The clinical problem that launched Dr. Bonafide’s research career was the challenge that physicians and nurses have in identifying deteriorating children in the hospital and then obtaining urgent assistance from intensive care physicians. He led early work to develop age-based vital sign percentile curves to help clinical staff distinguish expected hospital vital signs from those warranting closer attention. He also led work developing pediatric early warning scores and measuring the effects of implementing early warning scores and rapid response teams in children’s hospitals.
During these projects Dr. Bonafide learned that physiologic monitors generated hundreds of alarms per patient day, most of which were irrelevant and thus were ignored by staff.
Other research focused on measuring unintended adverse consequences of physiologic monitors and other technologies, with an emphasis on alarm and alert fatigue. Dr. Bonafide extended this work to the home setting when he demonstrated that a new class of consumer monitors that measure infants’ vital signs continuously and send alarms to parents’ smartphones suffered from serious accuracy problems that have the potential to lead to unnecessary hospital admissions, and inappropriate reassurance when infants are truly ill.
Dr. Bonafide, who serves as research director for Pediatric Hospital Medicine, is also an investigator within the Clinical Futures, a CHOP Research Institute Center of Emphasis. He directs Children’s Hospital of Philadelphia’s new Patient Safety Learning Laboratory, which addresses tough patient safety problems using a systems engineering framework, and also directs PHM Lab, focused on advancing the science of Pediatric Hospital Medicine.
Nationally, Dr. Bonafide serves on the executive council of the Pediatric Research in Inpatient Settings Network, a group of investigators from 120 hospitals working to improve the health of hospitalized children and their families by conducting large, multi-institutional studies in areas of inpatient pediatric care relevant to clinicians and the decisions they face when caring for children and their families.