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Weidemann DK, Orr CJ, Norwood V, Brophy P, Leonard MB, Ashoor I. Child Health Needs and the Pediatric Nephrology Subspecialty Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678P. [PMID: 38300004 DOI: 10.1542/peds.2023-063678p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Pediatric nephrology is dedicated to caring for children with kidney disease, a unique blend of acute care and chronic longitudinal patient relationships. Though historically a small field, trainee interest has declined over the past 2 decades. This has led to growing alarm about the health of the pediatric nephrology workforce, although concerns have been hampered by a lack of available data to enable feasible projections. This article is part of a supplement that anticipates the future pediatric subspecialty workforce supply. It draws on existing literature, data from the American Board of Pediatrics, and findings from a model that estimates the future supply of pediatric subspecialists developed by the Carolina Health Workforce Research Center at the University of North Carolina Chapel Hill's Cecil G. Sheps Center for Health Services Research and Strategic Modeling Analytics & Planning Ltd. The workforce projections from 2020 to 2040 incorporate population growth, clinical effort, and geographic trends and model alternate scenarios adjusting for changes in trainee interest, clinical efforts, and workforce attrition. The baseline model predicts growth of clinical work equivalents by 26% by 2040, but further widening geographic disparities worsen the existing mismatch between supply, clinical need, and market demand. The worst-case scenario projects 13% growth by 2040 which, at best, maintains the status quo of an already strained workforce. The models do not account for many factors expected to heighten demand over the coming decades. Urgent reforms are necessary now. Proposed solutions require multipronged changes in education and training pathways, remuneration, clinical practice models, and government policy.
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Affiliation(s)
- Darcy K Weidemann
- Division of Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
- School of Medicine, University of Missouri, Kansas City, Kansas City, Missouri
| | - Colin J Orr
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Victoria Norwood
- Division of Nephrology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Patrick Brophy
- Division of Nephrology, Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
| | - Mary B Leonard
- Division of Nephrology, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Isa Ashoor
- Boston Children's Hospital, Department of Pediatrics, Boston, Massachusetts
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Swanson MB, Weidemann DK, Harshman LA. The impact of rural status on pediatric chronic kidney disease. Pediatr Nephrol 2024; 39:435-446. [PMID: 37178207 PMCID: PMC10182542 DOI: 10.1007/s00467-023-06001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
Children and adolescents in rural areas with chronic kidney disease (CKD) face unique challenges related to accessing pediatric nephrology care. Challenges to obtaining care begin with living increased distances from pediatric health care centers. Recent trends of increasing centralization of pediatric care mean fewer locations have pediatric nephrology, inpatient, and intensive care services. In addition, access to care for rural populations expands beyond distance and encompasses domains of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Furthermore, the current literature identifies additional barriers to care for rural patients that include limited resources, including finances, education, and community/neighborhood social resources. Rural pediatric kidney failure patients have barriers to kidney replacement therapy options that may be even more limited for rural pediatric kidney failure patients when compared to rural adults with kidney failure. This educational review identifies possible strategies to improve health systems for rural CKD patients and their families: (1) increasing rural patient and hospital/clinic representation and focus in research, (2) understanding and mediating gaps in the geographic distribution of the pediatric nephrology workforce, (3) introducing regionalization models for delivering pediatric nephrology care to geographic areas, and (4) employing telehealth to expand the geographic reach of services and reduce family time and travel burden.
