps://innovationdistrict.childrensnational.org/wp-content/uploads/2023/12/innovationdistrict_logo-1-1030x165.pngInnovation District2024-09-23 15:51:302024-09-26 09:59:03Marc Levitt, M.D., reflects on the Colorectal & Pelvic Reconstruction Program
We are thrilled to announce that the Children’s National Spina Bifida Program has received official accreditation from the Spina Bifida Association (SBA).
We are thrilled to announce that the Children’s National Spina Bifida Program has received official accreditation from the Spina Bifida Association (SBA). This is a significant milestone that underscores our commitment to delivering the highest standards of clinical care and reflects the dedication of our entire team.
To gain a deeper understanding of what this accreditation means, we spoke with Christina Ho, M.D., Co-Director of the Children’s National Spina Bifida Program. Dr. Ho provided valuable insights into the significance of this achievement and its impact on the team and Spina Bifida Program.
Q: What does this accreditation mean to you and our program?
A: Achieving accreditation from the SBA signifies that our program is aligned with the best clinical practices and standards for spina bifida care. Over the past few years, we have made substantial strides, particularly in enhancing our adolescent transition program, implementing quality improvement projects and expanding community outreach.
This accreditation is a testament to the relentless efforts of our multidisciplinary team, each member of whom is committed to providing exceptional patient care. It acknowledges the hard work and dedication we invest daily to ensure the highest quality outcomes for our patients.
Q: How will this affect patient care?
A: As an accredited clinical care partner, we will have increased opportunities to collaborate on research projects with the SBA and other clinical care sites. This partnership will enable us to continue pushing the envelope on research-focused practices and cutting-edge care for all our patients. Our passion for excellence in patient care remains unwavering, and this accreditation will help us expand the breadth and quality of services and support we provide.
Q: What does this mean for patient families?
A: For families seeking comprehensive spina bifida care, this accreditation is a mark of assurance. By visiting the SBA website, families can now see that Children’s National Hospital is a recognized clinical care partner. This means they can access specialized, state-of-the-art spina bifida care right here in the Washington DC, Maryland and Virginia area. We are excited about the prospect of reaching more families in our region and welcoming those who seek the very best in spina bifida care.
A note on our team
Our program’s success is a direct result of the passion and dedication of our team members. Each individual brings an unwavering commitment to improving the lives of families living with spina bifida. It is this collective enthusiasm and expertise that truly distinguishes our program.
We look forward to continuing our mission of providing exceptional care and making a positive impact on the lives of those we serve. Thank you for your ongoing support and dedication.
Attending the American Association for Thoracic Surgery’s 104th Annual Meeting this weekend? Stop by the Children’s National Booth #1315! Here is a look at the topics that our Childrens National Heart Center will be presenting on. We look forward to connecting with you in Toronto.
The child-sized, lightweight, wearable band enables at-home monitoring of patient vital signs.
As their infant daughter recovered from a life-threatening virus, tech executive Jonathan Baut and his wife lived in a constant state of alert for any signs of a change in her condition. That experience prompted Baut to look for an at-home vital signs monitoring solution for parents facing medical challenges at home.
He located the technology in Belgium and found the clinical support to advance the innovation at Children’s National Hospital, tapping into its leadership of a pediatric device consortium funded by the Food and Drug Administration (FDA), the Alliance for Pediatric Device Innovation (APDI).
The technology platform, called Gabi SmartCare, features a tiny, lightweight, wearable band made for children that enables at-home monitoring of a patient’s vital signs including oxygen saturation, and heart rate movement. It also supports the collection of other data about health conditions through health assessment.
The big picture
Wireless home-based monitoring could reduce hospital stays while improving the transitional care provided to patients at home. It could also aid in the home care of chronically ill patients.
Recently, Gabi SmartCare received its FDA clearance as a class II device for monitoring use. Baut says the multifaceted support he received from Children’s National and APDI helped him achieve this critical milestone, including the hospital’s role as one of two U.S. clinical trial sites for the device.
He explained that the APDI team also connected him with experts in device trials, regulatory processes and reimbursement, which helped him better understand the U.S. market and the nuances of the pediatric continuum of care.
Physicians can remotely monitor patient’s oxygen saturation and heart rate movement.
As he focuses on getting his product into hospitals, Baut already has additional monitoring features in development for Gabi SmartCare including respiratory rate, actigraphy, skin auto-calibration and sleep phases.
