Hospital Medicine

The Division of Pediatric Hospital Medicine (PHM) provides top quality, family centered care for the hospitalized children of our region. Now spanning four inpatient sites, we emphasize an evidence-based approach, driven by best practice. We lead in educational excellence, as the primary teachers for medical students and residents in the inpatient pediatric setting, serving two medical schools, our own pediatric residency program, and three family medicine residency programs. As our young field evolved in 2019 into a formal subspecialty, we enjoyed our first year in 2020 as boardcertified pediatric hospitalists, with a 100 percent pass rate for our 12 faculty who sat for the first-ever PHM board exam. The field of PHM continues to grow and thrive, and at Connecticut Children’s, we help to shape that growth through our own academic scholarship.

The year 2020 was unlike any other – for our division, for Connecticut Children’s, and for the world. As pediatric hospitalists, we led the front line charge against Covid-19 and the related diagnosis of multisystem inflammatory syndrome in children (MIS-C). A second effect of the Covid-19 pandemic has been the explosion in behavioral health challenges for our society’s young people. Our division, in collaboration with our psychiatry and psychology colleagues, has been on the front lines of caring for these children when they require medical hospitalization. Amidst these new challenges, we continue to focus on our key areas of impact – clinical work, medical education, quality improvement, scholarly activity, and hospital leadership.

On the clinical front, we again had our busiest year ever, despite the massive changes caused by the Covid-19 pandemic. Patient volume increased over the prior year, and has nearly doubled within the past five years. We continue to provide inpatient care in four locations — at our main campus in Hartford, in our 12-bed satellite unit in Waterbury, as well as within the inpatient units and newborn nurseries of Danbury and Norwalk hospitals. We have brought to these practice sites our own brand of care, with an emphasis on family centered rounds, clinical pathways, and coverage models that promote strong communication with our community partners. Our hospitalists now cover 100 percent of general pediatric inpatients in all of these locations.

As a division, we are particularly proud of our clinical partnership with our advanced practice provider (APP) colleagues. The lead APP, Basia Adams, with a new doctor of nursing practice (DNP) degree in hand, was appointed in 2020 as co-director of the Advanced Practice Providers for all of Connecticut Children’s. This group has increased to over 180 members and remains an essential and valued part of our clinical work force. Christina Giudice, APRN, joined Cathy Sullivan, MD, to present nationally and in a regional grand rounds on the topic of somatic symptom disorders. Ms. Giudice joined Ilana Waynik, MD, in a national presentation on viral croup, and was also honored to receive the American Academy of Pediatrics PHM Travel Grant Award, one of just a few recipients nationally. We realize that fostering the talents of our APPs will help their growth while also benefiting Connecticut Children’s and the patients we serve.

In the realm of medical education, we led the institution on many levels. The pediatric residents awarded Patricia Garcia, MD, the 2020 Milton Markowitz/Edwin Zalneraitis Award for Outstanding Contribution to House Staff Education and Career Development. PHM again enjoyed the greatest number of nominations for the 2020 Faculty Award for Excellence in Teaching. Drs. Joanne Crowley, Patricia Garcia and Allyson McDermott were all given that honor. Melanie Rudnick, MD, was runner-up for the Timothy N. Kelly Award for Excellence in Teaching Acute Care. PHM division members won the monthly McNeil Teaching Award from the pediatric residents more often than members of any other division. The honor went to Drs. McDermott, Rudnick, Garcia, Hayley Wolfgruber, and Hareem Park.

Members of the division led in numerous educational positions. Dr. Crowley continues as director of Undergraduate Pediatric Education for the University of Connecticut, assisted by Dr. McDermott in her new role as assistant inpatient clerkship director. Dr. Rudnick leads the Quinnipiac University Netter School of Medicine pediatric clerkship at Connecticut Children’s. Marta Neubauer, MD, assists that role, spearheading the highly regarded Netter medical student experience at the St. Mary’s unit in Waterbury. Our APP group has taken on a role to help educate the Netter students, and that experience has been a model of collaborative interdisciplinary education. Christine Skurkis, MD, continues in her prominent role as associate director of the pediatric residency program. She also has a new national role as chair of the curriculum learning group for the Association of Pediatric Program Directors. As a division, we continue to pursue a goal of establishing our first Pediatric Hospitalist Medicine Fellowship program, which Dr. McDermott would lead. She already leads in this area as a member of the National Council of Pediatric Hospital Medicine fellowship directors.

On the quality improvement front, the year was dominated by Covid-19, and we are proud that one of our own, Dr. Ilana Waynik, leveraged the strengths of our Clinical Pathways Program to help lead us all. She oversaw the rapid development of over 14 new Covid-19-related clinical pathways at Connecticut Children’s. These were invaluable in guiding us in daily patient, staff and family care. Ever-evolving policies and changing clinical approaches mandated the use of these standardized pathways to provide the highest level of care for our Covid-19 and MIS-C patients. For this incredible accomplishment, she shared with Grace Hong, APRN, the Physician’s Quality Cup Safety Award. Dr. Waynik is the first recipient of this award from our division. The Clinical Pathways Program continued to evolve in non-Covid-19 ways as well. We achieved a major milestone as the program moved to an Internet site. It has since received over 31,000 hits, as providers from all over the country and the world benefit from the 45 to 50 evidence-based clinical pathways. This development extends the impact of Connecticut Children’s far beyond our doors.