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Affiliation(s)
- Morgan Bobb Swanson
- Department of Epidemiology, College of Medicine and College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Darcy K Weidemann
- Department of Pediatrics, Section of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Lyndsay A Harshman
- Department of Pediatrics, Division of Nephrology, Dialysis and Transplantation, University of Iowa, 425 General Hospital, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Jain K, Pivert KA, Burgner AM, Halbach SM, Weidemann DK, Boyle SM. Pregnancy and Family Policies in Nephrology Fellowships. Clin J Am Soc Nephrol 2023; 18:1613-1615. [PMID: 37656451 PMCID: PMC10723909 DOI: 10.2215/cjn.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Koyal Jain
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kurtis A. Pivert
- Department of Information and Outreach, American Society of Nephrology, Washington, DC
| | - Anna M. Burgner
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Susan M. Halbach
- Division of Nephrology, Department of Pediatrics, University of Washington Seattle Children's Hospital, Seattle, Washington
| | - Darcy K. Weidemann
- Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, Missouri
| | - Suzanne M. Boyle
- Division of Nephrology, Hypertension, and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Barani-Najafabadi B, Selewski DT, Soranno DE, Weidemann DK. Trends in the representation of women in the American Society of Pediatric Nephrology program at the Pediatric Academic Society annual meetings 2012-2021. Front Pediatr 2023; 11:1185329. [PMID: 37181423 PMCID: PMC10172499 DOI: 10.3389/fped.2023.1185329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Women are under-represented in virtually all fields of academic medicine. Even in pediatrics, a field that historically attracts a workforce with a majority of women physicians, substantial gender disparities persist in leadership positions. However, previous studies of gender representation in various academic settings are limited to small studies or aggregate pediatric subspecialties, thereby omitting important granularity within each subspecialty. No prior studies have investigated potential gender disparities in pediatric nephrology. The aim of this study is to determine the representation of women physicians in leadership and speaking roles in the annual American Society of Pediatric Nephrology (ASPN) meeting. Methods Data were analyzed from the 2012-2022 ASPN annual scientific meetings at the Pediatric Academic Society (PAS). Data were abstracted regarding gender and roles: speaker, chair/moderator, and lifetime achievement awardee. We performed a time series analysis using linear regression, with the year as the independent variable and the proportion of women as the dependent variable. Results Overall, there were statistically significant increases in the proportion of women speakers per year and percentage of women chairs or moderators. There were no specific trends noted for lifetime achievement awards and no statistically significant changes in the number of lifetime achievement awards. Discussion We found proportionate representations of gender representation with regards to speakers and chairs or moderators, although our data was limited by comparison to the American Board of Pediatrics (ABP) workforce cumulative "ever certified" data. The ABP data include a disproportionate representation of faculty who are men from earlier certification periods who may no longer be actively practicing pediatric nephrology.
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Affiliation(s)
- Bahar Barani-Najafabadi
- Children's Mercy Kansas City, Department of Graduate Medical Education, Kansas City, MO, United States
- Correspondence: Bahar Barani-Najafabadi
| | - David T. Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Danielle E. Soranno
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Darcy K. Weidemann
- Children's Mercy Kansas City, Department of Pediatrics, Division of Nephrology, Kansas City, MO, United States
- Department of Pediatrics, University of Missouri—Kansas City School of Medicine, Kansas City, MO, United States
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Kurzinski KL, Weidemann DK. The Burden of Mental Health Conditions in Children With CKD. Kidney Med 2022; 4:100478. [PMID: 35620086 PMCID: PMC9127687 DOI: 10.1016/j.xkme.2022.100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Weidemann DK, Ashoor IA, Soranno DE, Sheth R, Carter C, Brophy PD. Moving the Needle Toward Fair Compensation in Pediatric Nephrology. Front Pediatr 2022; 10:849826. [PMID: 35359890 PMCID: PMC8960267 DOI: 10.3389/fped.2022.849826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Remuneration issues are a substantial threat to the long-term stability of the pediatric nephrology workforce. It is uncertain whether the pediatric nephrology workforce will meet the growing needs of children with kidney disease without a substantial overhaul of the current reimbursement policies. In contrast to adult nephrology, the majority of pediatric nephrologists practice in an academic setting affiliated with a university and/or children's hospital. The pediatric nephrology service line is crucial to maintaining the financial health and wellness of a comprehensive children's hospital. However, in the current fee-for-service system, the clinical care for children with kidney disease is neither sufficiently valued, nor appropriately compensated. Current compensation models derived from the relative value unit (RVU) system contribute to the structural biases inherent in the current inequitable payment system. The perceived negative financial compensation is a significant driver of waning trainee interest in the field which is one of the least attractive specialties for students, with a significant proportion of training spots going unfilled each year and relatively stagnant growth rate as compared to the other pediatric subspecialties. This article reviews the current state of financial compensation issues plaguing the pediatric nephrology subspecialty. We further outline strategies for pediatric nephrologists, hospital administrators, and policy-makers to improve the landscape of financial reimbursement to pediatric subspecialists. A physician compensation model is proposed which aligns clinical activity with alternate metrics for current non-RVU producing activities that harmonizes hospital and personal mission statements.
