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Pediatric readmission

Jeniece Trast Ilkowitz, Steven Choi, Michael L Rinke, Kathy Vandervoot, Rubina A Heptulla
BACKGROUND: Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. METHODS: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families...
October 2016: Quality Management in Health Care
Ilaria Bergese, Simona Frigerio, Marco Clari, Emanuele Castagno, Antonietta De Clemente, Elena Ponticelli, Enrica Scavino, Paola Berchialla
OBJECTIVES: Return visit (RV) to the emergency department (ED) is considered a benchmarking clinical indicator for health care quality. The purpose of this study was to develop a predictive model for early readmission risk in pediatric EDs comparing the performances of 2 learning machine algorithms. METHODS: A retrospective study based on all children younger than 15 years spontaneously returning within 120 hours after discharge was conducted in an Italian university children's hospital between October 2012 and April 2013...
October 6, 2016: Pediatric Emergency Care
A Brad Hall, April Novotny, Donna M Bhisitkul, James Melton, Tim Regan, Maureen Leckie
Introduction While pediatric asthma continues to be a highly studied disease, data to suggest clear strategies to decrease asthma related revisits or readmissions is lacking. The purpose of our study was to assess the effect of emergency department (ED) direct dispensing of beta-agonist metered dose inhalers on pediatric asthma ED revisit and readmission rates. Methods We conducted a retrospective cohort study of pediatric patients discharged from the pediatric ED with a diagnosis of asthma. Our primary outcome measured the rate of asthma revisits to the ED or admissions to the hospital within 28 days...
October 7, 2016: Journal of Asthma: Official Journal of the Association for the Care of Asthma
Joanna L Gould, Ashwini S Poola, Shawn D St Peter, Pablo Aguayo
PURPOSE: After investigating barriers for same day discharge (SDD) after laparoscopic cholecystectomy (LC), we employed a protocol which we have followed with a prospective, observational study. METHODS: A single institution, prospective observational study was performed from July 2014 to 2015 (2nd period). These data were compared to our initial experience with an SDD protocol from January 2013 to July 2014 (1st period). RESULTS: A total of 191 LCs were analyzed, 116 in the 1st period and 75 in the second period...
September 15, 2016: Journal of Pediatric Surgery
Hibbut-Ur-Rauf Naseem, Robert Michael Dorman, Kathryn D Bass, David H Rothstein
BACKGROUND: Hospital readmission in adult trauma is associated with significant morbidity, mortality, and resource utilization. In this study, we examine pediatric intensive care unit (PICU) admission as a risk factor for hospital readmission in pediatric trauma. MATERIALS AND METHODS: This was a retrospective cohort study of patients aged 1 through 19 y in the Pediatric Health Information System database discharged with a trauma diagnosis. Patient and clinical variables included demographics, payer status, length of stay, chronic comorbid conditions, presence of mechanical ventilation, all-patient refined diagnosis-related group and calculated severity of illness, and discharge disposition...
October 2016: Journal of Surgical Research
Milos Jovanovic, Sandro Radovanovic, Milan Vukicevic, Sven Van Poucke, Boris Delibasic
OBJECTIVES: Quantification and early identification of unplanned readmission risk have the potential to improve the quality of care during hospitalization and after discharge. However, high dimensionality, sparsity, and class imbalance of electronic health data and the complexity of risk quantification, challenge the development of accurate predictive models. Predictive models require a certain level of interpretability in order to be applicable in real settings and create actionable insights...
September 2016: Artificial Intelligence in Medicine
Nesrin Al-Harthy, Kavita M Sudersanadas, Mohammed Al-Mutairi, Senthilvel Vasudevan, Ghada Bin Saleh, Malak Al-Mutairi, Lenna W Hussain
BACKGROUND: Discharge instructions are vital in postemergency patient care to help the caregiver understand the diagnosis and identify symptoms which require prompt readmission. In general, oral or written instructions are provided on discharge. However, there is a dearth of information on the efficacy of discharge instructions provided by physicians in KSA. OBJECTIVES: To evaluate the efficacy of discharge instructions for postpediatrics emergency visit. MATERIALS AND METHODS: This observational cross-sectional survey conducted in the Department of Paediatric Emergency at King Abdul Aziz Medical City, Riyadh, KSA, included 173 literate adult caregivers who had given their consent...
