Clinical Focus

  • Hospital Medicine
  • Pediatrics

Academic Appointments

  • Clinical Assistant Professor, Pediatrics

Professional Education

  • Board Certification: Pediatrics, American Board of Pediatrics (2007)
  • Residency:Medical College of Wisconsin (2007) WI
  • Medical Education:Feinberg School of Medicine - Northwestern University (2004) IL
  • Chief Residency, Medical College of Wisconsin, Pediatrics (2008)
  • Residency, Medical College of Wisconsin, Pediatrics (2007)
  • MD, Northwestern University, Medicine (2004)
  • BS, University of Notre Dame, Chemical Engineering (2000)


All Publications

  • Engaging Pediatric Resident Physicians in Quality Improvement Through Resident-Led Morbidity and Mortality Conferences. Joint Commission journal on quality and patient safety / Joint Commission Resources Destino, L. A., Kahana, M., Patel, S. J. 2016; 42 (3): 99-106


    Increasingly, medical disciplines have used morbidity and mortality conferences (MMCs) to address quality improvement and patient safety (QI/PS), as well as teach systems-based improvement to graduate trainees. The goal of this educational intervention was to establish a pediatric resident physician–led MMC that not only focused on QI/PS principles but also engaged resident physicians in QI/ PS endeavors in their clinical learning environments.Following a needs assessment, pediatric resident physicians at the Stanford University School of Medicine (Stanford, California) established a new MMC model in February 2010 as part of a required QI rotation. Cases were identified, explored, analyzed, and presented by resident physicians using the Johns Hopkins Learning from Defects tool. Discussions during the MMCs were resident physician– directed and systems-based, and resulted in projects to address care delivery. Faculty advisors assessed resident physician comprehension of QI/PS. Conferences were evaluated through the end of the 2012–2013 academic year and outcomes tracked through the 2013–2014 academic year to determine trainee involvement in systems change resulting from the MMCs.The MMC was well received and the number of MMCs increased over time. By the end of the 2013–2014 academic year, resident physicians were involved in address ing 14 systems-based issues resulting from 25 MMCs. Examples of the resident physician–initiated improvement work included increasing use of the rapid response team, institution of a gastrostomy (g)-tube order set, and establishing a face-to-face provider handoff for pediatric ICU–to-acute-care-floor transfers.A resident physician–run MMC exposes resident physicians to QI/PS concepts and principles, enables direct faculty assessment of QI/PS knowledge, and can propel resident physicians into real-time engagement in the culture of safety in a complex hospital environment.

    View details for PubMedID 26892704

  • Intern and Resident Workflow Patterns on Pediatric Inpatient Units: A Multicenter Time-Motion Study JAMA PEDIATRICS Starmer, A. J., Destino, L., Yoon, C. S., Landrigan, C. P. 2015; 169 (12): 1175-1177
  • Changes in Medical Errors after Implementation of a Handoff Program NEW ENGLAND JOURNAL OF MEDICINE Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., NOBLE, E. L., Tse, L. L., Dalal, A. K., Keohane, C. A., Lipsitz, S. R., Rothschild, J. M., Wien, M. F., Yoon, C. S., Zigmont, K. R., Wilson, K. M., O'Toole, J. K., Solan, L. G., Aylor, M., Bismilla, Z., Coffey, M., Mahant, S., Blankenburg, R. L., Destino, L. A., EVERHART, J. L., Patel, S. J., Bale, J. F., Spackman, J. B., Stevenson, A. T., Calaman, S., Cole, F. S., Balmer, D. F., Hepps, J. H., Lopreiato, J. O., Yu, C. E., Sectish, T. C., Landrigan, C. P. 2014; 371 (19): 1803-1812
  • Validity of respiratory scores in bronchiolitis. Hospital pediatrics Destino, L., Weisgerber, M. C., Soung, P., Bakalarski, D., Yan, K., Rehborg, R., Wagner, D. R., Gorelick, M. H., Simpson, P. 2012; 2 (4): 202-209


    The primary objective of this study was to establish the validity and reliability of 2 respiratory scores, the Respiratory Distress Assessment Instrument (RDAI) and the Children's Hospital of Wisconsin Respiratory Score (CHWRS), in bronchiolitis. A secondary objective was to identify the respiratory score components that most determine overall respiratory status.This was a prospective cohort study in infants aged < 1 year seen at Children's Hospital of Wisconsin for bronchiolitis. We evaluated: (1) discriminative validity (the score's ability to discriminate between 2 different outcomes) of the respiratory scores to identify emergency department (ED) disposition by using receiver operating characteristic curves; and (2) construct validity (the score's ability to measure what it is thought to measure, overall respiratory status) by using length of stay (LOS) as a proxy for disease severity and comparing correlations between changes in respiratory scores and LOS. Interrater reliability was established by using intraclass correlation. The contribution of individual respiratory score components to determine ED disposition was studied by using multivariate logistic regression.A total of 195 infants were included. The area under the receiver operating characteristic curve was 0.68 for CHWRS versus 0.51 for RDAI in predicting disposition. There was no correlation between initial respiratory scores or change in respiratory scores over the first 24 hours and LOS. Item analysis revealed that oxygen delivery, subcostal retractions, and respiratory rate were independently correlated with ED disposition. The CHWRS was more reliable than the RDAI.The CHWRS had modest discriminative validity in predicting ED disposition. Neither the CHWRS nor the RDAI had good construct validity. Respiratory rate, oxygen need, and presence of retractions were most useful in predicting ED disposition.

    View details for PubMedID 24313026

  • I-PASS, a Mnemonic to Standardize Verbal Handoffs PEDIATRICS Starmer, A. J., Spector, N. D., Srivastava, R., Allen, A. D., Landrigan, C. P., Sectish, T. C. 2012; 129 (2): 201-204

    View details for DOI 10.1542/peds.2011-2966

    View details for Web of Science ID 000300395100040

    View details for PubMedID 22232313

  • Establishing a Multisite Education and Research Project Requires Leadership, Expertise, Collaboration, and an Important Aim PEDIATRICS Sectish, T. C., Starmer, A. J., Landrigan, C. P., Spector, N. D. 2010; 126 (4): 619-622

    View details for DOI 10.1542/peds.2010-1793

    View details for Web of Science ID 000282526100030

    View details for PubMedID 20876168

  • Severe osteomyelitis caused by Myceliophthora thermophila after a pitchfork injury. Annals of clinical microbiology and antimicrobials Destino, L., Sutton, D. A., Helon, A. L., Havens, P. L., Thometz, J. G., Willoughby, R. E., Chusid, M. J. 2006; 5: 21-?


    Traumatic injuries occurring in agricultural settings are often associated with infections caused by unusual organisms. Such agents may be difficult to isolate, identify, and treat effectively.A 4-year-old boy developed an extensive infection of his knee and distal femur following a barnyard pitchfork injury. Ultimately the primary infecting agent was determined to be Myceliophthora thermophila, a thermophilic melanized hyphomycete, rarely associated with human infection, found in animal excreta. Because of resistance to standard antifungal agents including amphotericin B and caspofungin, therapy was instituted with a prolonged course of terbinafine and voriconazole. Voriconazole blood levels demonstrated that the patient required a drug dosage (13.4 mg/kg) several fold greater than that recommended for adults in order to attain therapeutic blood levels.Unusual pathogens should be sought following traumatic farm injuries. Pharmacokinetic studies may be of critical importance when utilizing antifungal therapy with agents for which little information exists regarding drug metabolism in children.

    View details for PubMedID 16961922