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Laboratory length of stay emergency pediatric

Yangyang R Yu, Paulette I Abbas, Carolyn M Smith, Kathleen E Carberry, Hui Ren, Binita Patel, Jed G Nuchtern, Monica E Lopez
PURPOSE: As reimbursement programs shift to value-based payment models emphasizing quality and efficient healthcare delivery, there exists a need to better understand process management to unearth true costs of patient care. We sought to identify cost-reduction opportunities in simple appendicitis management by applying a time-driven activity-based costing (TDABC) methodology to this high-volume surgical condition. METHODS: Process maps were created using medical record time stamps...
September 15, 2016: Journal of Pediatric Surgery
Andrea Pisesky, Eric I Benchimol, Coralie A Wong, Charles Hui, Megan Crowe, Marc-Andre Belair, Supichaya Pojsupap, Tim Karnauchow, Katie O'Hearn, Abdool S Yasseen, James D McNally
IMPORTANCE: RSV is a common illness among young children that causes significant morbidity and health care costs. OBJECTIVE: Routinely collected health administrative data can be used to track disease incidence, explore risk factors and conduct health services research. Due to potential for misclassification bias, the accuracy of data-elements should be validated prior to use. The objectives of this study were to validate an algorithm to accurately identify pediatric cases of hospitalized respiratory syncytial virus (RSV) from within Ontario's health administrative data, estimate annual incidence of hospitalization due to RSV and report the prevalence of major risk factors within hospitalized patients...
2016: PloS One
Sara C Fallon, David Delemos, Adesola Akinkuotu, Daniel Christopher, Bindi J Naik-Mathuria
BACKGROUND: A novel protocol to standardize the emergency center (EC) management of abdominal trauma in children was developed and implemented at our trauma center. The purpose of this study was to evaluate whether this protocol improved patient safety by decreasing unnecessary computed tomography (CT) radiation and improved quality of care by decreasing EC length of stay (LOS) and laboratory costs. METHODS: We performed a prospective, longitudinal study of children who presented to the EC with a mechanism for abdominal trauma and received an abdominal CT scan from January 2011 to September 2014...
January 2016: Journal of Trauma and Acute Care Surgery
I Claudet, E Grouteau, L Cordier, N Franchitto, C Bréhin
CONTEXT: Hyperglycemia has been described in severe scorpion envenomation, we wanted to analyze if it was applicable to viper bites in children. AIM: To describe clinical, biological, and therapeutic characteristics of 83 children bitten by European viper (Vipera spp.) and to confirm that hyperglycemia is a risk factor for high-grade envenomation. MATERIAL AND METHODS: A retrospective study was conducted between 2001 and 2014 in the pediatric emergency department of a tertiary level children's hospital...
2016: Clinical Toxicology
Shabnam Jain, Gary Frank, Kelly McCormick, Baohua Wu, Brent A Johnson
BACKGROUND AND OBJECTIVES: Variability in practice patterns and resource use in the emergency department (ED) can affect costs without affecting outcomes. ED quality measures have not included resource use in relation to ED outcomes and efficiency. Our objectives were to develop a tool for comprehensive physician feedback on practice patterns relative to peers and to study its impact on resource use, quality, and efficiency. METHODS: We evaluated condition-specific resource use (laboratory tests; imaging; antibiotics, intravenous fluids, and ondansetron; admission) by physicians at 2 tertiary pediatric EDs for 4 common conditions (fever, head injury, respiratory illness, gastroenteritis)...
September 2015: Pediatrics
Kenneth A Michelson, Michael C Monuteaux, Mark I Neuman
OBJECTIVE: To evaluate whether glucocorticoid administration is associated with improved outcomes in children with anaphylaxis. STUDY DESIGN: We included children from the Pediatric Health Information System database who were diagnosed with anaphylaxis at 35 US children's hospitals between 2009 and 2013. Patients were stratified by disposition from the emergency department (ED), either hospitalized or discharged. We evaluated the association between glucocorticoid administration and prolonged length of stay (LOS), defined as hospital stay ≥ 2 days, and subsequent epinephrine administration among hospitalized children...
