New Head of Pediatric Emergency Medicine at UH Rainbow Aims to Revolutionize Care for Kids

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Charles G. Macias, MD, MPH, leads several critical national emergency preparedness and quality improvement initiatives

UH Innovations in Pediatrics | Winter 2020

Charles Macias, MD, MPHCharles G. Macias, MD, MPH

When it comes to setting goals, Charles Macias, MD, MPH, thinks big. His aim is nothing less than to dramatically improve hospitals’ readiness to care for children, not only in disasters and emergencies, but also in more routine urgent situations and hospital care. Specifically, the goal is that every hospital anywhere could be “pediatric-ready every day for every child.”

“If you look at the recent national emergency department data on pediatric mortality, hospitals that scored in the top quartile in pediatric readiness had about a third the rate of mortality for severely ill children,” says Dr. Macias, new Division Chief of Pediatric Emergency Medicine and Chief Quality Officer at UH Rainbow Babies & Children’s Hospital. “Readiness matters. Our goal is to increase pediatric readiness so that we raise the level of sophistication to care for ill or injured children.”

To that end, Dr. Macias and his pediatric emergency medicine colleague and pediatric disaster and recovery response expert, Deanna Dahl-Grove, MD, Pediatric Emergency Medicine; and Associate Professor of Pediatrics, Case Western Reserve University School of Medicine, are recent recipients of a $3 million grant from the U.S. Department of Health and Human Services’ Office of the Assistant Secretary of Preparedness and Response (ASPR). The funds are being used to establish a Pediatric Disaster Care Center of Excellence – one of just two in the country. The Eastern Great Lakes Pediatric Consortium for Disaster Response, led by UH Rainbow and accompanied by five other children’s hospitals in Michigan and Ohio, is developing a multi-pronged approach to address gaps across the disaster cycle spectrum of mitigation, preparedness, response and recovery for nearly 7 million children.

“We face threats from disasters every day, which is why it is so important for hospitals, health care infrastructures, government and private entities to work together to create a coordinated emergency response model,” Dr. Macias says. “We are proud to be leading one of only two Pediatric Disaster Care Centers of Excellence in the country right here in Cleveland.”

“Often, health care organizations and government entities have pretty expansive plans that address adults, but when we think about the specific needs of children, they may be unique, yet not sufficiently addressed,” he adds. “Take a NICU. What do we do in the event of a disaster? If the disaster area is expansive and we don’t have the ability to transfer NICU patients across the region, do we have agreements across the state? Are there ways in which we can assure that there are transport capabilities? Can we depend on our partners in Michigan or across other states? On the recovery side, post an event, do we understand the specific needs of children if they are brought into facilities and are separated from their parents? Do we have ways to address reunification? Do we have data systems that can effectively tell us how to reconnect families and their health care needs and resources?”

Dr. Macias, Dr. Dahl-Grove and their collaborators within the Center of Excellence are working to develop best practice guidelines that answer these and other questions.

“I think this Center of Excellence will serve as a great model and demonstrate how innovation around quality ultimately is the solution for delivering the right care to the right patient at the right time – and how the needs of children can be carved out in that process,” he says. “Together, the two centers and other ASPR efforts will create a national model for pediatric disaster preparedness and recovery.”

INNOVATION AND QUALITY IMPROVEMENT

In addition to his work on pediatric disaster preparedness, Dr. Macias is also a national leader in how innovation and quality improvement can serve emergency medical services for children more broadly, serving as Executive Director of the National EMS for Children Innovation and Improvement Center.

“We have state partnerships in 58 states and territories to promote improvement in processes and outcomes for ill and injured children, and we facilitate the quality improvement strategies to guide improvement in those outcomes,” he says. “It’s all about making the country pediatric-ready to care for acutely ill or injured children anywhere in the emergency services continuum of care. What we have done is create quality improvement structures that help support more rapid adoption of innovation across the different states to achieve goals in targeted domains, especially identifying readiness in terms of equipment, supplies and personnel. We also offer as part of that process pediatric readiness tools, so organizations that aren’t pediatric-ready can learn what they can do to improve their readiness."

Another special interest of Dr. Macias’ is pediatric sepsis – and how to improve what are typically sub-optimal outcomes. As co-chair of a national quality improvement initiative within the Children’s Hospitals Association and in his leadership role at UH Rainbow, Dr. Macias is employing both high-tech and high-touch approaches.

”We want to help clinicians and health care infrastructures more rapidly identify patients with pediatric sepsis and help them more effectively manage those patients,” he says. “The approach is multipronged, but much centers on communications strategies, such as in structured huddles. But it’s also identifying those patients at risk with fairly sophisticated trigger tools, most of them built into the electronic health record, that can identify predictively who might be at risk for sepsis, and then linking those kids more accurately into early care, which has been found to be the most effective intervention.”

The potential of technology to make a difference with this thorny problem is enormous, he says.

“There are opportunities to be using machine learning and digital optimization to push the future of health care for pediatrics, not only across our health system, but across the country,” he says.  “We expect to see improvement in morbidity and mortality, but also improvement in patient-centered care and patients’ perceptions of the care they are receiving.”

“All of the work we do through quality improvement and safety strategies is about getting the right care, to the right patient at the right time and in the right venue,” Dr. Macias says. “That’s what improves outcomes for children.”

For more information about Dr. Macias and his work, please email PedsInnovations@UHhospitals.

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