Hospital pediatrics最新文献

{"title":"Process Improvement for Family-Centered Congenital Heart Disease Deliveries.","authors":"Sarah Gelehrter, Sarah Blonsky, Jasmeet Kataria-Hale, Ian Thomas, Courtney Strohacker, Naomi Laventhal","doi":"10.1542/hpeds.2024-008173","DOIUrl":"10.1542/hpeds.2024-008173","url":null,"abstract":"<p><strong>Background: </strong>Perinatal care coordination for the birth of infants with prenatally detected ductal-dependent congenital heart disease (DDCHD) has historically been limited by the siloing of cardiologists and neonatologists and by singular focus on risk reduction. The aim of this study was to increase time for parent-infant bonding and decrease overutilization of medical resources by developing and implementing a standardized delivery stratification system for infants with CHD.</p><p><strong>Methods/interventions: </strong>Over the course of multiple Plan-Do-Study-Act cycles from 2015 to 2023, we identified risk factors for respiratory intervention immediately after birth among infants with DDCHD, drivers of unnecessary intervention and resource utilization, and barriers to allowing time for parent-infant bonding. This led to development of standardized documentation and communication and a color-coded risk-stratification system that allowed for the identification of a low-risk cohort of infants eligible for demedicalized, immediate postnatal care despite the presence of critical CHD.</p><p><strong>Results: </strong>Through a series of process improvements and implementation of a delivery risk-stratification system, we were able to maintain neonatal safety while decreasing use of the operating room for vaginal deliveries from 100% to 10% and increasing the rate of time for parent-infant bonding in the first hours of life from 62% to 91%.</p><p><strong>Conclusion: </strong>Multidisciplinary collaboration and iterative quality improvement work supported the safe improvement in allowing parent-infant bonding after birth for infants with critical CHD with a decrease in unnecessary respiratory intervention and obstetric resource utilization. Our findings support adoption of a collaborative risk-stratification approach for other congenital anomaly cohorts.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"529-536"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Call to Action: Inadequate Resources for Children in Hospitals.","authors":"Ethan E Pfeifer, James Anthony Lin","doi":"10.1542/hpeds.2025-008350","DOIUrl":"10.1542/hpeds.2025-008350","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e254-e257"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Learner's Perspective on Upward Feedback in Pediatrics: A Qualitative Thematic Analysis.","authors":"Nicholas McKenzie, Christian Carrier, Sarah Vaughen, Kevin Chi, Helen Wei, Yi Shao, Melody Petty, H Barrett Fromme","doi":"10.1542/hpeds.2024-008160","DOIUrl":"10.1542/hpeds.2024-008160","url":null,"abstract":"<p><strong>Objective: </strong>Attending physicians rarely receive feedback to improve, but residents and medical students directly observe them and are uniquely positioned to provide feedback. This study explored factors impacting upward feedback from the trainee perspective, including the following: (1) domains of feedback that learners felt capable providing, (2) barriers to giving feedback, and (3) supervisor behaviors that facilitate feedback.</p><p><strong>Methods: </strong>Pediatric residents and medical students from 3 institutions participated in focus groups from October 2022 to February 2023. Four open-ended questions on their experience providing upward feedback were asked. Focus groups were examined through a qualitative content analysis, and a social constructionist approach was used to understand individual trainee experiences.</p><p><strong>Results: </strong>A total of 20 residents and 26 medical students participated. Themes identified as impactful factors on upward feedback were as follows: (1) feedback culture, ie, perceived ability to impact change at their institution and beliefs on hierarchy and fear of repercussions; (2) logistics, ie, the timing and location of feedback, as well as lack of guidance providing feedback and assessing attending performance; (3) attending factors, ie, the learning environment, attending openness, availability, perceived investment in trainees, personal goal-sharing, and active requests for feedback; and (4) focus of feedback, ie, feeling uncomfortable providing constructive feedback, especially on topics that attendings are considered experts in.</p><p><strong>Conclusions: </strong>Learners experience logistical, cultural, and attending-specific factors that influence their experience and perception of giving upward feedback regardless of their interest in doing so. Unique and modifiable factors may change the perceived barriers and subsequent comfort in the delivery of effective upward feedback.