Sara Toomey studies factors that affect the quality of pediatric patient care. At Boston Children’s Hospital, she is a practicing hospitalist, primary care pediatrician and Director/PI of the Center of Excellence for Pediatric Quality Measurement and Chief Experience Officer. The Center has developed the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey, 30-day pediatric readmission measures and the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool. Dr. Toomey’s research aims to measure the quality of pediatric care, demonstrate the association between quality measures and health care outcomes, and develop interventions to improve outcomes.
The Betsy Lehman Center: As Chief Experience Officer at Boston Children’s and a researcher in pediatric patient safety, can you speak to the relationship between the quality of the patient and family experience and patient safety?
Dr. Toomey: From my perspective, safety and experience certainly are connected; to have the safest environment possible, we need to clearly communicate with patients and families and involve them in their care. That said, it is possible to have an adverse event and still have a positive experience overall. Conversely, safe care does not guarantee a good experience. Patients and families value communication and being included on a cohesive care team, which helps us provide them with safe care.
The Betsy Lehman Center: In what ways do pediatric patients and families actively participate in patient safety at Boston Children’s?
Dr. Toomey: At Boston Children’s, we believe that partnering with patients and families is an important step in our high reliability journey. For instance, we have worked with patients, families and staff members to develop a Patient Family Safety Resource brochure. The goal of this brochure is to help patients and families understand that they are an essential part of the care team and that they should feel comfortable raising questions or concerns to us at any time. It is a brief guide that simply encourages families to speak up for safety. It was created by an interdisciplinary team and was rolled out recently in our inpatient setting. We also have other projects in which we encourage patients and families to participate in safety activities. For example, we have a mechanism for patients and families to activate our rapid response team and an initiative that involves families in preventing peripheral IV infiltrates.
The Betsy Lehman Center: Some of your recent research shows the rate of adverse events among pediatric hospital patients is twice as high in Latino children compared to white children. Do we understand why? Are there similar disparities among other racial or ethnic groups?
Dr. Toomey: Our study was not designed to determine why the rate of inpatient adverse events was higher for Latino children in comparison to white children. We did not find a similar disparity with other racial or ethnic groups. One potential contributing factor could be that those for whom English is not their first language often face challenges. Interpreters are not at the bedside throughout the hospitalization so communication may be sub-optimal and materials might not be available in their language. At times, cultural differences might play a role in a family’s comfort in speaking up and asking questions.
Taking a step back, identifying disparities in pediatric health and health care more generally is an important area of research. Understanding what disparities are present and analyzing whether disparities are narrowed, persist or are worsened as we adopt new models of care and trial interventions are critical for promoting the health of vulnerable populations.
The Betsy Lehman Center: Your recent research shows the rate of 30-day readmissions increased while admissions decreased overall in pediatric hospitals. The research also shows a correlation between readmission rates and increasing numbers of children admitted with complex chronic conditions. Is there more that can be done to safely care for pediatric patients at home?
Dr. Toomey: This is an important question. You are correct that our paper showed that children with complex chronic conditions are becoming a larger proportion of admitted pediatric patients, which is likely driving some increase in readmission rates. We are working to improve the transition to home for children with complex chronic conditions and, more generally, the safety of home care. These programs support families in caring for their children. Some examples of innovative programs include increased use of home visiting for patients at high risk, such as patients discharged from the NICU, and virtual visits with care teams, such as for children with central lines for ongoing parental nutrition. The CAPE (Critical Care, Anesthesia, Perioperative, Extension) and Home Ventilation Program is one program that brings much of this together at Boston Children’s. It provides comprehensive, longitudinal care for children with chronic respiratory insufficiency and technology dependence related to underlying medical complexities.
The Betsy Lehman Center: Some of your research involves huge data sets — 2.4 million pediatric patients, for example, in the recent readmissions study. How can a community hospital apply lessons from a vast study of that kind to local problems and conditions?
Dr. Toomey: Studies that use large data sets are critical for understanding important trends in pediatric care and health care quality. That said, that does not mean that these findings are uniformly applicable to every hospital. Hospitals need to think about how these findings apply to them. Hopefully, these larger studies identify new foci for local hospitals to examine in their system, provide an understanding of how their performance compares to national averages, and pose potential targets for interventions.