Why it matters
Reliable at-home monitoring tools can expand a pediatric hospital’s capabilities to support patients beyond the hospital setting. They can also help reduce trips to the emergency room and reduce the stress and anxiety parents experience when providing home care. Helping to advance devices like these can deliver those benefits to patient families at Children’s National and beyond.
“The pandemic underscored a great need for technologies that improve remote monitoring for children,” said Kolaleh Eskandanian, Ph.D. M.B.A., P.M.P., Children’s National vice president and chief innovation officer and program director of APDI. “At-home monitoring devices enable remote and continuous surveillance of pediatric patients, ensuring timely intervention and optimal care delivery even in remote or resource-limited settings. These technologies are needed now, and even more during public health emergencies.”
https://innovationdistrict.childrensnational.org/wp-content/uploads/2024/04/Gabi-SmartCare-feature.png300400Innovation Districthttps://innovationdistrict.childrensnational.org/wp-content/uploads/2023/12/innovationdistrict_logo-1-1030x165.pngInnovation District2024-04-23 10:59:082024-04-23 10:59:56Supporting breakthroughs in at-home pediatric monitoring
The Division of Urology at Children’s National has developed a first-of-its-kind orientation program for pediatric urology advanced practice providers (APPs). This program was created based on real feedback from pediatric urology APPs in the United States and Canada.
The primary purpose of the orientation program is to increase the knowledge and confidence of pediatric APP’s in transition to independent practice. The program prepares the next group of advanced practice providers in the Division of Urology to achieve the same high quality of care that the current group provides to our patients.
“I think what makes our orientation program unique is how involved leadership is in training the orientee. We are with our orientee every step of the way every week. We are there making sure that they are attaining their skills and their knowledge. We’re checking in on them very regularly, and we also are trying to make it very individualized to that person.” said Katie Scarpaci, nurse practitioner and creator of the APP orientation program.
https://innovationdistrict.childrensnational.org/wp-content/uploads/2024/03/AAP-still-feature.png300400Innovation Districthttps://innovationdistrict.childrensnational.org/wp-content/uploads/2023/12/innovationdistrict_logo-1-1030x165.pngInnovation District2024-03-20 12:50:252024-03-20 12:51:33The division of urology creates tailored orientation program
The 2023 International Congress on Early Onset Scoliosis and the Growing Spine (ICEOS) was a three-day conference for surgeons and health professionals from around the world. The sessions focused on solutions for pediatric spine deformities. Matthew Oetgen, M.D., chief of Orthopaedic Surgery and Sports Medicine at Children’s National Hospital, was a member of the faculty.
Session highlights included:
Pre-Course: Pediatric Spine Study Group (PSSG) Mini-Research Symposium – Considerations for your biosketch, regulatory and IRB
How Do You Propel Your Research Team
“Overall this was a great meeting with valuable content,” says Dr. Oetgen. “Learning and teaching alongside fellow orthopaedic leaders is a fantastic opportunity for everyone involved.”
Dr. Oetgen participated in the following sessions:
Timing of Hemivertebra Excision
Let’s Debate! nView Workshop – 3D imaging and guidance, available technologies for pediatric spine and when to use them
Hip preservation treats a wide variety of conditions such as hip dysplasia, hip impingement, hip torsion/rotation abnormalities, hip synovitis, snapping hip and hip labrum tears.
The Hip Preservation Program at Children’s National Hospital offers advanced care to children and adults with hip pain, providing a continuum of care that extends well into adulthood. Jeffrey Peck, M.D., an orthopaedic surgeon with subspecialty interests in pediatric and young adult hip preservation, discusses the program and what Children’s National is doing to move the needle forward in patient care.
Q: What is hip preservation and what are common conditions it addresses?
A: The field of hip preservation is dedicated to diagnosing and treating hip conditions that result in hip pain and can potentially result in hip degeneration.
There are several potential conditions that can lead to hip pain and eventual hip joint degeneration. These include atypical anatomy in and around the hip joint, which can be congenital, developmental or traumatic in origin. Strains and sprains of the muscles and ligaments around the hip may also cause hip joint pain. Hip preservation treats a wide variety of conditions such as hip dysplasia, hip impingement, hip torsion/rotation abnormalities, hip synovitis, snapping hip and hip labrum tears.
Q: Who is affected and when should a patient seek out an orthopaedic expert?
A: The people most often affected by conditions treated through hip preservation are adolescents and young adults up to age 45 years old who develop hip pain. When hip pain does not subside, it can be due to a condition that has resulted in hip joint inflammation that may eventually begin to cause hip joint degeneration leading to arthritis if the condition is not treated. If a patient has hip pain that lasts for multiple months without improving, it is prudent to seek evaluation with a hip preservation orthopaedic surgeon specialist.
