Synopsis
Pediatric rapid response systems were first described right at RCH Melbourne in a paper published in 2005. The medical emergency team and the activation criteria described in that paper helped launch worldwide efforts to implement rapid response systems to reduce cardiac arrest and mortality, and inspired researchers to pursue efforts to refine and further improve systems to detect deteriorating patients. Now, 11 years after the original description, significant improvements in arrests and mortality have been described worldwide, yet children still experience preventable deterioration outside the ICU at many hospitals.
In his Grand Rounds lecture, Dr. Bonafide will review what we know about the challenges in identifying deteriorating children in ward settings, including difficulties interpreting vital signs, recognizing changes in children with complex chronic illnesses, and alarm fatigue from physiologic monitors. He will then discuss solutions to these issues that have been proven effective, and address opportunities for research and quality improvement—many of which involve leveraging data and clinical decision support in the electronic health record—to continue moving the field forward.
Speaker
Dr. Chris Bonafide is a pediatric hospitalist at The Children’s Hospital of Philadelphia and an Assistant Professor of Pediatrics at the University of Pennsylvania. He grew up in Sanbornton, New Hampshire. He studied psychology in Maine, and went on to medical school at the Pennsylvania State University College of Medicine. Dr. Bonafide completed residency and a fellowship in academic general pediatrics at The Children’s Hospital of Philadelphia. During his fellowship he received a Master of Science in Clinical Epidemiology degree from the University of Pennsylvania.
Dr. Bonafide’s research focuses on the best ways to identify deteriorating patients in the hospital, and the best mechanisms to respond to those patients. He is also interested in identifying unintended consequences of interventions intended to improve patient safety. Dr. Bonafide has investigated these areas using a wide range of study designs and methods. He is currently funded by a Career Development Award from NIH/NHLBI focused on measuring alarm fatigue— a significant barrier to promptly recognizing clinical deterioration— from physiologic monitoring devices. He also holds a Young Investigator Award from the Academic Pediatric Association focused on evaluating an intervention to reduce unnecessary monitor alarms in hospitalized children. In addition, Dr. Bonafide co-directs a pediatric hospital medicine research fellowship at CHOP, the Pediatric Hospital Epidemiology and Outcomes Training (PHEOT) Program.
In addition to his publications in journals such as JAMA Pediatrics, Journal of the American Medical Informatics Association, and Pediatrics, his work has recently been featured on National Public Radio and in The Wall Street Journal. Dr. Bonafide serves as an Associate Editor of the Journal of Hospital Medicine and is an Editorial Board Member of a new journal, Pediatric Quality and Safety.