September 2016: Journal of Family & Community Medicine
Harsheen Kaur, James M Naessens, Andrew C Hanson, Karen Fryer, Michael E Nemergut, Sandeep Tripathi
OBJECTIVE: No risk prediction model is currently available to measure patient's probability for readmission to the pediatric intensive care unit (PICU). This retrospective case-control study was designed to assess the applicability of an adult risk prediction score (Stability and Workload Index for Transfer [SWIFT]) and to create a pediatric version (PRediction Of PICU Early Readmissions [PROPER]). DESIGN: Eighty-six unplanned early (<48 hours) PICU readmissions from January 07, 2007, to June 30, 2014, were compared with 170 random controls...
September 6, 2016: Journal of Intensive Care Medicine
Rebecca E Rosenberg, Stacey Trzcinski, Mindy Cohen, Mark Erickson, Thomas Errico, Lisa McLeod
STUDY DESIGN: Comparative effectiveness database study. OBJECTIVE: To describe variation in use of adjuvant therapies for managing postoperative pain in in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic (AIS) and determine association between use of these therapies and patient outcomes. SUMMARY OF BACKGROUND DATA: Variation in postoperative pain management for children undergoing PSF for AIS likely impacts outcomes...
August 31, 2016: Spine
Manuel Rocha Melo, Manuel Ferreira-Magalhães, Filipa Flor-Lima, Mariana Rodrigues, Milton Severo, Luis Almeida-Santos, Alberto Caldas-Afonso, Pedro Pita Barros, António Ferreira
BACKGROUND: Dedicated pediatricians in emergency departments (EDs) may be beneficial, though no previous studies have assessed the related costs and benefits/harms. We aimed to evaluate the net benefits and costs of dedicated emergency pediatricians in a pediatric ED. METHODS: Cost-consequences analysis of visits to a pediatric ED of a tertiary hospital. Two pediatric ED Medical Teams (MT) were compared: MT-A (May-September 2012), with general pediatrics physicians only; and MT-B (May-September 2013), with emergency dedicated pediatricians...
2016: PloS One
Katherine W Gonzalez, Brian G Dalton, Brendan Kurtz, Michael C Keirsey, Tolulope A Oyetunji, Shawn D St Peter
BACKGROUND: Wound classification has catapulted to the forefront of surgical literature and quality care discussions. However, it has not been validated in laparoscopy or children. We analyzed pediatric infection rates based on wound classification and reviewed the most common noninfectious complications which could be a more appropriate measure for quality assessment. METHODS: We performed a retrospective review of 800 patients from 2011 to 2014 undergoing common procedures at a tertiary pediatric hospital...
November 2016: Journal of Pediatric Surgery
Ching-Lun Chen, Hsun-Chin Chao, Man-Shan Kong, Shih-Yen Chen
BACKGROUND: With effective antibiotics against enteric flora and computed tomography-guided drainage for abscesses, the initial use of nonoperative therapy for children with appendicitis has increased both in recent reports and at our hospital. However, it has been reported that these patients have a relatively longer hospital stay and that their treatment is more expensive than those who undergo aggressive surgical intervention. METHODS: This was a retrospective cohort study based in a single medical center...
July 15, 2016: Pediatrics and Neonatology
JoAnna K Leyenaar, Arti D Desai, Q Burkhart, Layla Parast, Carol P Roth, Julie McGalliard, Jordan Marmet, Tamara D Simon, Carolyn Allshouse, Maria T Britto, Courtney A Gidengil, Marc N Elliott, Elizabeth A McGlynn, Rita Mangione-Smith
BACKGROUND: Transitions between sites of care are inherent to all hospitalizations, yet we lack pediatric-specific transitions-of-care quality measures. We describe the development and validation of new transitions-of-care quality measures obtained from medical record data. METHODS: After an evidence review, a multistakeholder panel prioritized quality measures by using the RAND/University of California, Los Angeles modified Delphi method. Three measures were endorsed, operationalized, and field-tested at 3 children's hospitals and 2 community hospitals: quality of hospital-to-home transition record content, timeliness of discharge communication between inpatient and outpatient providers, and ICU-to-floor transition note quality...