September 2015: Journal of Pediatrics
Ireneusz Haponiuk, Ewelina Kwasniak, Maciej Chojnicki, Radoslaw Jaworski, Mariusz Steffens, Aneta Sendrowska, Katarzyna Gierat-Haponiuk, Katarzyna Leszczyńska, Konrad Paczkowski, Jacek Zielinski
INTRODUCTION: Cardiac tamponade is excessive collection of fluid in the pericardial sac surrounding the heart that leads to restriction of cardiac function and causes critical cardiogenic shock and rapid circulatory depression. Despite the potential variety of different etiologies in the face of a dangerous decrease of cardiac output, the emergency life-saving procedure is surgical pericardial fluid evacuation. AIM: To perform a retrospective analysis of clinical data and the results of minimally invasive transxiphoid pediatric cardiac tamponade evacuation procedures performed in a cardiac surgery center...
April 2015: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
Shan Yin, Alysha Behrman, Jonathan Colvin
BACKGROUND: Case reports and poison center series have highlighted increased safety concerns with laundry packs, especially when compared to traditional laundry detergents. OBJECTIVE: The purpose of this study was to examine the clinical experience with laundry pack exposures at a single institution. METHODS: A retrospective chart review was performed for exposures to laundry packs seen at a single tertiary care children's hospital medical center...
May 2015: Journal of Emergency Medicine
Adam J Singer, Gregory Garra, Henry C Thode
OBJECTIVES: Dedicated pediatric emergency departments (ED) staffed by pediatric emergency medicine physicians are becoming more common. We compared processes of care and outcomes before and after opening a dedicated pediatric ED. METHODS: A before and after trial design was used to estimate whether there were any changes in ordering of laboratory tests, radiographic imaging, admission rates, ED length of stay (LOS), rates of left without being seen (LWBS) and patient satisfaction scores after opening a dedicated pediatric ED staffed by pediatric emergency medicine physicians...
October 2014: Pediatric Emergency Care
Fatih Ünal, Murat Çakır, Maşallah Baran, Şengül Duygulu, Sema Aydoğdu
BACKGROUND/AIMS: Data about the efficiency and outcome of therapeutic endoscopic techniques in children with nonvariceal upper gastrointestinal bleeding (UGB) are scarce. We aimed to analyze our experience with endoscopic hemoclip application in children with non-variceal UGB. MATERIALS AND METHODS: During a 3-year period, a total of 1715 endoscopies were performed in our pediatric endoscopy unit; 182 (10.6%) of them were performed for UGB to 158 patients. Fifty-six of them had emergent endoscopy...
April 2014: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Linda Horwood, Robert T Brouillette, Christine D McGregor, John J Manoukian, Evelyn Constantin
IMPORTANCE: Evaluation of pediatric obstructive sleep apnea in resource-limited health care systems necessitates testing modalities that are accurate and more cost-effective than polysomnography. OBJECTIVE: To trace the clinical pathway of children referred to our sleep laboratory for possible obstructive sleep apnea who were evaluated using nocturnal pulse oximetry and the McGill Oximetry Score. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study of children 2 to 17 years old with suspected obstructive sleep apnea due to adenotonsillar hypertrophy, conducted at a Canadian pediatric tertiary care center...
July 2014: JAMA Otolaryngology—Head & Neck Surgery
Eeva Kokko, Matti Korppi, Merja Helminen, Nina Hutri-Kähönen
BACKGROUND: Elevated white blood cells (WBC) in blood and C-reactive protein (CRP) in serum are often used as non-specific markers for bacterial etiology of infection in children. The aim of the present study was to evaluate how rapid WBC and CRP testing influences patient flow and cost in the pediatric emergency room (ER). METHODS: This study was a retrospective chart review. In all, 166 children who were treated during 3 months in the ER of a children's hospital, and in whom rapid tests for WBC and CRP were done, were included...
October 2014: Pediatrics International: Official Journal of the Japan Pediatric Society
Amanda S Newton, Sachin Rathee, Simran Grewal, Nadia Dow, Rhonda J Rosychuk
Objective. This study explores the association of patient and emergency department (ED) mental health visit characteristics with wait time and length of stay (LOS). Methods. We examined data from 580 ED mental health visits made to two urban EDs by children aged ≤18 years from April 1, 2004, to March 31, 2006. Logistic regressions identified characteristics associated with wait time and LOS using hazard ratios (HR) with 95% confidence intervals (CIs). Results. Sex (male: HR = 1.48, 95% CI = 1.20-1.84), ED type (pediatric ED: HR = 5...