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Affiliation(s)
- Darcy K Weidemann
- Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, United States.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - I A Ashoor
- Division of Nephrology, LSU Health New Orleans and Children's Hospital, New Orleans, LA, United States
| | - D E Soranno
- Departments of Pediatrics, University of Colorado, Bioengineering, and Medicine, Anschutz Medical Campus, Aurora, CO, United States
| | - R Sheth
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | - C Carter
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, San Diego, San Diego, CA, United States
| | - P D Brophy
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, United States
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Garg U, Taboada E, Kurzinski KL, Frazee CC, Weidemann DK, Srivastava T. Solving an unusual case of acute kidney injury: Answers. Pediatr Nephrol 2021; 36:4137-4140. [PMID: 34606004 DOI: 10.1007/s00467-021-05263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Uttam Garg
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Eugenio Taboada
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Katherine L Kurzinski
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pediatrics, Section of Nephrology, Children's Mercy Hospital, MO, Kansas City, USA
| | - Clarence C Frazee
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Darcy K Weidemann
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pediatrics, Section of Nephrology, Children's Mercy Hospital, MO, Kansas City, USA
| | - Tarak Srivastava
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. .,Department of Pediatrics, Section of Nephrology, Children's Mercy Hospital, MO, Kansas City, USA.
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Garg U, Taboada E, Kurzinski KL, Frazee CC, Weidemann DK, Srivastava T. Solving an unusual case of acute kidney injury: Questions. Pediatr Nephrol 2021; 36:4135-4136. [PMID: 34606003 DOI: 10.1007/s00467-021-05258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Uttam Garg
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Eugenio Taboada
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Katherine L Kurzinski
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pediatrics, Section of Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Clarence C Frazee
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Darcy K Weidemann
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pediatrics, Section of Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Tarak Srivastava
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. .,Department of Pediatrics, Section of Nephrology, Children's Mercy Hospital, Kansas City, MO, USA.
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Abraham AG, Xu Y, Roem JL, Greenberg JH, Weidemann DK, Sabbisetti VS, Bonventre JV, Denburg M, Warady BA, Furth SL. Variability in CKD Biomarker Studies: Soluble Urokinase Plasminogen Activator Receptor (suPAR) and Kidney Disease Progression in the Chronic Kidney Disease in Children (CKiD) Study. Kidney Med 2021; 3:712-721.e1. [PMID: 34693253 PMCID: PMC8515077 DOI: 10.1016/j.xkme.2021.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Rationale & Objective Biomarker studies are important for generating mechanistic insight and providing clinically useful predictors of chronic kidney disease (CKD) progression. However, variability across studies can often muddy the evidence waters. Here we evaluated real-world variability in biomarker studies using two published studies, independently conducted, of the novel plasma marker soluble urokinase-type plasminogen activator receptor (suPAR) for predicting CKD progression in children with CKD. Study Design A comparison of 2 prospective cohort studies. Setting & Participants 541 children from the Chronic Kidney Disease in Children (CKiD) study, median age 12 years, median glomerular filtration rate (GFR) of 54 mL/min/1.73m2. Outcome The first occurrence of either a 50% decline in GFR from baseline or incident end-stage kidney disease. Analytical Approach The suPAR plasma marker was measured using the Quantikine ELISA immunoassay in the first study and Meso Scale Discovery (MSD) platform in the second. The analytical approaches varied. We used suPAR data from the 2 assays and mimicked each analytical approach in an overlapping subset. Results We found that switching assays had the greatest impact on inferences, resulting in a 38% to 66% change in the magnitude of the effect estimates. Covariate and modeling choices resulted in an additional 8% to 40% variability in the effect estimate. The cumulative variability led to different inferences despite using a similar sample of CKiD participants and addressing the same question. Limitations The estimated variability does not represent optimal repeatability but instead illustrates real-world variability that may be present in the CKD biomarker literature. Conclusions Our results highlight the importance of validation, avoiding conclusions based on P value thresholds, and providing comparable metrics. Further transparency of data and equal weighting of negative and positive findings in explorations of novel biomarkers will allow investigators to more quickly weed out less promising biomarkers.
