New physician scientist already conducting pioneering research in neonatology

As a recently recruited young physician scientist on CHOC’s neonatal intensive care unit (NICU), Dr. Grant Shafer is maintaining a busy clinical schedule while settling into a new life in Southern California.

And Dr. Shafer, who joined CHOC on Sept. 1 after finishing a fellowship at Texas Children’s Hospital (TCH), arrives here with some pioneering result already under his belt – with more to come.

Dr. Grant Shafer, CHOC neonatologist

In one of the first such large studies of its kind in neonatology, Dr. Shafer is researching the prevalence of diagnostic errors and the ethical responsibilities of providers to disclose such errors to families of impacted NICU patients. 

“Studying and quantitating diagnostic errors is a relative new science in the field of neonatology,” said Dr. Vijay Dhar, medical director of CHOC’s NICU, and division chief, Neonatology, at CHOC/UCI. “Grant has been an outstanding addition to our growing young faculty in the division.”

In March 2020, Dr. Shafer, with a TCH colleague, authored the paper “The Ethics of Disclosing Diagnostic Errors: What is the Researcher’s Duty?” that was published in JAMA Pediatrics, a monthly peer-reviewed medical journal of the American Medical Association.

And in late October, Dr. Shafer was one of eight former distinguished fellows who spoke on a panel before a global international audience at the Society to Improve Diagnosis in Medicine’s (SIDM) Diagnosing Errors in Medicine 13th Annual International Conference.

“To me, this research is interesting because it’s about how we provide the care we provide,” Dr. Shafer said. “It’s the kind of research that I really enjoy. Some people enjoy benchwork, some people enjoy working in the lab, some enjoy clinical studies.

“I really enjoy research that looks at the systems in which we practice medicine and how that impacts the care we provide, and diagnostic errors encapsulates all of that,” he added. “But it’s a field that we really haven’t studied yet. There’s just not a lot of information out there. All the data we’re finding is new to everyone.”

Earned a master’s in English Literature before becoming a doctor

Dr. Shafer, whose parents are from Hawaii, grew up in Denver. His mother, Andrea, is a retired school administrator and his father, Duane, worked in finance. He has a younger sister who runs a CrossFit gym in Kansas City with her husband.

Dr. Shafer earned bachelor’s and master’s degrees in English Literature from Wayne State University in Detroit. He went on to earn his medical degree from the University of Cincinnati College of Medicine and completed his pediatrics residency at University of Texas Southwestern.

At Baylor College of Medicine at TCH, Dr. Shafer completed a neonatal-perinatal medicine fellowship and, over the last year, also completed a second research fellowship in diagnostic excellence through SIDM.

In his JAMA Pediatrics paper, Dr. Shafer and co-author Dr. Frank X. Placencia probed the duty of a researcher performing retrospective medical reviews to disclose diagnostic errors. They concluded that because researchers are outside the patient-clinician relationship, the researcher is not ethically obligated to disclose a diagnostic error directly to a patient with whom they have no formal relationship.

However, Drs. Shafer and Placencia concluded, there is potentially a responsibility to discuss the error with the treating clinician, who then assumes the responsibility of contacting the patient.

Elaborating on this ethical framework during his SIDM panel presentation, Dr. Shafer noted many researchers feel uncertain how to proceed when they come across a diagnostic error that potentially could cause harm to a patient. Because of the sensitive nature of the information, Dr. Shafer recommended that it be delivered to the clinician in a structured setting.

Dr. Shafer said with hard numbers about diagnostic errors in NICUs still years away, a lot of research remains to be done.

“It’s widely acknowledged that diagnostic errors occur in the NICU, but we don’t know how often or how much harm they are causing, which means we can’t try to make things better,” he said.

And making things better – building on CHOC’s already sterling reputation in the field of neonatology — is the whole point, he added.

“I think this is the right place and right time to really push this research forward,” Dr. Shafer said. “I’m humbled and excited to have the opportunity to provide clinical care to babies here in the NICU at CHOC as well as research how we can continue to improve the diagnostic care we provide moving forward.”

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CHOC Neonatology by the Numbers

In honor of Prematurity Awareness Month, we share an inside look at our neonatologists and services they provide to care for babies daily in Orange County. CHOC is proud to have a Neonatal Intensive Care Unit (NICU) rated by the American Academy of Pediatrics as a Level 4 – the highest rating available. Our NICU is also rated among the top 35 NICUs in the nation by U.S. News & World Report. CHOC is proud to be entrusted with giving babies a healthy start.

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CHOC Begins NICU Expansion

To enhance its patient- and family-centered care experience and meet the growing demand for services, CHOC Hospital has launched an exp  ansion to its neonatal intensive care unit.

The build-out will create 36 private patient rooms with amenities to allow parents and guardians to comfortably stay overnight with their critically ill babies receiving highly specialized care at CHOC.

“Every parent wants to stay as close to their baby as possible, especially when the infant needs a high level of medical attention,” said Dr. Vijay Dhar, medical director of CHOC’s NICU. “The expansion to CHOC’s NICU will offer parents and guardians reassurance that they’ll be nearby while their baby receives the highest level of care. As an organization committed to patient- and family-centered care, CHOC is proud to soon offer private rooms to our smallest patients and their parents.”

CHOC NICU Patient Room

Expected to open in summer 2017, the new solo rooms will be housed on the fourth floor of the state-of-the-art Bill Holmes Tower. A potential second phase of construction could add more beds.

