What Leads to Lower-Quality Patient Care?


According to Evan Fieldston, MD, MBA, MSHP, the mismatches between a hospital staff’s workload and its workforce might predict periods of lower-quality care of patients. With a five-year research project in place, Dr. Fieldston is examining the impact of these mismatches on patient care at the Children’s Hospital of Philadelphia (CHOP), where he serves as an assistant professor in pediatrics. He is examining administrative data on approximately 40,500 retrospective cases and conducting more specific prospective validation on approximately 500 cases.

Part of his project is supported by SHM’s Junior Faculty Development Award, a two-year $50,000 grant awarded for the first time in April.

Dr. Fieldston explained to the TH eWire how he’s using the research funds.

Question: What have you done to organize the project?

Answer: I’ve put together an outstanding mentoring and advisory team to guide me through the design of these projects … the analysis and interpretation. I have also secured local support at the hospital and in the department of pediatrics. Now I’m starting to frame out the specifics and the logistics of each of the projects, and I’m preparing the applications for the institutional review board.

Q: How are you spending the grant?

A: The research grant is going to be spent primarily for two research assistants to work on data collection and validation. Frontline observations are important to patient care quality and patient flow work, so I am excited to have the funds to support that work. Other parts of funding are to support biostatistical programming and operations management expertise.

Q: How will you balance your time between research and hospital rounds?

A: Very fortunately, my faculty position here at the University of Pennsylvania and CHOP is primarily for research, so 75% of my time is dedicated to research purposes. As a hospitalist, I attend on the general pediatrics inpatient teaching service for about six to eight weeks a year. … On the weeks that I am on service, it’s a lot more challenging to do research work, but I still try to touch base with the various aspects of the project.

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