James Fackler, MD, Associate Professor, Pediatric Anesthesia; Director of Safety, Quality, and Logistics in the PICU

Associate Professor
Director of Safety, Quality, and Logistics in the PICU
jim@jhmi.edu

After completing his training at Johns Hopkins, Jim Fackler left the hospital in 1986, only to return again 10 years later as an attending physician. He currently is the Director of Safety, Quality, and Logistics in the PICU. In the Safety role, he holds multidisciplinary meetings weekly to discuss a broad array of safety issues. Based on their discussions, the safety team has made a number of system-wide changes. For example, they have initiated a comprehensive strategy to fight central line-associated bloodstream infections. Working on communication, the group scripted family-centered bedside rounds and continuously revises the script. They are also beginning an effort to look at the relationship between unit acuity (severity of all patient illness) and unit workload to see its effect on patient safety. In the Quality role, Dr. Fackler has begun an effort to report severity of illness-adjusted outcomes and to benchmark the results against those in the rest of the country. The quality team has also begun a multidisciplinary research project to identify and track novel quality indicators, such as by routinely collecting and reporting antibiotic administration for children with sepsis. In the Logistics role, Dr. Fackler manages PICU bed availability.

In his research, Dr. Fackler is analyzing the tasks that are performed in the PICU and building computer models that could better organize them. The practice of medicine has changed little in the last 150 years, but technology has changed tremendously. He hopes that his research will make medicine more efficient and more effective by identifying new tasks and new ways to use technologies. He thinks that by revolutionizing the practice of medicine, hospitals can achieve a 10-fold improvement in patient safety in 5 years, and a 50% improvement in clinician productivity in 10 years. He is also trying to get a telemonitoring system established in the PICU. This system, together with vital sign data from the monitors, would be very valuable for future research analysis. Additionally, Dr. Fackler has funding from Virtual PICU System, LLC to collect data from ventilators that can be used to improve compliance with guidelines for mechanical ventilation of children with severe lung disease. Research indicates that in critically ill patients with lung disease, giving ventilator breaths that are too big causes damage to the lung. His research will take the data from the ventilator and run it through a computer algorithm to help support clinical decisions regarding breath sizes. He also has funding from a small company to take the physiologic data and correlate it with poor outcomes. The results could potentially be used to help predict which patients are at high risk for problems.

In the future, Dr. Fackler would like to create a nonprofit organization to further his research initiative. Ultimately, he would like to be able to restructure the medical system into one that could save more than one life at a time. Outside of work Dr. Fackler loves skiing, learning to play the piano, and spending time with his family and dog.

Education
Dr. Fackler attended Rush Medical School in Chicago from 1975 to 1980. He then came to Johns Hopkins, where he did his pediatric residency (1980-1983), anesthesiology residency (1984-1987), and PICU fellowship (1985-1986).

Selected Publications

  1. Hardart GE, Fackler JC. Predictors of intracranial hemorrhage during neonatal extracorporeal membrane oxygenation. J Pediatr 134:156–9, 1999.
  2. Morrison WE, Haas EC, Shaffner DH, Garrett ES, Fackler JC. Noise, stress, and annoyance in a pediatric intensive care unit. Crit Care Med 1:113–9, 2003.
  3. Morrison WE, Arbelaez JJ, Fackler JC, De Maio A, Paidas CN. Gender and age effects on outcome after pediatric traumatic brain injury. Pediatr Crit Care Med 5:145–51, 2004.
  4. White JR, Veltri MA, Fackler JC. Preventing adverse events in the pediatric intensive care unit: prospectively targeting factors that lead to intravenous potassium chloride order errors. Pediatr Crit Care Med 1:25–32,2005.
  5. Curley MA, Arnold JH, Thompson JE, Fackler JC, Grant MJ, Fineman LD, Cvijanovich N, Barr FE, Molitor-Kirsch S, Steinhorn DM, Matthay MA, Hibberd PL; for the Pediatric Prone Positioning Study Group. Clinical trial design–effect of prone positioning on clinical outcomes in infants and children with acute respiratory distress syndrome. J Crit Care 21:23–32, 2006.