There were great academic strides in the past year, despite the inability to travel for our numerous national presentations. Multiple faculty members were able to deliver talks or lead workshops virtually at the national level for a number of organizations: Pediatric Academic Society, Pediatric Hospital Medicine, the Association of Pediatric Program Directors, the Council on Medical

Student Education in Pediatrics, and the American Academy of Pediatrics. An exciting year was concluded with wonderful academic news. We learned that Connecticut Children’s was one of eight sites nationally to receive a multimillion dollar grant to study Covid19-related MIS-C. Our division member and pipeline researcher Alex Hogan, MD, is a co-investigator for this award, and will assist Physician-in-Chief Juan Salazar, MD, MPH, in this project to look for biomarkers for MIS-C and Kawasaki’s disease. Our division will help to ensure the success of this study, as the majority of inpatients will be from our inpatient service.

Fostering leadership across local, regional and national spheres has been a priority for our division for many years. Division chief Anand Sekaran, MD, served on the 12-member American Academy of Pediatrics PHM PREP editorial board. This group created the first national exam for pediatric hospital medicine, and it will continue to provide this primary learning tool for the PHM board exam. Dr. Sekaran also served as associate editor for the PHM core competencies, which helped to determine the knowledge and skills that are inherent to being a pediatric hospitalist. Kathy Kalkbrenner, MD, took the group to new levels of cohesiveness and engagement in her critical role as the division’s clinical director. Dr. Neubauer further evolved her leadership role as site director of our St. Mary’s unit, bringing a higher level of quality and positive movement in expanding our partnership with Trinity Health of New England. Beth Natt, MD, MPH, in her role as regional director of the division, oversees expansion of PHM to other locations, ensuring the highest quality of care close to home for our patients. MacDara Tynan, MD, MBA, served as senior director of practice operations for Connecticut Children’s Specialty Group. Jane Im, MD, and Jill Herring, APRN, brought their expertise to roles within Information Solutions, working innovatively to improve efficiency.

As pediatric hospitalists, we continue to evolve in how we provide value to our patients and families, educate trainees, and improve inpatient care. Our goal is not only to measure our performance against national standards but to be at the top of those benchmarks. Yet as we continue to grow, we strive to maintain our greatest core value of putting patients and families first in all we do.

PUBLICATIONS

Andrews AL, Williams DC, Hogan AH. Clinical progress note: Care of children hospitalized for acute asthma exacerbation. J Hosp Med. 2020;8-10. doi:10.12788/ jhm.3382.

Hogan AH, Flores G. Social determinants of health and the hospitalized child. Hosp Pediatr. 2020;10(1):101103. doi:10.1542/hpeds.2019-0289.

Lewis E, Waynik I, Mackey S. Decreasing pain experienced by hospitalized pediatric patients by increasing the use of topical anesthetics for peripheral intravenous (PIV) line placement. BMJ Open Quality. Dec 2019;8(S2)A16-A19. doi:10.1136/bmjoq-2019-ihi.10.

McMahon E, Fried A, Rudnick M, Corden M. Intraventricular hemorrhage in a term neonate. Ped Rev. 2020 Jan;41(1):31-33. doi.org/10.1542/ pir.2018-0156.

Silver AH, Andrews AL, Azzarone G, Bhansali P, Hjelmesth E, Hogan AH, O’Connor KM, Romo N, Parikh K. Engagement and leadership in firearmrelated violence prevention: the role of the pediatric hospitalist. Hosp Pediatr. 2020;10(6). doi:10.1542/ hpeds.2019-0327.

STAFF

Anand Sekaran, MD, Division Chief Kathy Kalkbrenner, MD, Clinical Director Joanne Crowley, MD Patricia Garcia, MD Alex Hogan, MD Jane Im, MD Kathy Kalkbrenner, MD Allyson McDermott, MD Marta Neubauer, MD Hareem Park, MD Melanie Rudnick, MD Christine Skurkis, MD Catherine Sullivan, MD MacDara Tynan, MD, MBA Ilana Waynik, MD Hayley Wolfgruber, MD

Basia Adams, APRN, DNP, lead APP Kara Denz-Fluck, PA-C Christine Giudice, APRN Jill Herring, APRN St. Mary’s Health Providers Kayla Ingram, PA-C, lead PA Kalin Balides, PA-C Lauren Dale, PA-C Marisa Shaker, PA-C

Nuvance Health Providers Beth Natt, MD, MPH, Regional Director Donald Sampson, MD Alicia Briggs, MD Amanda Begley, MD

Jacqueline Talbot, PA-C, lead PA, Danbury Beth Cross, PA-C Alexandra Pavain, PA-C Alexis D’Aloisio, PA-C Lauren Smith, PA-C

Pamela Fanning, PA-C, lead PA, Norwalk Jennifer Napolitano, PA-C Nora Croll, PA-C Kimberly Orzech, PA-C Jacquelyn Brown, PA-C