Passionate about patient care

Passionate, dedicated and driven only begin to describe Fiona H. Levy, M.D., associate professor of pediatrics.

As the medical director of the Pediatric Intensive Care Unit (PICU) at St. Louis Children’s Hospital, Levy oversees a multidisciplinary team that cares for critically ill children and infants.

“I have been given the opportunity to make a difference in a patient’s life,” she says. “It’s an unexplainable feeling that is truly amazing.”

Every year, Levy and her frontline team treat more than 1,200 young patients with life-threatening conditions, from respiratory failure to central nervous system dysfunction, trauma, congenital heart disease and a variety of other medical and surgical problems.

Since her appointment as PICU medical director in 1999, Levy has dedicated herself to creating a comprehensive approach to improving the quality of patient care and ensuring patient safety.

“Fiona is a spectacular doctor, and she becomes invested in every one of her patients and applies herself wholeheartedly to their care,” says J. Julio Pérez-Fontán, M.D., director of the University’s Division of Pediatric Critical Care Medicine and director of Intensive Care Services at Children’s Hospital. “Perhaps the biggest tribute that I could pay to her abilities is to say that I would have no hesitation trusting her with the care of my own children.”

The fast-paced, constantly changing environment and the variety of cases are what drew Levy to critical care medicine, but it’s her role as the medical director of quality management for Children’s Hospital that truly fuels her passion today.

“There’s nothing more important than improving patient safety and reducing medical errors,” she stresses. “But when we start talking about those issues, it means we have to admit that there are problems.”

But Levy doesn’t shy away from tough issues.

“Tracking medical errors and unintended events can be constructive,” she says. “We can create positive results by looking at negative situations.”

The news media has widely reported the Institute of Medicine’s findings that each year in U.S. hospitals, as many as 98,000 people die as a result of medical errors.

“Fiona realizes that medical errors are a manifestation of a larger deficiency in medical culture,” explains Pérez-Fontán, also the Alumni Endowed Professor of Pediatrics. “Accordingly, she has embarked on a valiant expedition to chart the limits of this deficiency and to develop the analytical tools needed to assess what we do and to determine how we can do it better.”

Since 2001, when Levy was appointed medical director of quality management, her frontline team in the PICU has made reducing medical errors, enhancing medical care and improving patient safety its top priorities.

“Fiona’s ability to effectively communicate the importance of quality management and the necessity of strategies to address the underlying issues is a tribute to her passion for this area of medicine,” says Alan L. Schwartz, Ph.D., M.D., the Harriet B. Spoehrer Professor of Medicine and chairman of the Department of Pediatrics. “She has enormous energy, intelligence and dedication to providing patients the highest quality care.”

Quality work

When Levy came to the University as an instructor of pediatrics in 1993, she never imagined that the focus of her medical career would shift to quality care management.

After finishing a fellowship in pediatric critical care medicine at the University of Washington, Levy was drawn to Washington University because it was one of the few places in the nation that offered critical care physicians the opportunity to develop careers as basic scientists and spend time in the lab.

“A labor-intensive specialty like critical care medicine requires a serious institutional commitment to developing clinician-scientists,” she says. “And the University offered me an unparalleled opportunity to explore a career in research.”

After spending six years investigating cardiac metabolic adaptations of hypoxia, or low oxygen levels, which was backed by funding from an NIH career development award, she realized that continuing in bench research wasn’t the right fit.

“It just wasn’t how I was going to leave my legacy,” she admits. “It wasn’t my inner passion.”

After that realization, she wrestled with how she could best give back to medicine. She would find the answer where she least expected: the Olin School of Business.

In 2000, she began to pursue a master of business administration degree from the University — while carrying a full clinical load. She attended classes on the weekend as part of the school’s intensive 18-month Executive Education M.B.A. Program.

“It was the best thing I’ve ever done, if for no other reason than it’s a privilege to learn for the sake of learning,” she says. “I didn’t know for sure where it was going to lead, but I had a sense it was the right direction.”

The six-week elective on quality management ultimately shaped her future career. She explains that the principles of quality management, well established in industry, are not as well developed in medicine. And she saw an opportunity to make a real difference.

On the right track

As medical director of the PICU, Levy spearheaded the formation of a multidisciplinary team to improve the quality of care.

“To embark on this project, we realized that we needed data to identify our deficiencies. Unfortunately, the data-collecting systems in place were less than optimal for our needs, so we created our own,” she says.

This anonymous card-tracking system is paper-based rather than monitored by a computer and tracks information by medical discipline to identity various types of medical errors and unintended events.

Levy and her PICU team have collected event reports that have been used to direct efforts at improving patient safety in the PICU.

Two of Levy’s recent interventions have yielded promising results. The first, directed at improving the safety of patients on mechanical ventilator support, has yielded improvements that have been sustained for the past two years. The second intervention has dramatically improved the delivery of medications to patients and greatly reduced the opportunity for medication-related near-misses and errors.

The card-tracking system has been so successful in the PICU that it’s now being rolled out in other patient-care units at Children’s Hospital to further improve safety.

“When this program started, my colleagues called it ‘Fiona’s Cards,’ but this isn’t my project,” she insists. “The success of this project belongs to the entire frontline staff of the PICU.

“Our staff really has taken the lead in identifying medical errors and near-misses and improving patient safety.”

But Levy admits there’s still more work to be done. She says it’s necessary to look beyond data collection and apply well-defined scientific methodology to improving quality of care. She also hopes to direct hypothesis-driven research to test the most effective systems of reporting medical errors.

“Fiona has an amazing ability to reduce complex issues to their essence,” Pérez-Fontán explains. “She is disciplined and rigorous — both qualities that she learned from using the scientific method in the laboratory — but at the same time, she can perceive all the textures of an issue and, in the end, her judgment and decisions are always informed by a powerful sense of what is right and just.”

According to Levy, one of the major challenges rests with aligning the vision and action plan for quality improvement between the University’s Department of Pediatrics and Children’s Hospital.

“Neither institution can exist in isolation,” she says. “We are on the right track, but we have a great deal of work ahead.

“It’s time to run, even if it hurts a little. We don’t have anything to lose by trying. We need to remember that ensuring patient safety and quality of care is everyone’s responsibility.”