Private NICU rooms are setting a new standard for improved patient outcomes. A recent study published in the journal Pediatrics found that infants cared for in single-family rooms weighed more at discharge and gained weight more rapidly than those who received care in an open design. Also, they required fewer medical procedures, had increased attention, and experienced less stress, lethargy and pain. The researchers attributed these findings to increased maternal involvement.

Further, the private-room setting provides the space and privacy that parents need to be more intimately involved in the care of their baby, including breast-feeding and skin-to-skin contact, and parents can stay overnight with their child. In addition, private rooms give staff more access to and interaction with the family and patient.

CHOC’s expanded unit will also feature a multipurpose family room, sibling activity room, additional office space and other enhanced amenities.

CHOC NICU Main Waiting RoomA fundraising campaign by CHOC to raise $22 million is underway to complete the project. To that end, CHOC has received a $100,000 gift in support of the project from Ray Zadjmool and Nazy Fouladirad on behalf of Tevora, an Orange County information security consulting firm. A room in the unit will be named in honor of the gift.

“We are very happy to support CHOC in the work they do for our community, our neighbors, and our kids,” said Zadjmool, Tevora’s chief executive officer.

Other donors who have contributed to the project include the estate of Martha Sheff; the late Margaret Sprague; the estate of Ruth Miller; Credit Union for Kids; the Tinkerbell Guild;  Richard and Bobby Ann Stegemeier; Dr. Sherry Phelan & John H. Phelan, Jr.; Ashly and Brandon Howald; and the estate of Florence Jones.

CHOC NICU Corridor Nurse Alcove

For several decades, CHOC has served infants requiring the highest level of care. CHOC’s neonatal services currently offer 67 beds at CHOC Orange and the CHOC NICU at St. Joseph Hospital, 22 beds at CHOC at Mission Hospital, and a team of premier neonatologists who provide coverage at hospitals throughout Southern California.

A suite of specialized services comprises the CHOC NICU: the Surgical NICU, which provides dedicated care to babies needing or recovering from surgery; the Small Baby Unit, where infants with extremely low birth weights receive coordinated care; the Neurocritical NICU, where babies with neurological problems are cohorted; and the Cardiac NICU, which provides comprehensive care for neonates with congenital heart defects.

CHOC’s NICU was recently named one of the nation’s “top 25” by U.S. News & World Report, reflecting CHOC’s unwavering commitment to the highest standards of patient care and safety.

To learn more about the NICU expansion, visit http://www.choc.org/nicuinitiative.

November is Prematurity Awareness Month – CHOC Offers Innovative and Life-Saving Neonatal Care

In recognition of National Prematurity Awareness month, we’re highlighting the innovative life-saving treatment provided to some of the tiniest and most fragile babies through our neonatology services.

Premature birth is the leading cause of newborn death in the United States. While California has one of the lowest premature birth rates in the nation, almost 9 percent of infants born in 2013 in the state were premature, according to the March of Dimes. Pre-term newborns often need immediate specialized care not available at birthing centers, and CHOC is ready to help if the baby needs to be transferred.

CHOC uses the latest in life-saving technology and trained neonatal specialists to provide the best possible outcomes for both pre- and full-term newborns. While many hospitals offer neonatal intensive care units (NICUs), the CHOC NICU is rated by the American Academy of Pediatrics as a Level 4 NICU – the highest rating available – and is among the top 25 in the nation, according to U.S. News & World Report.

“Because of our innovation and advanced protocols, our survival of low-birth-weight babies, and the long term quality of health of such babies, admitted to the CHOC NICU are the best in California according to the California Perinatal Quality Care Collaborative,” said Dr. Vijay Dhar, medical director, CHOC NICU. “Coordinated care across multiple specialties ensures that these fragile newborns receive treatment from a full medical team.”

With access to a full range of CHOC pediatric subspecialists, the NICU offers a number of life-saving technologies and advanced respiratory support such as high-frequency ventilation and inhaled nitric oxide; advanced brain and body cooling; the only extracorporeal membrane oxygenation (ECMO) unit in Orange County; and innovative procedures including mandibular distraction and epidural anesthesia.

For babies born as young as 24 weeks, or who weigh less than 1,000 grams, the CHOC NICU has a Small Baby Unit (SBU) — the only one of its kind — to focus on caring for the unique needs of these newborns. We also have the only Surgical NICU on the West Coast, which cares for babies needing complex surgery; the only Cardiac NICU in Orange County that performs open heart surgery on newborns; and a Neurocritical NICU to treat babies with neurological issues such as seizures, asphyxiation and brain damage. All four areas provide the highly specialized care needed for fragile newborns.

CHOC has three NICUs, serving CHOC Hospital, St. Joseph Hospital and CHOC at Mission Hospital. In addition, our neonatologists have privileges at more than a dozen hospitals across Southern California. And, we are currently building 36 private, state-of-the-art rooms at CHOC Hospital, which will further advance the quality, safety and outcomes of our neonatology program.

Neonatal Intensive Care Unit (NICU) Referrals:

When a baby is born, the CHOC Transport Team is ready and waiting to transport newborns to CHOC from other hospitals in Southern California. Our neonatologists and surgeons are available for consultations with other hospitals around the clock and can collaborate with referring physicians via phone, telemedicine and secure text messaging.

For any questions, to request a consultation with an on-call neonatologist, or to schedule a transport, referring hospitals may call the CHOC  NICU 24/7 at 714-509-8540.