About

Charlotte Z. Woods-Hill, MD, MSHP, is an Assistant Professor of Anesthesiology and Critical Care at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia. She is an attending physician in the Department of Anesthesiology and Critical Care Medicine at the Children's Hospital of Philadelphia. Her educational background includes a BA in Biology and Religious Studies from the University of Miami, an MD from the University of South Florida, Morsani College of Medicine, and an MSHP in Health Policy from the University of Pennsylvania. Her research focuses on pediatric critical care, with particular attention to blood culture practices, diagnostic stewardship, firearm injury prevention, and disparities in pediatric outcomes. She has contributed to multiple studies and presentations related to pediatric emergency care, critical care medicine, and health disparities.

Research topics

• Medicine
• Intensive care medicine
• Emergency medicine
• Medical emergency
• Family medicine

Selected publications

• Pediatric Emergency Department Care for Septic Shock in Sub-Saharan Africa: Single-Center Outcomes Before-Vs.-After Implementation of a Telesimulation Program, 2023–2024

  Pediatric Critical Care Medicine · 2026-04-02

  article

  OBJECTIVES: Sepsis is a leading cause of preventable death in low-resource settings, where delays in recognition and emergency department (ED) treatment are common. Limited access to training also contributes to poor outcomes. We hypothesized that a contextualized telesimulation and debriefing program would be associated with better sepsis-related outcomes and time-critical care processes in children presenting to our center in Kumasi, Ghana. We also determined the program's acceptability and feasibility in our clinical providers. DESIGN: We conducted a 12-month mixed-method quasi-experimental (before vs. after implementation) study at Komfo Anokye Teaching Hospital, 2023-2024. Pediatric ED providers completed 30-minute, low-bandwidth telesimulation sessions using culturally-adapted real patient videos, filmed in the local Ghanaian hospital. Clinical outcomes and care processes were evaluated pre- and post-intervention. Trained observers recorded time-critical interventions: shock recognition, oxygen use, IV access, fluid bolus, reassessment, blood cultures, and antibiotics. Acceptability and feasibility were assessed using validated surveys. SETTING: Tertiary academic hospital with 1200 beds, including 15 pediatric ED beds and 4 PICU beds. PARTICIPANTS: ED healthcare providers as well as clinical data from patients 2 months to 14 years old, screened at triage for suspected sepsis or septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Post- vs pre-implementation care periods had mortality of 7 of 67 (10%) vs. 25 of 70 (36%), which represents an associated decrease in odds ratio (OR) of death 0.2 (95% CI, 0.1-0.5; p = 0.001). The post- vs pre-implementation changes in care characteristics, included: greater odds of supplemental oxygen use (OR 2.4 [95% CI, 1.0-5.7] p = 0.044) and IV placement (OR 3.8 [95% CI, 1.3-13.1] p = 0.012). Also, among trainees, 44/45 agreed that the program was acceptable and feasible. CONCLUSIONS: In our 2023-2024 pre- vs. post-implementation study, we found that contextualized telesimulation and debriefing were associated with lower odds of mortality, improved characteristics of care, and were acceptable and feasible to the healthcare team.

  PublisherDOI

• Reduced Severity of Arterial Catheter-Associated Proximal Ischemic Injuries Through a Quality Improvement Initiative

  Pediatric Critical Care Medicine · 2025-03-03 · 3 citations

  article

  OBJECTIVES: To define and reduce the incidence of severe arterial catheter-associated proximal ischemic injuries (ACAPII). DESIGN: Quality improvement (QI) initiative. SETTING: University affiliated PICU in a quaternary children's hospital. PATIENTS: All patients with indwelling arterial catheters (ACs) in the PICU at the Children's Hospital of Philadelphia from January 2020 to December 2022. INTERVENTIONS: Phase I (January 2021 to December 2021) included defining ACAPII and daily rounding on all ACs by a dedicated PICU-specific vascular access team. Phase II (January 2022 to December 2022) introduced standardized recommendations and interventions including the use of topical nitroglycerin ointment (TNG) as a therapeutic option for mild injuries. MEASUREMENTS AND MAIN RESULTS: From January 2021 to December 2022, the rounding team evaluated 1916 ACs for a total of 5793 rounding episodes (line-days). During phase I, the overall number of ACAPII increased compared with prior year pre-QI (35 vs. 11, 318%). During phase II, the administration of TNG was associated with an increase in arterial line-days per AC in patients with mild injury (6.58 line-days per line, 158 d/24 lines) compared with pre-QI, phase I, and phase II mild injuries without use of TNG (3.27, 198/61; incident rate difference [95% CI], 3.31 [2.11-4.51]; p < 0.001). Special cause indicators shifted centerline from a weighted average 33.0-342.3 line-days between severe injuries. The cumulative severe ACAPII incidence rate decreased from its peak early in phase I (April 2021: 5.65 per 1000 line-days) to the end of phase II (December 2022: 2.11 per 1000 line-days). The overall rate of arterial line-days per AC during phase II increased compared with pre-QI ( p < 0.01) and phase I ( p < 0.01). CONCLUSIONS: The development of a newly defined measurable harm index, ACAPII, and implementation of increased surveillance resulted in increased awareness and reduction of severe injury as measured by rates and line-days between severe injuries in our critically ill patients. Protocolized management during phase II, including introducing TNG as a therapeutic option, resulted in increased AC line-days per catheter with sustained reduction in severe ACAPII rates.