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"501-510"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers, Facilitators, and Time Costs of Implementing a Pediatric Clinical Pathway Intervention.","authors":"Sara M Aziz, Kathleen Bonsmith, Ralph Gonzales, Andrew Auerbach, Angela Douglas, Madison Anderson, Sara Thompson, Yeelen Edwards, Sunitha V Kaiser","doi":"10.1542/hpeds.2024-008120","DOIUrl":"10.1542/hpeds.2024-008120","url":null,"abstract":"<p><strong>Objectives: </strong>Clinical pathways can improve care and outcomes for children with respiratory illnesses. The Simultaneously Implementing Pathways for Improving Asthma, Pneumonia, and Bronchiolitis Care for Hospitalized Children (SIP) trial is a multicenter, randomized trial of a high-efficiency pathway intervention in general and community hospitals. Our objective was to describe implementation fidelity, strategy use, time costs, barriers, and facilitators.</p><p><strong>Methods: </strong>We conducted a mixed-methods study. Hospitals received clinical pathways (intervention) and used 5 implementation strategies: quality improvement (QI) mentor meetings, education, iterative changes, audit and feedback, and clinical decision support via electronic order sets. Data were collected through monthly surveys (11 months) of site leaders and recordings of mentor meetings. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using thematic content analysis.</p><p><strong>Results: </strong>Eighteen site leaders (from 18 hospitals) and 8 QI mentors participated. Monthly survey completion rates were 72% to 100%. Pathway implementation fidelity was high (94%). Implementation strategies with the highest use were QI mentor meetings, iterative changes, and electronic order sets. Audit and feedback had the lowest use, driven by information technology challenges and delays in data collection. Implementation time costs were approximately 14 hours per month, and data collection had the highest time cost. Implementation barriers included time limitations and stakeholder resistance to change. Facilitators included SIP study resources, engagement of multidisciplinary staff, and alignment with institutional goals.</p><p><strong>Conclusions: </strong>Our multicenter study provides detailed guidance on implementation fidelity, strategy use, time costs, barriers, and facilitators for general and community hospitals implementing high-efficiency pediatric pathway interventions.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"457-465"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Good Grief? Introducing the TEARS Framework for Health Professions Educators to Support Learners Experiencing Grief.","authors":"Hadley Bloomhardt, Sarah Tremallo","doi":"10.1542/hpeds.2024-008096","DOIUrl":"10.1542/hpeds.2024-008096","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e261-e264"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Acute Suppurative Cervical Lymphadenitis: A Condition Ripe for Improved Health Care Value.","authors":"Hannah Rector, Jenn Horton, Payton Erickson, Zachary Daines, Nathan Money","doi":"10.1542/hpeds.2024-008232","DOIUrl":"10.1542/hpeds.2024-008232","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e265-e268"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood Socioeconomic Deprivation and Length of Stay in Children With Medical Complexity.","authors":"Amanda Warniment, Yin Zhang, Bin Huang, Joanna Thomson, Katherine A Auger","doi":"10.1542/hpeds.2024-008053","DOIUrl":"10.1542/hpeds.2024-008053","url":null,"abstract":"<p><strong>Objective: </strong>Children with medical complexity (CMC) often experience long hospital length of stay (LOS). Many families of CMC experience financial and social hardships, which impact arrangement of the home supports necessary for discharge. Understanding neighborhood context in which CMC live is one way to examine the effects of these hardships on LOS. We aimed to evaluate the association between neighborhood socioeconomic deprivation and hospital LOS in CMC.</p><p><strong>Methods: </strong>We conducted a single-center retrospective study including hospitalized children aged up to 21 years with 2 or more complex chronic conditions discharged from hospital medicine in 2016 to 2022. We excluded neonatal intensive care hospitalizations. We mapped home addresses to US census-tract data to calculate the primary exposure, the Brokamp neighborhood socioeconomic deprivation index. We used linear mixed models to examine the association between deprivation index and LOS (continuous days), adjusting for covariates (eg, patient clinical characteristics) and accounting for within patient clustering.</p><p><strong>Results: </strong>We included 4697 encounters from 2186 CMC. The median deprivation index was 0.33 (IQR, 0.25-0.42) and median LOS was 3.29 days (IQR, 1.86-6.91). In adjusted analysis, for each 0.1 increase in deprivation index, LOS increased 1.05-fold (95% CI, 1.03-1.08). Therefore, we expect a 9% increase in LOS for CMC living in more socioeconomically deprived neighborhoods (our cohort's 75th percentile deprivation index: 0.42) vs less deprived neighborhoods (our cohort's 25th percentile deprivation index: 0.25).