Q: What is Children’s National doing to move the needle for hip preservation patients?
A: Children’s National cares for patients with hip pain using an integrated care team, featuring a Hip Preservation fellowship trained surgeon, physiatry experts, sports psychologists, radiologists and physical therapists with a focus on adolescents and young adults. We work in a collaborative environment with the shared goal of helping patients with hip pain return to living life without the pain that has held them back.
The Children’s National team also collects patient reported outcome scores to better understand the severity of patient symptoms and, later, how surgery has improved those symptoms. Additionally, Children’s National is engaged in research endeavors evaluating hip conditions and how patients have responded to treatment. By pursuing these efforts, we not only assist the patients we see today, but also contribute to advancing care to better help future patients.
Q: What excites you about the future for the field of hip preservation?
A: The field of Hip Preservation is a young specialty within orthopaedic surgery that has demonstrated consistently positive outcomes for patients who previously had very limited treatment options for their hip pain. With this comparative newness comes continual innovation and advancement as we learn more about how hip pain can occur and what we can do to best treat that pain. Procedures that we perform at Children’s National such as the Ganz Periacetabular Osteotomy (PAO) and the use of hip arthroscopy to treat hip impingement are relatively new innovations in the field of orthopaedics that can provide immense relief to patients having hip pain.
https://innovationdistrict.childrensnational.org/wp-content/uploads/2024/01/hip-x-ray-feature.png300400Innovation Districthttps://innovationdistrict.childrensnational.org/wp-content/uploads/2023/12/innovationdistrict_logo-1-1030x165.pngInnovation District2024-01-09 16:30:492024-01-16 16:07:52Hip preservation: Moving the needle in patient care
“With each kidney transplant, we’re not just restoring the health of children, we’re pioneering progress and setting new benchmarks for the field of pediatric nephrology,” says Marva Moxey-Mims, M.D., chief of Nephrology at Children’s National Hospital.
“With each kidney transplant, we’re not just restoring the health of children, we’re pioneering progress and setting new benchmarks for the field of pediatric nephrology,” says Marva Moxey-Mims, M.D., chief of Nephrology at Children’s National Hospital. “We offer not just treatment, but a chance for our patients to flourish and live their best life.”
Big picture
The Kidney Transplantation Program at Children’s National is the only one of its kind in the Washington, D.C., region focused on the needs of children and teens with kidney disease.
Performing an average of 15-20 kidney transplants per year, the program’s latest one- and three-year graft and patient survival data from the Scientific Registry for Transplant Recipients is 100%.
“Our program surpasses national numbers, reflecting a commitment to exceptional care, superior patient outcomes and a focus on setting a new standard for excellence in transplant support,” says Dr. Moxey-Mims.
Children’s National leads the way
At the forefront of groundbreaking treatment, the nephrology team is pioneering progress by providing innovative care and resources. One example is the hospital’s collaboration with the National Kidney Registry and MedStar Georgetown Transplant Institute’s Living Donor Program. This provides a greater chance of finding more suitable donors for difficult-to-match children and has resulted in altruistic donations.
“Through living kidney donations, we redefine the timeline for pediatric transplants. Children experience shorter waits and swifter paths to renewed health compared to the national wait list,” says Asha Moudgil, M.D., medical director of the Kidney Transplantation Program at Children’s National. “It’s a testament to our commitment to making a difference in every child’s life.”
That commitment is also seen in the hospital’s focus on making sure families have the resources they need during their medical journey.
“Caring for a child with renal disease is an immense challenge, not only for the young patients but also for their families. The demanding schedule of hospital visits, often three times a week, adds an extra layer of stress and disruption to daily life,” says Dr. Moudgil.
Through grant funding from donors and national programs, families with children undergoing kidney transplants and dialysis can receive financial assistance. In some cases, families receive up to $2,000 of mortgage or rental payment assistance. Families can also receive funds for medication co-pays and other expenses incurred around the time of the transplant.
“In the face of medical adversity, these funds become a source of support,” says Dr. Moudgil. “We make sure every family, regardless of financial constraints, can access the care and resources their child needs.”
Bottom line
Children’s National is at the forefront of pediatric kidney transplantation. “Our unique approach ensures every facet of a patient’s journey is considered,” says Dr. Moxey-Mims. “We’ve created an environment where success is not just a medical outcome but a comprehensive and sustained improvement in a child’s overall quality of life.”