  PublisherDOI

• Diagnostic Stewardship of Blood Cultures in the Pediatric ICU Using Machine Learning

  Hospital Pediatrics · 2025-05-21

  articleOpen access

  OBJECTIVE: The medical community recently experienced a severe shortage of blood culture media bottles. Rates of blood stream infection (BSI) among critically ill children are low. We sought to design a machine learning (ML) model able to identify children at low risk for BSI to improve blood culture diagnostic stewardship. METHODS: We developed and validated an extreme gradient-boosting ML classifier using an existing dataset of retrospective pediatric intensive care unit (PICU) patients from a single institution. Data from children aged 3 months to 18 years who had a blood culture collected within 24 hours of PICU admission were included. The first 80% of patients (1/1/2011-12/21/2018) were used for model training and the last 20% (12/22/2018-12/25/2020) for testing (temporal validation). All 121 variables from the original dataset (vital sign, laboratory, and other clinical data) were included as predictors. Negative predictive value (NPV) was the primary evaluation metric. RESULTS: Of the 3121 blood cultures obtained during 2320 PICU admissions (2100 unique children), 205 (6.6%) were positive. Model NPV was 0.997 in the training set and identified 667/2321 (28.7%) of negative cultures. NPV was 0.993 in the test set and identified 151/595 (25.4%) of negative cultures. The number needed to harm was 151 (151 negative blood cultures could be avoided for each false negative prediction). Key predictors included central line presence, temperature rate of change, and mean platelet volume. CONCLUSIONS: We trained and validated an ML model that accurately predicted >25% of subsequently negative blood cultures. If implemented prospectively, such models could help reduce unnecessary blood cultures among low-risk children.

  PublisherOA PDFDOI

• Timing and Mode of Death after Pediatric In- and Out-of-Hospital Cardiac Arrest: A Single Center Retrospective Study

  SSRN Electronic Journal · 2025-01-01

  preprintOpen access
  PublisherDOI

• 1629: IMPLEMENTING A NOVEL TELE-SIMULATION SEPTIC SHOCK TRAINING PROGRAM FOR LOW-RESOURCED SETTINGS

  Critical Care Medicine · 2025-01-01

  article
  PublisherDOI

• Diagnostic Stewardship of Endotracheal Aspirate Cultures in Hospitalized Children With Artificial Airways: Expert Consensus Statements From the BrighT STAR (Testing STewardship for Antibiotic Reduction) Respiratory Collaborative