2014: Emergency Medicine International
Sara C Fallon, David Delemos, Daniel Christopher, Mary Frost, David E Wesson, Bindi Naik-Mathuria
PURPOSE: At our level 1 pediatric trauma center, 9-54 intermediate-level ("level 2") trauma activations are received per month. Previously, the surgery team was required to respond to and assume responsibility for all patients who had "level 2" trauma activations. In 8/2011, we implemented a protocol where the emergency room (ER) physician primarily manages these patients with trauma consultation for surgical evaluation or admission. The purpose of this study was to prospectively evaluate the effects of the new protocol to ensure that patient safety and quality of care were maintained...
January 2014: Journal of Pediatric Surgery
J Joelle Donofrio, Genevieve Santillanes, Bradley D McCammack, Chun Nok Lam, Michael D Menchine, Amy H Kaji, Ilene A Claudius
STUDY OBJECTIVE: We assess whether screening laboratory tests obtained to medically clear pediatric psychiatric patients altered management or disposition. METHODS: This was a retrospective chart review of consecutive patients younger than 18 years and presenting to an academic pediatric emergency department for medical clearance of an acute psychiatric emergency potentially requiring an involuntary hold (danger to self, danger to others, grave disability) from July 2009 to December 2010...
June 2014: Annals of Emergency Medicine
Hilton P Gottschalk, Molly A Moor, Abd R Muhamad, Dennis R Wenger, Burt Yaszay
BACKGROUND: Accurately diagnosing and treating childhood hip sepsis is challenging. Adjacent bone and soft-tissue infections are common and can lead to delayed and inappropriate treatment. This study evaluated the effect of early advanced imaging (bone scan, magnetic resonance imaging) in the management of suspected hip sepsis. METHODS: A retrospective review of pediatric patients admitted between 2003 and 2009 with suspected hip sepsis was performed. Patients were classified into 2 categories: group I-immediate hip aspiration or group II-advanced imaging performed before intervention...
April 2014: Journal of Pediatric Orthopedics
Matthew DeLaney, Kate D Zimmerman, Tania D Strout, Megan L Fix
PURPOSE: Research regarding the effect of trainees on emergency department (ED) operations has demonstrated mixed results. In this study, the authors evaluated the effect of trainees on ED length of stay (LOS), door to medical provider (DTMP) time, and door to disposition decision (DTDD) time while accounting for covariates known to influence ED efficiency and timeliness. METHOD: The authors used retrospective cohort data for ED visits to Maine Medical Center's mixed adult and pediatric ED for the calendar years 2005 through 2009...
November 2013: Academic Medicine: Journal of the Association of American Medical Colleges
Chee Chun Tan, Karen M McDowell, Matthew Fenchel, Rhonda Szczesniak, Carolyn M Kercsmar
Asthma is the most common chronic disorder of childhood and continues to be a leading cause of pediatric hospital admission. The National Asthma Education and Prevention Program (NAEPP) recommends that spirometry be obtained for asthma patients upon hospital admission, after bronchodilation during the acute phase of asthma symptoms, and at least one additional time before discharge from the hospital. The objectives of this study were to describe the use of spirometry in children hospitalized with asthma and to determine association of pulmonary function with future exacerbations...
May 2014: Pediatric Pulmonology
Beena A Kazi, Gregory J Buffone, Paula A Revell, Lakshmi Chandramohan, Michael D Dowlin, Andrea T Cruz
PURPOSE: The purpose of this study is to determine whether point-of-care (POCT) urinalysis (UA) is as accurate as laboratory-performed UA in diagnosing urinary tract infections (UTIs) in the pediatric emergency department (PED). BASIC PROCEDURES: This was a retrospective series of children (0-18 years old) seen at a tertiary care PED from July 2008 to December 2012 in whom UA and urine culture were obtained. Urinalyses were considered positive if leukocyte esterase and/or nitrites were positive...
September 2013: American Journal of Emergency Medicine
Bridget Freyne, Ray Divilley, Ghia Kissoon-Harrison, Michael B O'Neill
Background. Serious bacterial illness (SBI) presents a diagnostic challenge in febrile infants. History, clinical signs, and laboratory information combined with experiential knowledge affects decisions to admit and treat. Aim. To assess the utility of serum procalcitonin and the Acute Infantile Observation Score (AIOS) performed at emergency department presentation in predicting (a) confirmed serious bacterial illness and (b) illness severity. Methods. Sensitivity, specificity, and likelihood ratios were calculated for C-reactive protein, white cell count, serum procalcitonin, and AIOS...
June 2013: Clinical Pediatrics
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