UH Rainbows New Chair of Pediatrics is a Pioneer in Pediatric Patient Safety and Healthcare Quality

What's the best care for kids?

Innovations in Pediatrics - Summer 2018

What does clinical excellence look like when it comes to caring for kids? And how does it differ when the care is provided to adults? Marlene R. Miller, MD, MSc, a pioneer in pediatric patient safety and healthcare quality, has spent a career squarely addressing this issue.

 Marlene R. Miller, MD

“There are very different measures for adults,” says Dr. Miller, who recently joined UH Rainbow Babies & Children’s Hospital as Pediatrician-in-Chief for University Hospitals and Chair of the Department of Pediatrics. “There are very different interventions for adults. There are very different benchmarks and performance goal data for adults. Unless you have a focused effort to say, ‘What is the right care for kids, and how will we assess whether we’re doing it?’ you can be lost.”

Dr. Miller previously spent 19 years at Johns Hopkins Children’s Center in Baltimore, where she served as Vice Chair of Quality and Safety since 2003 and as Chief Quality Officer, Pediatrics, for the health system since 2014. While there, she conducted one of the first published analyses of patient safety events during pediatric hospitalizations, analyzing 3.8 million discharge records for children under 19 from 22 states. In addition, she and her team developed a best-practice protocol for reducing central line-associated bloodstream infections (CLABSI) in the Pediatric Intensive Care Unit (PICU) – and showed its value. Writing in the journal Pediatrics, Dr. Miller and her team reported that focused attention on continued adherence to the use of pediatric-specific central line insertion and maintenance ‘bundles’ produced sustained, continually decreasing PICU CLABSI rates. A few years later, she and her team posted similar results with a similar multi-center, quality improvement project, reducing CLABSI rates for pediatric hematology/oncology inpatients.

Dr. Miller, who is trained as a pediatric cardiologist, holds and has held leadership roles for numerous national healthcare organizations, and currently serves on the Pediatric Steering Committee of the National Quality Forum. She served as Vice President of Quality for the Children’s Hospital Association, an international organization representing more than 200 children’s hospitals, for seven years. She received the U.S. Department of Health and Human Services Secretary’s Award for Distinguished Service in 2002 and was named Paul V. Miles Fellow in Quality Improvement by the American Board of Pediatrics in 2014.

As she begins her tenure at UH Rainbow, Dr. Miller says she looks forward to collaborating with children’s hospital colleagues across the country to tackle some of the big unresolved issues in pediatric healthcare quality and safety.

“Some of the big unanswered questions in pediatric healthcare quality are still centered on establishing uniform best practices for children across the country and scientifically knowing that these best practices truly improve child health,” she says.  “It’s very hard to do impactful quality improvement when you have small numbers of patients, which inevitably is often the case with the care of children.  For us to be effectual, to know we’re scientifically improving things, we as children’s hospitals and providers of care to children need to typically band together.  The goal is to collaborate across institutions, extract these learnings and then help them be implemented across all children’s hospitals. That, to me, is still where we need to go.”

This work, she says, fits well within the UH mission: To Heal. To Teach. To Discover.

“We need to build the capacity of our workforce at all levels to do meaningful quality improvement work so that we can implement changes, scientifically study them and determine whether they actually made a difference for patients,” she says.