Learn more about our latest advances in pediatric Nephrology.
https://innovationdistrict.childrensnational.org/wp-content/uploads/2023/12/Marva-Moxey-Mims-in-the-lab-feature.png300400Innovation Districthttps://innovationdistrict.childrensnational.org/wp-content/uploads/2023/12/innovationdistrict_logo-1-1030x165.pngInnovation District2023-12-15 12:14:532024-11-08 13:32:36Revolutionizing pediatric nephrology one patient at a time
Perspective: Rethinking racial benchmarks in pediatric safety events
The research team estimated that 754 pediatric safety events could be avoided annually if all racial groups performed as well as the top-rated group for each type of safety event studied.
Quality and safety would improve in pediatric healthcare – for all races – if the practice of benchmarking outcomes and performance against white patients changed. Instead, investigators should consider using the best-performing group to improve healthcare disparities, according to a new Pediatrics perspective from a multi-center research team led by Children’s National Hospital.
The team examined seven pediatric safety indicators from their previous research, including postoperative infection and accidental lacerations. They determined the best-performing group was not always the white subset, but data in scientific research is often benchmarked against white patients. This can perpetuate racism and erroneously imply that white patients should define the standard for healthcare, the investigators found.
The patient benefit
The research team estimated that 754 pediatric safety events could be avoided annually if all racial groups performed as well as the top-rated group for each type of safety event studied. For some safety events, this would require benchmarking against Black, Hispanic, Asian and Pacific Islander populations.
“By looking at the data with a new lens, we believe that clinicians and researchers could make a major step forward in shrinking and eliminating disparities across pediatric healthcare,” said Kavita Parikh, M.D., MSHS, medical director of Quality & Safety Research and research director of the Division of Hospital Medicine at Children’s National. “If we can employ a more precise understanding of patient and family experience as they interact with the healthcare system, we can prevent negative outcomes that can impact entire lifetimes.”
What’s ahead
The multi-center team continues to work on ways to improve quality and safety at pediatric hospitals. With broad partnerships, the researchers hope to redesign national safety models to encourage hospitals to overcome health-equity hurdles, such as racism, language barriers and other social factors that lead to disparities.
“This call to action is not new, but it demands renewed urgency,” said Dr. Parikh, the first author of the perspective. “We propose future analyses that infuse antiracist principles with quality improvement and patient safety standards to design more effective interventions.”
You can read the complete perspective – “Analyzing Pediatric Safety Events Using Antiracist Principles” – in Pediatrics.
Ten sustainable steps to mitigate the climate crisis
A new manuscript published in the Cambridge University Press outlines 10 actionable steps that infectious diseases professionals can take to reduce their environmental impact.
The U.S. healthcare sector contributes disproportionately to greenhouse gas emissions. A new manuscript published in the Cambridge University Press outlines 10 actionable steps that infectious diseases professionals can take to reduce their environmental impact, from better waste management to promoting telehealth and advocating for hospital-wide sustainability initiatives.
Shreya Doshi, M.D., pediatric fellow at Children’s National Hospital, shares some key highlights from this manuscript below:
Q: What’s been the hold-up in the field?
A: Despite the healthcare sector’s significant contribution to greenhouse gas emissions, we are not doing enough as a community, a nation and as an industry. Much more needs to be done, and a lack of awareness is a major barrier. To truly protect children’s health and keep them out of hospitals, we must focus on reducing harm to their environment. Currently, the healthcare industry is responsible for approximately 8.5 percent of total emissions in the U.S.
Q: How will this benefit patients?
A: By adopting sustainable practices, healthcare systems can reduce pollution and its related health effects. Simultaneously, the resource-efficient use of medical supplies and medications can also lead to more cost-effective care without compromising patient safety, ultimately leading to better health outcomes.
Q: How is Children’s National leading in this space? How unique is this work?
A: This work stands out by focusing on simple, actionable steps that everyone can take, while emphasizing the leadership role that infection preventionists, antimicrobial stewards, and other ID professionals can play in advancing healthcare sustainability. We also have a hospital-wide Sustainability Council that fosters interdisciplinary collaboration. To get involved, email Sustainabilitycouncil@childrensnational.org to join!
You can read the full study, 10 sustainable steps infectious disease professionals can take to mitigate the climate crisis, in the Cambridge University Press.
Marc Levitt, M.D., reflects on the Colorectal & Pelvic Reconstruction Program
Dr. Levitt shares insights into the program’s journey, key successes and future goals.