August 2016: Pediatrics
Philip A Gaudreau, Hannah Greenlick, Tiffany Dong, Michelle Levy, Alyssa Hackett, Diego Preciado, George Zalzal, Brian K Reilly
Importance: Pediatric tracheostomy is commonly performed for upper airway obstruction and prolonged mechanical ventilation. Children undergoing tracheostomy typically have multiple chronic medical problems that place them at high risk for readmission and additional complications. Objective: To determine whether the institution of a postoperative protocol for parent education and wound care with a nurse trained in tracheostomy care decreases the rate of readmission and other complications...
July 28, 2016: JAMA Otolaryngology—Head & Neck Surgery
Susan Wu, Amy Tyler, Tina Logsdon, Nicholas M Holmes, Ara Balkian, Mark Brittan, LaVonda Hoover, Sara Martin, Melisa Paradis, Rhonda Sparr-Perkins, Teresa Stanley, Rachel Weber, Michele Saysana
OBJECTIVE: To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges. METHODS: This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children's hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan-do-study-act cycles were conducted on patient populations selected by each site...
August 2016: Pediatrics
Heather L Short, Samir Sarda, Kurt F Heiss, Joshua J Chern, Mehul V Raval
Postprocedural revisits, readmissions, and reoperations are commonly tracked quality metrics and have reimbursement and hospital-level comparison implications. Our purpose was to document these rates after pediatric appendectomy and to identify patient factors related to these metrics. This study included 3756 appendectomies performed at a single institution from 2009 to 2013. Data were prospectively collected and clinical events within 30 days of discharge were analyzed. Regression models identified factors associated with each metric...
July 2016: American Surgeon
Mark Brittan, Samir S Shah, Katherine A Auger
No abstract text is available yet for this article.
August 2016: Pediatrics
Karan Dua, William C McAvoy, Sybil A Klaus, David I Rappaport, Rebecca E Rosenberg, Joshua M Abzug
PURPOSE: The benefits of hospitalist co-management of pediatric surgical patients include bettering patient safety, decreasing negative patient outcomes, providing comprehensive medical care, and establishing a dedicated resource to patients for postoperative care. The purpose of this study was to characterize the nature of patients co-managed by a pediatric hospitalist. The authors hypothesize that hospitalist co-management is safe and efficacious in pediatric orthopaedic surgical patients who are admitted to a community hospital...
2016: Maryland Medicine: MM: a Publication of MEDCHI, the Maryland State Medical Society
Henry T Puls, Matthew Hall, Jessica Bettenhausen, Matthew B Johnson, Christina Peacock, Jean L Raphael, Jason G Newland, Jeffrey D Colvin
OBJECTIVES: Risk factors for failure to thrive (FTT) readmissions, including medical complexity, have not been described. We sought to characterize children hospitalized for FTT and identify risk factors associated with FTT-specific readmissions during the current era of increasing medical complexity among hospitalized children. METHODS: This retrospective cohort study used the Pediatric Health Information System database of 43 freestanding children's hospitals across the United States...
August 2016: Hospital Pediatrics
C K Sinha, E Decker, D Rex, Z Mukhtar, F Murphy, E Nicholls, B Okoye, S Giuliani
INTRODUCTION: The aim of this study was to investigate readmissions within 30days of operation (ReAd) in the setting of a tertiary pediatric surgical practice in the UK. METHODS: Using Hospital Episode Statistics, cases that were readmitted within 30days of primary operation were identified retrospectively. Demographics including age, gender, preexisting comorbidities, diagnosis on primary admission and the treatment, length of stay, and diagnosis on readmission with treatment, including further surgical intervention, were collected from discharge summaries and hospital notes...
July 5, 2016: Journal of Pediatric Surgery
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