  Pediatric Critical Care Medicine · 2025-02-12 · 5 citations

  articleOpen access

  OBJECTIVE: To develop consensus statements that clinicians can apply to standardize and optimize endotracheal aspirate culture (EAC) practices in hospitalized children with artificial airways who are being evaluated for a bacterial lower respiratory tract infection (LRTI). DESIGN: A modified Delphi consensus process with expert panelists. Panelists conducted a "pre-survey" to itemize respiratory signs of bacterial LRTI. Round 1 included a literature summary and electronic survey of 50 potential statements sent to all panelists. We surveyed panelist opinions using a 5-point Likert scale. We grouped the responses "agree" and "strongly agree" as agreement. Consensus was defined as statements reaching greater than 75% agreement. Round 2 was moderated by an independent expert in consensus methodology. Panelists convened in person in November 2023, discussed any statements not reaching consensus or statements with disagreement, were resurveyed, and finalized statements in real time. SETTING: Electronic surveys and in-person meetings in Baltimore, MD. SUBJECTS: The BrighT STAR (Testing STewardship for Antibiotic Reduction) collaborative along with U.S.-based pediatric experts in critical care, cardiac critical care, infectious diseases, hospital medicine, otolaryngology, pulmonology, and clinical microbiology. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Thirty-eight of 40 invited panelists completed round 1. Of 50 initial statements, 28 reached greater than 90% agreement, 16 had 75-89% agreement, and 6 had less than 75% agreement. Twenty-eight statements were finalized. Round 2 involved 37 panelists: 23 statements were discussed, of which 17 reached an agreement and 6 did not reach consensus. We concluded with 30 statements and 15 sub-statements, 37 of which had greater than 90% agreement. Final statements informed a clinical decision support algorithm. CONCLUSIONS: The BrighT STAR collaborative group achieved consensus for 45 clinical practice statements that can standardize EAC practices, including indications to consider for testing, reasons to defer, optimal specimen collection, and result interpretation. These statements offer a starting point for clinical decision support tools and diagnostic stewardship programs for EAC practices in patients with artificial airways.

  PublisherDOI

• 416. Impact of clinical diagnostic stewardship of respiratory cultures across a multicenter PICU collaborative

  Open Forum Infectious Diseases · 2025-01-29

  articleOpen access

  Abstract Background Respiratory culture practices for critically ill patients with artificial airways vary across and within institutions. Over-testing contributes to unnecessary antibiotic treatment. This study aimed to evaluate the efficacy and safety of implementing clinical decision support to standardize indications of respiratory cultures across a multicenter PICU collaborative. Monthly Respiratory Culture Rate per 100 Ventilator-Days Before and After Implementing Diagnostic Stewardship Programs The monthly respiratory culture rate is shown for 15 pediatric intensive care units participating in BrighT STAR Respiratory, a multicenter diagnostic stewardship quality improvement collaborative, 24 months before and 18 months after implementing diagnostic stewardship programs. The mean monthly average rate over time was estimated using a smoothing spline. Methods 15 U.S. PICUs participated in the BrighT STAR Respiratory Collaborative, a prospective multicenter quality improvement program (QI) from 2019-2023. Each hospital executed local QI programs to improve respiratory culture practices, facilitated by the larger collaborative. The primary outcome was the monthly rate of respiratory cultures per 100 ventilator-days. Process and safety measures included the proportion of cultures repeated within 3 days, bronchoalveolar lavage (BAL) cultures per 100 ventilator-days, and ventilator-associated events (VAE) per 100 ventilator-days among 3 centers conducting this surveillance. We analyzed rates 24 months pre- and 18 months post-intervention using a Poisson generalized linear mixed model with random intercept for sites, robust variance estimates and adjustment for seasonality. Site leads surveyed local faculty for patient safety concerns. Results Across 15 PICUs, the monthly average respiratory culture rate was 7.80 per 100 ventilator-days pre-implementation and 6.55 per 100 ventilator-days post-implementation, a 16% rate ratio (RR) reduction (95% confidence interval (CI) 0.78-0.90, P&amp;lt; 0.001). Cultures repeated within 3 days declined 22% from 13% to 10% (95%CI 0.68-0.89, P&amp;lt; 0.001). The BAL culture rate did not change from 0.67 to 0.72 (RR 1.07, 95% 0.85-1.34, P=0.57). The VAE rate did not change from 0.21 to 0.25 (RR 1.17, 95%CI 0.87-1.58, P=0.28). Among 2,525 inquiries to attendings about safety concerns, 2348 replied (93%); 2 concerns were reported (0.08%) regarding perceived delay to cultures with no resulting patient harm. Conclusion Standardizing respiratory culture ordering practices may be an effective diagnostic stewardship approach for pediatric patients with artificial airways. We plan to assess impact on clinical outcomes and antibiotic use and to assess facilitators and barriers to implementation. Disclosures Aaron Milstone, MD, MHS, Merck: Grant/Research Support

  PublisherDOI

• 893: A MACHINE LEARNING APPROACH TO IDENTIFY CHILD OPPORTUNITY PREDICTORS ASSOCIATED WITH FIREARM INJURY

  Critical Care Medicine · 2025-01-01

  article
  PublisherDOI

• Practices, perceptions and attitudes of paediatric critical care practitioners in the evaluation of critically ill children for bacteraemia in the United Kingdom and the Republic of Ireland, a BrighT STAR survey