This September, the Colorectal and Pelvic Reconstruction Program at Children’s National proudly marks five years of commitment to patient-centered care for children and their families. Under the guidance of Division Chief Marc Levitt, M.D., the program has achieved remarkable advancements in clinical care, improving patient outcomes and enhancing family experiences.
Dr. Levitt shares insights into the program’s journey, key successes and future goals, highlighting the importance of collaboration among specialists and the continuous pursuit of innovative treatments.
Q: What was your vision for the program when it first launched? Has the vision changed?
A: When the Colorectal Program first launched, we aimed to establish a comprehensive program for colorectal patient care. This included integrating specialists across multiple disciplines, such as pediatric general surgery, urology, gynecology, gastroenterology, nursing, neurosurgery, orthopedics, pathology, radiology, anesthesia, psychology and pelvic floor therapy. Our efforts have exceeded expectations; the team has developed a cohesive and collaborative dynamic where each specialist contributes effectively to patient care. This integrated approach enhances outcomes, as patients and their families are at the center of our model, surrounded by a network of dedicated caregivers and coordinators, all focused on improving the patients’ quality of life.
Q: Can you highlight some key successes or achievements of the program?
A: The creation of our integrated colorectal care program at Children’s National has been a significant success, bolstered by strong institutional support. While this model requires considerable effort, it ultimately attracts patients and leads to outstanding outcomes. We’ve received patient inquiries from 48 states (AK,AL, AR, AZ, CA, CO, CT, D.C., DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, TN, TX, UT, VA, VT, WA, WI, WV) and 68 countries (Australia, Bahamas, Bangladesh, Bulgaria, Canada, Chile, Croatia, Cyprus, Dominican Republic, Ecuador, Egypt, England, Ethiopia, France, Germany, Greece, Guatemala, Haiti, Hong Kong, India, Ireland, Israel, Jamaica, Jordan, Kazakhstan, Kenya, Kuwait, Lithuania, Maldives, Mauritania, Mexico, Monaco, Morocco, Myanmar, The Netherlands, New Zealand, Nepal, Nigeria, Northern Ireland, Norway, Oman, Palestine, Pakistan, Paraguay, Papua New Guinea, Peru, Philippines, Portugal, Romania, Russia, Saint Lucia, Saudi Arabia, Scotland, Serbia, Singapore, Slovakia, Slovenia, Spain, Sri Lanka, South Korea, St. Kitts & Nevis, Sudan, Sweden, Ukraine, Uzbekistan, United Arab Emirates, Venezuela, Wales).
Some key successes include the development of innovative surgical procedures for conditions such as imperforate anus and anorectal malformations, advanced repair techniques for cloacal malformations, integrated care strategies for colonic dysmotility, and novel approaches for the newborn care of patients with cloacal exstrophy. All these new approaches were developed at Children’s National over the past five years.
In addition to clinical innovations, we have significantly enhanced our academic environment. Over the last five years, our team has authored more than one hundred articles and three well-regarded books, helping health care professionals around the world improve the care they provide to their patients. We have also trained surgical fellows and nurses in colorectal care and welcomed clinicians from over 30 countries for specialized training. This outreach is especially fulfilling, as it enables us to influence the care of children around the globe whom we may never meet, by sharing valuable skills and knowledge with these practitioners.
Q: Can you share examples of particularly challenging cases or high-profile cases that have influenced the program’s clinical approach?
A: The way we care for a patient with a cloaca is unique – the entire team joins together in the operating room to assess the anatomy, and every member then gives their thoughts on how to approach the reconstruction. The very next day we perform that surgery, with the understanding of the anatomy in mind, and what plays out in that operating room is quite magical. This collaborative approach frequently leads to exceptional outcomes, as our diverse ideas come together to form a cohesive plan. Through this teamwork, we have developed creative ways to solve complex anatomical problems that no one individual surgeon would have thought of on their own.
Q: How have patient outcomes improved over time?
A: We have optimized the collaborative experience so that patients only need a single visit to see all the specialists they require. Our outcomes for complex colorectal surgeries have significantly improved, particularly for conditions like cloaca, Hirschsprung disease and anorectal malformations. Advances in surgical techniques and enhancements in nursing care have led to dramatically better results. We have reduced, and in some cases eliminated, complications from these surgeries, while also seeing improvements in bowel continence and kidney health. Our nursing teams — outpatient, operating room and inpatient — play a crucial role, offering unique insights into pre- and post-operative care that are vital for achieving successful outcomes.
Q: What have been the biggest challenges or barriers faced by the program and how have you addressed these challenges?
