Research and Scholarship

I am a Clinician Educator, and clinical service comprises the backbone of my practice. 52 weeks of clinical service in the Pediatric ICU (PICU)are divided equally amongst all the attendings, which varies in numberbetween 5 and 7. We provide 24/7in-house coverage, and procedural sedationfor both outpatient and inpatient procedures. My group also provide Extracorporeal Membrane Oxygenation services for critically ill infants and children. The breadth of my practice keeps it challenging and interesting, and affords many opportunities for teaching and collaboration. The intensive care unit lends itself well to bedsideteaching, which I particularly enjoy. Didactic lectures, particularly in the areas of respiratory failure, shock and hemodynamicmonitoring, diabetic ketoacidosis and traumatic brain injury/neuromonitoring, supplement the bedside teaching, and really drive home important concepts in real time. Every week of service, Iprovide 2-3 interactive, white board lectures to residents and medical students, integrating pathophysiology and literature review with specific patient examples. The informal, interactive formatallows discussion of different management styles, an issue that is often confusing to residents. Ialso provide an annualDiabetic Ketoacidosis lecture for the annual Core Curriculum Summer Lecture series. Last year I worked with the Office of the University Counsel to provide a 2-part lectureon Medical Errors. In addition, I have lecturedto nurses in the PICU on topicssuch as Post-op Monitoring after Cardiac Surgery, Stroke, Traumatic Brain Injuryand DKA. I mentor residents in preparing and presenting a quarterly PICUMorbidity and Mortality (M&m) Conference. These take between 2 and 4 weeks of preparation each, covering both teaching points and a Quality Improvement analysis. These conferences consistently get good feedback from both the residents presenting and those in the audience. I have also enjoyed teaching undergraduate students and medical students, in courses such as “So You Think You Want To Be A Doctor?,“The Health of New Mexico”, “Transitions”, “Pediatric Tutorial” and “Clinical Reasoning 2”. My scholarship efforts at UNM have revolved around Quality Improvement (QI). My first efforts were unit-based projects such as an evidence-basedProne Positioning Procedure for Ventilated Patients and a multi-disciplinary Chest Tube Care Guideline. I organize our quarterly PICU Morbidity & Mortality Conference,which has led to two QI projects: (1) the acquisition of an Easy IO vascular access kit for the PICU and (2) revision of the PEWS Action Algorithm on the Pediatrics wardsto make is easier to use. The first was a passion project for one of our PICU nurses, and the second was a QI project for a Pediatrics resident. Next, I worked with the hospital’s Stroke Committee ona 2 year, multi-disciplinary effort to create a Pediatric Stroke Protocol. This guideline dovetails with the existing Adult Comprehensive Stroke Procedure, has the buy in of all stakeholders and is available on the hospital’s Intranet under Policies and Procedures. The ultimate goal is to regionalize the care of large volume strokes in children to UNMH, theonly center in the state withexpertise in life-saving therapies such as thrombectomy and hemicraniectomy. In 2016, I represented Pediatricsin creating a uniform Central Line Insertion Policy for the hospital. In 2017 I became the Quality and Safety Officer (QSO) for the Department of Pediatrics and have been working to improve our performance in metrics such as Mortality Index, Hospital Acquired Infections and Readmissions.This effort issupported by the UNMH Office of Quality and Safety through monthly QSO meetings and informal mentorship. Current ongoing departmental projects include providing feedback on Patient Safety Events to providers, reviewing pediatric Readmission data and looking for opportunities to improve, reviewing the last three years of pediatric Venous Thromboembolism to identify opportunities for improvement, and workingwith Hospital Epidemiology to keep our central line infection and urinary catheter infection rates low.The next phase of this QI work is to find opportunities for publishable projects andmentor residents in that Page 4of 9arena. Pediatrics was given a good review by the Quality Oversight Committee at our 2018 annual review, for our efforts and progress in Quality Improvement.