  Intensive Care Medicine – Paediatric and Neonatal · 2025-10-28

  articleOpen access

  Abstract Background Blood cultures, whilst essential in investigating for sepsis, can, if overused, lead to patient harm through over-investigation, increased antibiotic exposure and antimicrobial resistance development. We aimed to survey current practices and perceptions regarding blood culture use in paediatric critical care (PCC) in the United Kingdom (UK) and the Republic of Ireland (ROI). Methods A cross-sectional electronic survey, designed by the Testing STewardship for Antibiotic Reduction (BrighT STAR) collaborative and endorsed by the Paediatric Critical Care Society (PCCS), distributed to all PCCS members between October and November 2024. Results One hundred seventy-eight responses were received from 27/29 UK and ROI PCC sites (unit response rate 93.1%). 85% respondents (150/176) reported a new or persistent fever would trigger a blood culture in their PCC, increasing to 97% (170/176) if a central line were also present. Variability regarding surveillance cultures, triggers to screen for bacteraemia and preferred sites for sampling were reported. Recognition of potential negative consequences of blood cultures differed among roles, reported by 30% nurses, 65% Nurse Practitioners and 75% medical staff. Barriers to changing practice included fear of missing sepsis (77%, 105/137) and, amongst non-consultant respondents, pressure to meet metrics (73%, 58/79) and the opinion of other specialities (78%, 18/23 resident doctors). Facilitators for change included collaborative efforts (73%, 94/128) and consensus recommendations (80%, 102/128). Conclusions To change the “culture of cultures” in a UK or Irish PCC, all stakeholders need to be engaged. Collaborative efforts could facilitate change in practice, reduce unnecessary testing, and increase alignment to consensus recommendations.

  PublisherOA PDFDOI

• Implementing and evaluating a Paediatric Early Warning System (PEWS) at a National Referral Hospital in Botswana

  BMJ Paediatrics Open · 2025-10-01

  articleOpen accessSenior author

  BACKGROUND: Mortality among hospitalised children in low-resource settings remains much higher than in high-resource environments. Paediatric Early Warning Systems (PEWSs) have been shown to improve vital signs collection, strengthen interprofessional communication, lower healthcare costs and reduce paediatric hospital mortality in multiple low- and middle-income countries. Providers at Botswana's national referral center, Princess Marina Hospital (PMH), face significant challenges in identifying children at risk for clinical deterioration. METHODS: We used PEWS previously validated in resource-limited settings to create the PMH PEWS. We piloted the PMH PEWS from December 2022 to March 2023. We assessed (1) effectiveness of PEWS at reducing unplanned escalations of care by comparing pre-implementation and post implementation rates of clinical deterioration events (unplanned intensive care unit (ICU) transfer; use of inotropic medications, mechanical ventilation or mannitol; cardiopulmonary resuscitation; non-palliative mortality), (2) acceptability and feasibility of PEWS adoption using the acceptability and feasibility of implementation measures and (3) barriers and facilitators to implementation through stakeholder interviews structured around Consolidated Framework for Implementation Research domains. RESULTS: The relative frequency of clinical deterioration events changed post-PEWS implementation (p=0.01) such that initiation of mechanical ventilation (12.3% vs 23.2%) and inotropes (18.5% vs 35.7%) decreased while ICU transfers increased (27.7% vs 8.9%). Both doctors and nurses found PEWS to be acceptable and feasible. Staff universally reported that PEWS improved patient care, increased clinician provider accountability for deteriorating patients and strengthened interprofessional communication. Nurses reported greater engagement with PEWS adaptation than doctors. Physical resource limitations and inter- and intra-professional hierarchies were widely endorsed barriers to implementation. CONCLUSIONS: PEWS has the potential to improve the care of hospitalised children in Botswana by strengthening interprofessional communication and increasing clinician accountability for deteriorating patients.

  PublisherOA PDFDOI

Recent grants

• Leveraging implementation and behavioral science to reduce harmful overuse of diagnostic testing in critically ill children

  NIH · $890k · 2021–2026

Frequent coauthors

• Aaron M. Milstone

  Johns Hopkins University

  120 shared

• Anping Xie

  Johns Hopkins Medicine

  108 shared

• James C. Fackler

  Children's Center

  90 shared

• Marlene R. Miller

  Rainbow Babies & Children's Hospital

  68 shared

• Annie Voskertchian

  Johns Hopkins University

  65 shared

• Danielle Koontz

  Johns Hopkins Medicine

  54 shared

• Anne King

  Johns Hopkins Medicine

  46 shared

• Elizabeth Colantuoni

  Johns Hopkins University

  34 shared