A: One of the biggest challenges we face is ensuring that patients can get to us. Many patients encounter obstacles with insurance companies that restrict travel outside their network, or they deal with the difficulties of traveling from far away for their surgery. We have worked diligently to address these issues by improving our insurance approval process and making families comfortable during their stay in Washington, D.C., including assistance with accommodations, necessary medical supplies, etc. If we can remove these barriers, we can care for more patients and make the experience easier for them and their families.
Q: How does the colorectal program collaborate with other departments or services? How has the program integrated from various specialties (e.g., urology, gynecology, GI) to enhance patient care?
A: We have specialists who are fully integrated in their roles on the colorectal and pelvic reconstruction team. General pediatric surgeons, urologists, gynecologists and gastroenterologists work both in the colorectal program and in their home program in a uniquely integrated fashion. For example, our urologists each spend half of their time in general urology and the other half in colorectal, handling the urologic aspects of colorectal patients’ care. In this way collaboration is enhanced and encouraged.
Q: What are the future goals or plans for the colorectal program?
A: Our future goals for the colorectal program are focused on expanding our impact and enhancing patient care. First and foremost, we aim to help as many patients as possible. We plan to collaborate with other colorectal centers worldwide to share knowledge and best practices. Training surgeons and nurses remains a priority, as we want to equip as many healthcare professionals as possible with the skills needed in this field. Additionally, we are committed to traveling to the developing world to provide care for children who cannot access services at Children’s National. Finally, we intend to enhance our research efforts, leveraging basic science to investigate and address conditions related to the colon, ultimately seeking to reduce or eliminate associated illnesses.
Celebrating excellence: Children’s National Spina Bifida Program earns SBA accreditation
We are thrilled to announce that the Children’s National Spina Bifida Program has received official accreditation from the Spina Bifida Association (SBA).
We are thrilled to announce that the Children’s National Spina Bifida Program has received official accreditation from the Spina Bifida Association (SBA). This is a significant milestone that underscores our commitment to delivering the highest standards of clinical care and reflects the dedication of our entire team.
To gain a deeper understanding of what this accreditation means, we spoke with Christina Ho, M.D., Co-Director of the Children’s National Spina Bifida Program. Dr. Ho provided valuable insights into the significance of this achievement and its impact on the team and Spina Bifida Program.
Q: What does this accreditation mean to you and our program?
A: Achieving accreditation from the SBA signifies that our program is aligned with the best clinical practices and standards for spina bifida care. Over the past few years, we have made substantial strides, particularly in enhancing our adolescent transition program, implementing quality improvement projects and expanding community outreach.
This accreditation is a testament to the relentless efforts of our multidisciplinary team, each member of whom is committed to providing exceptional patient care. It acknowledges the hard work and dedication we invest daily to ensure the highest quality outcomes for our patients.
Q: How will this affect patient care?
A: As an accredited clinical care partner, we will have increased opportunities to collaborate on research projects with the SBA and other clinical care sites. This partnership will enable us to continue pushing the envelope on research-focused practices and cutting-edge care for all our patients. Our passion for excellence in patient care remains unwavering, and this accreditation will help us expand the breadth and quality of services and support we provide.
Q: What does this mean for patient families?
A: For families seeking comprehensive spina bifida care, this accreditation is a mark of assurance. By visiting the SBA website, families can now see that Children’s National Hospital is a recognized clinical care partner. This means they can access specialized, state-of-the-art spina bifida care right here in the Washington DC, Maryland and Virginia area. We are excited about the prospect of reaching more families in our region and welcoming those who seek the very best in spina bifida care.
A note on our team
Our program’s success is a direct result of the passion and dedication of our team members. Each individual brings an unwavering commitment to improving the lives of families living with spina bifida. It is this collective enthusiasm and expertise that truly distinguishes our program.
We look forward to continuing our mission of providing exceptional care and making a positive impact on the lives of those we serve. Thank you for your ongoing support and dedication.
Learn more about Children’s National Spina Bifida program.
Children’s National at the104th Annual AATS Meeting
Attending the American Association for Thoracic Surgery’s 104th Annual Meeting this weekend? Stop by the Children’s National Booth #1315! Here is a look at the topics that our Childrens National Heart Center will be presenting on. We look forward to connecting with you in Toronto.
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Supporting breakthroughs in at-home pediatric monitoring
The child-sized, lightweight, wearable band enables at-home monitoring of patient vital signs.
As their infant daughter recovered from a life-threatening virus, tech executive Jonathan Baut and his wife lived in a constant state of alert for any signs of a change in her condition. That experience prompted Baut to look for an at-home vital signs monitoring solution for parents facing medical challenges at home.
