# Ambulatory Pediatric Safety Learning Lab

> **NIH AHRQ R18** · BOSTON CHILDREN'S HOSPITAL · 2020 · $505,119

## Abstract

ABSTRACT
After almost two decades of research and quality improvement, hospitalized children in the US are safer from
healthcare-related harm. The vast-majority of healthcare, however, is provided in the clinic and at home, and
few studies in this context have demonstrated how to improve safety. Children are especially vulnerable to
preventable harm caused by healthcare for many reasons, including weight-based medication dosing, handoffs
between caregivers, and their limited ability to communicate evolving symptoms. At home, two in five children
with chronic disease have a medication error. Of these, 3.6% are injured due to these errors—the same rate as
hospitalized children. Among the 165,000 children with type 1 diabetes (T1D) nationally, 20% have poor
glycemic control. The leading cause of death before age 30 among individuals with T1D is acute complications
(e.g., severe hypoglycemia, diabetic ketoacidosis). One in 68 children have autism spectrum disorder (ASD).
Of these children, 40% take antipsychotic medications, and most are not screened for complications.
Management of chronic conditions with families is complex and offers a myriad of opportunities for system
failures to occur that can lead to patient harm. We have identified 3 key opportunities to reduce the 2 most
egregious harms in this setting—medication errors and treatment delays—in 2 different conditions.
The Ambulatory Pediatric Patient Safety Learning Lab aims to:
 1. Redesign processes for adjustment of medication dosing based on clinical information gathered by the
 patient/family to prevent medication errors. (This will be studied in type 1 diabetes)
 2. Create processes for patient/family medication monitoring and communication with clinic to prevent
 adverse drug events. (This will be studied in children with Autism spectrum disorder on antipsychotics)
 3. Design a workflow to plan for, detect and prompt management of serious illness among children with
 chronic conditions at home (This will be studied in both populations)
This learning lab integrates design and systems engineering—in collaboration with Mad*Pow, and University
of Wisconsin Systems Engineering Initiative for Patient Safety—with Cincinnati Children’s expertise in patient-
centered research and implementation. The overarching goal is to redesign systems of care and coordination
between the clinic and home to eliminate harm due to healthcare in these settings. Problem analysis will
include ethnography in the home and clinic, interviews, FMEAs, and digital diaries. We will implement all
interventions together in the simulated environment and evaluate using a randomized factorial trial. Finally,
we will implement in our clinical system with qualitative and quantitative evaluation. The intent is to develop a
scalable model which leverages health systems and patient/family strengths to ensure safe healthcare among
all children. Upon completion of this proposal, our team is perfectly poised to scale this nationally...

## Key facts

- **NIH application ID:** 10011807
- **Project number:** 7R18HS026644-03
- **Recipient organization:** BOSTON CHILDREN'S HOSPITAL
- **Principal Investigator:** Eric Steven Kirkendall
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $505,119
- **Award type:** 7
- **Project period:** 2018-09-30 → 2022-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10011807

## Citation

> US National Institutes of Health, RePORTER application 10011807, Ambulatory Pediatric Safety Learning Lab (7R18HS026644-03). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10011807. Licensed CC0.

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