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Hospital Pediatrics

Ashley Murphy, Mary Lou Lindegren, William Schaffner, David Johnson, Lindsay Riley, James D Chappell, Joshua D Doyle, Anna Kate Moen, Grant P Saxton, Rahul P Shah, Derek J Williams
OBJECTIVES: National guidelines recommend influenza testing for children hospitalized with influenza-like illness (ILI) during influenza season and treatment of those with confirmed influenza. Using quality improvement methods, we sought to increase influenza testing and treatment of children admitted to our hospital medicine service with ILI from 65% to 90% during the 2014-2015 influenza season. METHODS: We targeted several key drivers using multiple plan-do-study-act cycles...
August 14, 2018: Hospital Pediatrics
Louis Ehwerhemuepha, Stacey Finn, Michael Rothman, Cyril Rakovski, William Feaster
OBJECTIVES: To develop a model to assist clinicians in reducing 30-day unplanned pediatric readmissions and to enhance understanding of risk factors leading to such readmissions. METHODS: Data consisting of 38 143 inpatient clinical encounters at a tertiary pediatric hospital were retrieved, and 50% were used for training on a multivariate logistic regression model. The pediatric Rothman Index (pRI) was 1 of the novel candidate predictors considered. Multivariate model selection was conducted by minimization of Akaike Information Criteria...
August 9, 2018: Hospital Pediatrics
Kathryn O Mansel, Sophia W Chen, April A Mathews, M David Gothard, Michael T Bigham
BACKGROUND: Children admitted to the general care floor sometimes require acute escalation of care and rapid transfer (RT) to the PICU shortly after admission. In this study, we aim to investigate the characteristics of RTs and the impact RTs have on patient outcomes, including PICU length of stay (LOS), mortality, and emergency transfer defined as critical care interventions occurring within 1 hour on either side of transfer to the PICU. METHODS: We conducted a 2-year, single-center, retrospective analysis including all patients admitted to the general care floor of a tertiary children's hospital that were subsequently transferred to the PICU, with attention to those transferred within 4 hours of admission, meeting criteria as RTs...
August 7, 2018: Hospital Pediatrics
Andrea C Postier, Donna Eull, Craig Schulz, Maura Fitzgerald, Barbara Symalla, David Watson, Lexie Goertzen, Stefan J Friedrichsdorf
OBJECTIVES: Pain in hospitalized children remains under-assessed and undertreated. With this study, we aim to describe results from a repeat single-day, hospital-wide survey of children's pain and its treatment after the initiation of a hospital-wide quality improvement initiative used to reduce or eliminate pain caused by needle procedures. METHODS: All patients and parents listed on the inpatient morning census, in emergency department and outpatient surgery registration lists, were invited to participate in a brief single-day point prevalence survey of their experience with pain and its management in the hospital setting...
August 3, 2018: Hospital Pediatrics
Jaspreet Loyal, Christian M Pettker, Cheryl A Raab, Elizabeth O'Mara, Heather S Lipkind
OBJECTIVES: We sought to report the frequency of, circumstances surrounding, and outcomes of newborn falls in our hospital. We evaluated the impact of specific interventions on the frequency of newborn falls and the time between falls. METHODS: We performed a retrospective study of newborn falls reported on our postpartum unit over a 13-year period. Demographic information and circumstances of falls were collected via an electronic event reporting system and medical record review...
August 1, 2018: Hospital Pediatrics
Carl Seashore, Kristin P Tully
No abstract text is available yet for this article.
August 1, 2018: Hospital Pediatrics
Carl O Eriksson, Nicole Ovregaard, Matthew Hansen, Garth Meckler, Barbara Skarica, Jeanne-Marie Guise
BACKGROUND AND OBJECTIVES: Although medical errors in the hospital are a recognized source of morbidity and mortality, less is known about safety events in the prehospital care of children. As part of a multiphase study, we developed and evaluated the reliability and usability of the pediatric prehospital safety event detection system (PEDS), a tool used to identify safety events in prehospital care. METHODS: The tool was based on hospital chart review tools, literature review, and results from focus groups and a national Delphi survey...
July 30, 2018: Hospital Pediatrics
Julie K Wood, Elizabeth E Halvorson, Jeanna R Auriemma, Sean E Ervin, Danielle P Thurtle, Vahakn S Keskinyan, David M DeWeese, Melanie C Marsh, Lindly A Theroux, Julia Rushing, Cara Haberman
OBJECTIVES: Although hypothermia has long been considered a sign of serious bacterial infection (SBI) in neonates, there is a lack of medical literature on this topic, and little is known about the prevalence of serious infection in these patients. Our primary objective was to assess the prevalence and type of serious infection in neonates with hypothermia. Our secondary objective was to describe the prevalence and type of significant pathology overall in this cohort. METHODS: We examined neonates (≤28 days old) evaluated in the emergency department and/or admitted to the hospital with hypothermia over a 3-year period...