He located the technology in Belgium and found the clinical support to advance the innovation at Children’s National Hospital, tapping into its leadership of a pediatric device consortium funded by the Food and Drug Administration (FDA), the Alliance for Pediatric Device Innovation (APDI).
The technology platform, called Gabi SmartCare, features a tiny, lightweight, wearable band made for children that enables at-home monitoring of a patient’s vital signs including oxygen saturation, and heart rate movement. It also supports the collection of other data about health conditions through health assessment.
The big picture
Wireless home-based monitoring could reduce hospital stays while improving the transitional care provided to patients at home. It could also aid in the home care of chronically ill patients.
Recently, Gabi SmartCare received its FDA clearance as a class II device for monitoring use. Baut says the multifaceted support he received from Children’s National and APDI helped him achieve this critical milestone, including the hospital’s role as one of two U.S. clinical trial sites for the device.
He explained that the APDI team also connected him with experts in device trials, regulatory processes and reimbursement, which helped him better understand the U.S. market and the nuances of the pediatric continuum of care.
Physicians can remotely monitor patient’s oxygen saturation and heart rate movement.
As he focuses on getting his product into hospitals, Baut already has additional monitoring features in development for Gabi SmartCare including respiratory rate, actigraphy, skin auto-calibration and sleep phases.
Why it matters
Reliable at-home monitoring tools can expand a pediatric hospital’s capabilities to support patients beyond the hospital setting. They can also help reduce trips to the emergency room and reduce the stress and anxiety parents experience when providing home care. Helping to advance devices like these can deliver those benefits to patient families at Children’s National and beyond.
“The pandemic underscored a great need for technologies that improve remote monitoring for children,” said Kolaleh Eskandanian, Ph.D. M.B.A., P.M.P., Children’s National vice president and chief innovation officer and program director of APDI. “At-home monitoring devices enable remote and continuous surveillance of pediatric patients, ensuring timely intervention and optimal care delivery even in remote or resource-limited settings. These technologies are needed now, and even more during public health emergencies.”
The division of urology creates tailored orientation program
The Division of Urology at Children’s National has developed a first-of-its-kind orientation program for pediatric urology advanced practice providers (APPs). This program was created based on real feedback from pediatric urology APPs in the United States and Canada.
The primary purpose of the orientation program is to increase the knowledge and confidence of pediatric APP’s in transition to independent practice. The program prepares the next group of advanced practice providers in the Division of Urology to achieve the same high quality of care that the current group provides to our patients.
“I think what makes our orientation program unique is how involved leadership is in training the orientee. We are with our orientee every step of the way every week. We are there making sure that they are attaining their skills and their knowledge. We’re checking in on them very regularly, and we also are trying to make it very individualized to that person.” said Katie Scarpaci, nurse practitioner and creator of the APP orientation program.
Global summit to address complex pediatric scoliosis
Session highlights included:
“Overall this was a great meeting with valuable content,” says Dr. Oetgen. “Learning and teaching alongside fellow orthopaedic leaders is a fantastic opportunity for everyone involved.”
Dr. Oetgen participated in the following sessions:
The 2024 ICEOS Meeting will be November 13-15 in Phoenix, AZ.
Hip preservation: Moving the needle in patient care
Hip preservation treats a wide variety of conditions such as hip dysplasia, hip impingement, hip torsion/rotation abnormalities, hip synovitis, snapping hip and hip labrum tears.
The Hip Preservation Program at Children’s National Hospital offers advanced care to children and adults with hip pain, providing a continuum of care that extends well into adulthood. Jeffrey Peck, M.D., an orthopaedic surgeon with subspecialty interests in pediatric and young adult hip preservation, discusses the program and what Children’s National is doing to move the needle forward in patient care.
Q: What is hip preservation and what are common conditions it addresses?
A: The field of hip preservation is dedicated to diagnosing and treating hip conditions that result in hip pain and can potentially result in hip degeneration.
There are several potential conditions that can lead to hip pain and eventual hip joint degeneration. These include atypical anatomy in and around the hip joint, which can be congenital, developmental or traumatic in origin. Strains and sprains of the muscles and ligaments around the hip may also cause hip joint pain. Hip preservation treats a wide variety of conditions such as hip dysplasia, hip impingement, hip torsion/rotation abnormalities, hip synovitis, snapping hip and hip labrum tears.
Q: Who is affected and when should a patient seek out an orthopaedic expert?
