Research & Publications
Our recent research has shown critical deficiencies in acute pediatric care in United States' Emergency Departments. My research focus is in identifying and improving areas of deficiencies in hospitals and healthcare systems compared to nationally published guidelines or high-performing pediatric care centers.
Extensive Research Description
Assessing pediatric emergency care
A key goal of my research is measuring the quality of pediatric emergency care. One of my key contributions to the literature was an epidemiologic study of 318 million pediatric Emergency Department (ED) visits from 2006 to 2014. The study found major gaps in mortality in low pediatric volume EDs compared to high pediatric volume EDs. Importantly, these observations in poorer mortality and other measures in low volume EDs have been the focus of further work to close the gap between high and low pediatric volume EDs.
Another key contribution of my work has been around the pediatric readiness survey (PRS) as a measurement tool for pediatric readiness. We recently published a study in Pediatric Critical Care Medicine that described the association of the PRS and with patient outcomes in a prospective, countrywide study that was conducted in Latvia. This study adds critical evidence around the utility of the PRS as a measurement tool for pediatric emergency care.
Interventions, tools and policies to improve pediatric emergency care
My primary research interest uses technology and innovative techniques to improve the quality of pediatric care. The research interest relies on the use of simulation as a research methodology. I have developed analytical techniques to use simulation-based assessments to describe differences in care across a large spectrum of Emergency Departments (EDs). As an example of this, I am well known in the field of pediatric emergency medicine for the use of radar plots to display multiple measures of pediatric care across many hospitals. I have been central in a large ~200-center study examining differences in care across EDs across the United States to measure and compare—and improve—the quality of care in acutely ill pediatric patients.
We’ve measured significant improvements in pediatric readiness in EDs around the country. I recently finished an analysis of a dataset of 36 EDs across the US where we used a simulation-based intervention to improve pediatric readiness, and we saw a 16-point improvement in the 36 EDs (p<0.001).
One of my key interests is in disaster preparedness for pediatrics and using novel tools to improve pediatric disaster triage preparedness. We have published a series of papers on a videogame-based pediatric disaster triage training tool, 60 Seconds to Survival. We have shown that this videogame-based approach is able to improve disaster triage skills in EMS personnel. Additionally, I performed cost-effectiveness analyses to show that this tool was more cost-effective at improving pediatric disaster triage skills compared to a traditional, live simulation. This videogame-based approach can be easily scaled up to train remote health systems pediatric disaster triage (e.g., COVID19-related disasters).
Telemedicine and Technology for Improvement of Pediatric Care
Finally, I have collaborated on a series of studies on exploring modes of telemedicine to improve the delivery of pediatric care in several different settings. We have demonstrated the benefit of telemedicine in improving neonatal resuscitation in the ED (in a simulated setting) and have studied the nuances of telemedicine delivery. Additionally, we have used telesimulations between Yale at Latvia to train a local instructor in the country to conduct simulations locally.
Data Collection; Data Display; Delivery of Health Care; Organizational Innovation; Pediatrics; Quality of Health Care; Quality Improvement
Public Health Interests
- 60 Seconds to Survival Video Game: A Multi-Site Study to Improve Prehospital Pediatric Disaster TriageCicero MX, Whitfill T, Overly F, Baird J, Walsh B, Yarzebski J, Riera A, Adelgais K, Meckler GD, Baum C, Cone DC, Auerbach M. 60 Seconds to Survival Video Game: A Multi-Site Study to Improve Prehospital Pediatric Disaster Triage. AEM Education and Training. 2018 (In Press).
- Do you see what I see? A randomized trial of simulation-based master training with videolaryngoscopy for neonatal intubationJohnston L, Chen R, Whitfill T, Bruno C, Levit O, et al. Do you see what I see? A randomized trial of simulation-based master training with videolaryngoscopy for neonatal intubation. BMJ Simulation & Technology Enhanced Learning. 2016;
- Therapeutic treatment of skin disease with recombinant commensal skin microorganismsWhitfill TM, Munivar AM, inventors. Azitra Inc., assignee. Therapeutic treatment of skin disease with recombinant commensal skin microorganisms. PCT WO2015184134. 2014 May 30.