July 3, 2018: Hospital Pediatrics
Mariam L Krikorian, Amanda S Growdon, Alyna T Chien
BACKGROUND: A key juncture in patient hospitalization is determining which type of physician should be primarily responsible for directing treatment. We (1) examine the frequency hospitalists and subspecialists agree on preferred assignments and (2) compare preferred assignment with actual assignment. METHODS: Using a mixed methods approach, we first surveyed 66 physicians in 8 specialties about hospitalist assignments versus subspecialist assignments for 176 diagnoses at an academic children's hospital...
August 2018: Hospital Pediatrics
Michael DeLucia, Anna Martens, JoAnna Leyenaar, Leah A Mallory
BACKGROUND AND OBJECTIVES: Hospital-to-home transitions present safety risks for patients. Children discharged with new foster caregivers may be especially vulnerable to poor discharge outcomes. With this study, our objective is to identify differences in discharge quality and outcomes for children discharged from the hospital with new foster caregivers compared with children discharged to their preadmission caregivers. METHODS: Pediatric patients discharged from the Barbara Bush Children's Hospital at Maine Medical Center between January 2014 and May 2017 were eligible for inclusion in this retrospective cohort study...
August 2018: Hospital Pediatrics
Scott D Krugman, Carolyn J Cumpsty-Fowler
BACKGROUND AND OBJECTIVES: Sudden unexpected infant deaths (SUID) most often occur because infants are placed in unsafe sleep environments. Although authors of previous literature have demonstrated that parents who receive comprehensive safe sleep education increase knowledge and intention to place children in safe sleep environments, no studies have demonstrated improved outcomes. We describe the development of a hospital-based newborn SUID risk reduction quality improvement project and its effectiveness in reducing subsequent SUIDs in a community using linked outcome data from local Child Fatality Review Teams...
August 2018: Hospital Pediatrics
Stephanie Kuhlmann, Carolyn R Ahlers-Schmidt
No abstract text is available yet for this article.
August 2018: Hospital Pediatrics
Christine C Cheston, Lizzeth N Alarcon, Julio F Martinez, Scott E Hadland, James M Moses
OBJECTIVES: No best practice has been defined for incorporating in-person interpreters into family-centered rounds (FCRs) for patients with limited English proficiency (LEP). We hypothesized that addressing barriers to scheduling in-person interpreters would make FCR encounters more likely, and thus ensure more equitable care for LEP patients. METHODS: A quality improvement initiative was conducted from October 2014 to March 2016 to arrange in-person interpreters for LEP patients during FCRs on the inpatient pediatric service of a large, urban, tertiary care center in Boston...
August 2018: Hospital Pediatrics
Laura A Burnham, Adriana M Lopera, Wenyang Mao, Marcy McMahon, Barbara L Philipp, Margaret G Parker
BACKGROUND AND OBJECTIVES: Late preterm (LPT) infants are at risk for feeding difficulties. Our objectives were to reduce the use of intravenous (IV) fluids and increase breastfeeding at discharge among LPT infants admitted to our NICU. METHODS: We implemented a feeding guideline and evaluated its effect using a pre-post design. We examined rates of our main outcomes, IV fluid use, and any or exclusive breastfeeding at discharge, as well as several secondary outcomes, including hypoglycemia (glucose <50 mg/dL) at >8 hours of life, by using χ2 and t tests...
August 2018: Hospital Pediatrics
Burton H Shen, Nivedita Muralidhar, Jeffrey Riese
No abstract text is available yet for this article.
August 2018: Hospital Pediatrics
Adam K Berkwitt, Matthew R Grossman, Paul L Aronson
No abstract text is available yet for this article.
August 2018: Hospital Pediatrics
Beverly R Young, Tran H P Nguyen, Amy Alabaster, Tara L Greenhow
OBJECTIVES: This study evaluates whether bacterial meningitis prevalence differs by urinalysis result and whether antibiotic treatment of presumed urinary tract infection without cerebrospinal fluid (CSF) culture produces adverse sequelae in febrile infants 29 to 60 days old. METHODS: This retrospective cohort study identified febrile infants 29 to 60 days old presenting to Kaiser Permanente Northern California sites from 2007 to 2015 who underwent urinalysis and blood, urine, and CSF cultures, comparing the prevalence of meningitis among infants with positive versus negative urinalysis results using a two 1-sided test for equivalence...
August 2018: Hospital Pediatrics
Sam Stubblefield
No abstract text is available yet for this article.
August 2018: Hospital Pediatrics
Paul L Aronson, Marie E Wang, Lise E Nigrovic, Samir S Shah, Sanyukta Desai, Christopher M Pruitt, Fran Balamuth, Laura Sartori, Richard D Marble, Sahar N Rooholamini, Rianna C Leazer, Christopher Woll, Adrienne G DePorre, Mark I Neuman
OBJECTIVES: We sought to determine the time to pathogen detection in blood and cerebrospinal fluid (CSF) for infants ≤60 days old with bacteremia and/or bacterial meningitis and to explore whether time to pathogen detection differed for non-ill-appearing and ill-appearing infants. METHODS: We included infants ≤60 days old with bacteremia and/or bacterial meningitis evaluated in the emergency departments of 10 children's hospitals between July 1, 2011, and June 30, 2016...
July 2018: Hospital Pediatrics
Stephen J Harris
No abstract text is available yet for this article.
July 2018: Hospital Pediatrics
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