A: The people most often affected by conditions treated through hip preservation are adolescents and young adults up to age 45 years old who develop hip pain. When hip pain does not subside, it can be due to a condition that has resulted in hip joint inflammation that may eventually begin to cause hip joint degeneration leading to arthritis if the condition is not treated. If a patient has hip pain that lasts for multiple months without improving, it is prudent to seek evaluation with a hip preservation orthopaedic surgeon specialist.
Q: What is Children’s National doing to move the needle for hip preservation patients?
A: Children’s National cares for patients with hip pain using an integrated care team, featuring a Hip Preservation fellowship trained surgeon, physiatry experts, sports psychologists, radiologists and physical therapists with a focus on adolescents and young adults. We work in a collaborative environment with the shared goal of helping patients with hip pain return to living life without the pain that has held them back.
The Children’s National team also collects patient reported outcome scores to better understand the severity of patient symptoms and, later, how surgery has improved those symptoms. Additionally, Children’s National is engaged in research endeavors evaluating hip conditions and how patients have responded to treatment. By pursuing these efforts, we not only assist the patients we see today, but also contribute to advancing care to better help future patients.
Q: What excites you about the future for the field of hip preservation?
A: The field of Hip Preservation is a young specialty within orthopaedic surgery that has demonstrated consistently positive outcomes for patients who previously had very limited treatment options for their hip pain. With this comparative newness comes continual innovation and advancement as we learn more about how hip pain can occur and what we can do to best treat that pain. Procedures that we perform at Children’s National such as the Ganz Periacetabular Osteotomy (PAO) and the use of hip arthroscopy to treat hip impingement are relatively new innovations in the field of orthopaedics that can provide immense relief to patients having hip pain.
Revolutionizing pediatric nephrology one patient at a time
“With each kidney transplant, we’re not just restoring the health of children, we’re pioneering progress and setting new benchmarks for the field of pediatric nephrology,” says Marva Moxey-Mims, M.D., chief of Nephrology at Children’s National Hospital.
“With each kidney transplant, we’re not just restoring the health of children, we’re pioneering progress and setting new benchmarks for the field of pediatric nephrology,” says Marva Moxey-Mims, M.D., chief of Nephrology at Children’s National Hospital. “We offer not just treatment, but a chance for our patients to flourish and live their best life.”
Big picture
The Kidney Transplantation Program at Children’s National is the only one of its kind in the Washington, D.C., region focused on the needs of children and teens with kidney disease.
Performing an average of 15-20 kidney transplants per year, the program’s latest one- and three-year graft and patient survival data from the Scientific Registry for Transplant Recipients is 100%.
“Our program surpasses national numbers, reflecting a commitment to exceptional care, superior patient outcomes and a focus on setting a new standard for excellence in transplant support,” says Dr. Moxey-Mims.
Children’s National leads the way
At the forefront of groundbreaking treatment, the nephrology team is pioneering progress by providing innovative care and resources. One example is the hospital’s collaboration with the National Kidney Registry and MedStar Georgetown Transplant Institute’s Living Donor Program. This provides a greater chance of finding more suitable donors for difficult-to-match children and has resulted in altruistic donations.
“Through living kidney donations, we redefine the timeline for pediatric transplants. Children experience shorter waits and swifter paths to renewed health compared to the national wait list,” says Asha Moudgil, M.D., medical director of the Kidney Transplantation Program at Children’s National. “It’s a testament to our commitment to making a difference in every child’s life.”
That commitment is also seen in the hospital’s focus on making sure families have the resources they need during their medical journey.
“Caring for a child with renal disease is an immense challenge, not only for the young patients but also for their families. The demanding schedule of hospital visits, often three times a week, adds an extra layer of stress and disruption to daily life,” says Dr. Moudgil.
Through grant funding from donors and national programs, families with children undergoing kidney transplants and dialysis can receive financial assistance. In some cases, families receive up to $2,000 of mortgage or rental payment assistance. Families can also receive funds for medication co-pays and other expenses incurred around the time of the transplant.
“In the face of medical adversity, these funds become a source of support,” says Dr. Moudgil. “We make sure every family, regardless of financial constraints, can access the care and resources their child needs.”
Bottom line
Children’s National is at the forefront of pediatric kidney transplantation. “Our unique approach ensures every facet of a patient’s journey is considered,” says Dr. Moxey-Mims. “We’ve created an environment where success is not just a medical outcome but a comprehensive and sustained improvement in a child’s overall quality of life.”
Learn more about our latest advances in pediatric Nephrology.