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Affiliation(s)
- Alison G Abraham
- Department of Epidemiology, School of Public Health, University of Colorado, Aurora, CO.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yunwen Xu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer L Roem
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jason H Greenberg
- Department of Pediatrics, Section of Nephrology, School of Medicine, Yale University, New Haven, CT.,Program of Applied Translational Research, School of Medicine, Yale University, New Haven, CT
| | - Darcy K Weidemann
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City School of Medicine, University of Missouri, Kansas City, MO
| | - Venkata S Sabbisetti
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joseph V Bonventre
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michelle Denburg
- Department of Pediatrics, Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City School of Medicine, University of Missouri, Kansas City, MO
| | - Susan L Furth
- Department of Pediatrics and Department of Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA
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Weidemann DK, Abraham AG, Roem JL, Furth SL, Warady BA. Plasma Soluble Urokinase Plasminogen Activator Receptor (suPAR) and CKD Progression in Children. Am J Kidney Dis 2020; 76:194-202. [PMID: 31987488 DOI: 10.1053/j.ajkd.2019.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/04/2019] [Indexed: 12/21/2022]
Abstract
RATIONALE & OBJECTIVE Soluble urokinase plasminogen activator receptor (suPAR) is a novel biomarker associated with incident chronic kidney disease (CKD) and has been identified as an independent risk factor for CKD progression in children, although these findings remain preliminary, limited to a single point in time, and unreplicated in pediatric cohorts. STUDY DESIGN Prospective longitudinal cohort study. SETTING & PARTICIPANTS 565 participants aged 1 to 16 years enrolled in the Chronic Kidney Disease in Children (CKiD) Study. EXPOSURE Plasma suPAR levels, categorized by quartiles, measured at study entry and a 6-month follow-up interval. OUTCOME CKD progression, defined as the initiation of kidney replacement therapy (dialysis or transplantation) or >50% decline in estimated glomerular filtrate rate (eGFR). ANALYTIC APPROACH Associations between plasma suPAR quartiles and risk for CKD progression were estimated using lognormal survival models, adjusting for potential confounders. RESULTS Participants in the highest suPAR quartile experienced 54% faster progression compared with the lowest quartile after adjustment for demographic and traditional CKD risk factors (P < 0.001). Addition of eGFR to the model attenuated the risk, although those in the highest quartile experienced 33% faster progression compared with the lowest quartile (P = 0.008). Plasma suPAR levels showed little change over 6 months. LIMITATIONS Potential for residual confounding, reliance on observational data, relatively fewer patients with higher eGFRs for subgroup analysis. CONCLUSIONS Higher suPAR levels are associated with shorter time to kidney replacement therapy or halving of eGFR in children with CKD. This association is attenuated slightly with inclusion of eGFR in regression modeling but remains a significant association for participants with the highest suPAR levels.
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Affiliation(s)
- Darcy K Weidemann
- Division of Pediatric Nephrology, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
| | - Alison G Abraham
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer L Roem
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
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Pino FA, Weidemann DK, Schroeder LL, Pabst DB, Kennedy AR. Failure mode and effects analysis to reduce risk of heparin use. Am J Health Syst Pharm 2019; 76:1972-1979. [DOI: 10.1093/ajhp/zxz229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
Failure mode and effects analysis (FMEA) was used to identify safety risks of unfractionated heparin (UFH) use and to develop and implement countermeasures to improve safety.
Methods
FMEA was used to analyze the transportation, preparation, dispensation, administration, therapeutic monitoring, and disposal of UFH in a tertiary care, freestanding pediatric hospital. The FMEA was conducted in a stepwise fashion. First, frontline staff mapped the different steps within the UFH use process. Next, key stakeholders identified potential failures of each process step. Finally, using calibrated scales, the stakeholders ranked the likelihood of occurrence, severity, and detectability for each potential failure’s cause. The rankings were used to prioritize high-risk areas on which to focus efforts for improvement countermeasures.
Results
The analysis revealed 233 potential failures and 737 unique potential causes. After ranking of all identified potential causes, 45 were deemed high scoring. Those 45 causes were further refined into 13 underlying contributing causes. To address the contributing causes, selected team members developed 22 countermeasures. The FMEA showed that implementation of the countermeasures reduced the level of mathematical risk.
Conclusion
FMEA was helpful in identifying, ranking, and prioritizing medication risks in the UFH use process. Twenty-two countermeasures were developed to reduce potential for error in the riskiest steps of the process.
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Affiliation(s)
- Felicity A Pino
- Children’s Mercy, Kansas City, MO, and Assistant Professor, School of Medicine and Bloch School of Management, University of Missouri-Kansas City, Kansas City, MO
| | - Darcy K Weidemann
- Children’s Mercy, Kansas City, MO, and University of Missouri-Kansas City, Kansas City, MO
| | - Lisa L Schroeder
- Medical Administration, Children’s Mercy, Kansas City, MO, and University of Missouri-Kansas City, Kansas City, MO
| | - Damon B Pabst
- Pharmacy Department, Children’s Mercy, Kansas City, MO, and School of Pharmacy, University of Missouri, Kansas City, MO
| | - Audrey R Kennedy
- Clinical Safety Department, Children’s Mercy, Kansas City, MO, and School of Pharmacy, University of Kansas, Lawrence, KS
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Weidemann DK, Warady BA, Furth SL. Childhood Kidney Disease: A Troubling Prognosis? Am J Kidney Dis 2018; 72:764-766. [DOI: 10.1053/j.ajkd.2018.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/26/2018] [Indexed: 11/11/2022]
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