</p><p><strong>Conclusions: </strong>CMC from neighborhoods with greater socioeconomic deprivation experienced longer hospitalizations even when accounting for level of complexity and severity of illness. While the clinical effect is small individually, our results highlight systemic inequities.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"474-482"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural-Urban Disparities in Mortality Among US-Born Preterm Infants.","authors":"Stephanie L Bourque, Kathleen E Hannan, Sara C Handley, Molly Passarella, Joshua Radack, Brielle Formanowski, Scott A Lorch, Sunah S Hwang","doi":"10.1542/hpeds.2025-008328","DOIUrl":"10.1542/hpeds.2025-008328","url":null,"abstract":"<p><strong>Background: </strong>US infant mortality rate (IMR), defined as deaths under 1 year of age per 1000 live births, is higher among rural infants than their urban counterparts. Although much is known about rural-urban inequities in IMR, disaggregated data by preterm birth status are lacking.</p><p><strong>Objectives: </strong>(1) Evaluate the differences in rural-urban IMR among preterm infants born earlier than 37 weeks' gestation. (2) Determine the prevalence and predictors of infant mortality by race and ethnicity and rural or urban residence.</p><p><strong>Methods: </strong>Linked national birth and death certificate data from 2005 to 2014 were used. Rural and urban residence was categorized based on 2013 Urban Influence Codes. χ2 analysis was used to compare sociodemographic and clinical characteristics by residence. Multivariable logistic regression was used to assess the independent association between preterm IMR, residence, race, and ethnicity.</p><p><strong>Results: </strong>Among 4 095 410 preterm births, 132 388 (3.23%) infants died. Rural preterm infants experienced higher odds of infant mortality (adjusted odds ratio [aOR], 1.09; 95% CI, 1.07-1.11) compared with their urban counterparts. Compared with preterm infants born to urban non-Hispanic white individuals, those born to rural non-Hispanic white (aOR, 1.10; 95% CI, 1.07-1.12) and American Indian and Alaska Native (aOR, 1.33; 95% CI, 1.22-1.46) individuals had higher odds of infant mortality.</p><p><strong>Conclusion: </strong>Overall, preterm infants residing in rural counties are more likely to experience infant mortality compared with their urban counterparts with differences noted by race and ethnicity. These data support the need to develop interventions to mitigate mortality in the rural preterm population throughout the first year of life.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"519-528"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent Use and Perspective of Hospital MyChart Bedside.","authors":"Marisa Román, Kelsey Porada, Sarah Corey Bauer","doi":"10.1542/hpeds.2024-008148","DOIUrl":"10.1542/hpeds.2024-008148","url":null,"abstract":"<p><strong>Background: </strong>Since the initiation and requirement of open access electronic health records (EHRs), research has shown benefits for adult patients and children's caregivers. Few studies have included the adolescent perspective.</p><p><strong>Methods: </strong>Hospitalized adolescents aged 14 to 20 years with an active Epic MyChart Bedside (inpatient portal device) account were recruited via convenience sampling. Participants were surveyed, assessing their understanding of the care plan, awareness and use of MyChart Bedside, and free-text responses. EHR information (age, sex, length of stay [LOS], race, ethnicity, insurance, chronic conditions) was paired with survey responses.</p><p><strong>Results: </strong>Thirty-two patients enrolled. No significant differences were noted in use based on sex, age, LOS, ethnicity, race, insurance type, or number of chronic conditions. Sixty-three percent were aware of access; of those, 55% used the tablet. Thirty-eight percent were unaware of access, and 83% indicated interest in using after learning about it. Free-text responses highlighted perceived advantages; 91% understood the care plan well. Overall offering of MyChart Bedside was low.</p><p><strong>Discussion/conclusion: </strong>This exploratory study begins to address a knowledge gap by assessing hospitalized adolescents' perspectives on open access bedside EHRs. Use was limited by access to and awareness of the tool and did not appear to be impacted by various factors. Despite sample size limitations, this study is an important step in understanding adolescents' engagement with open access EHRs. Future work should include larger sample sizes, assess factors contributing to use, and evaluate whether EHR access in adolescence enhances understanding of their health care.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e245-e250"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How FIKA Are You?","authors":"Allison E Williams, Laura M Panko, Maia Y Taft, Tony R Tarchichi","doi":"10.1542/hpeds.2024-008267","DOIUrl":"10.1542/hpeds.2024-008267","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e258-e260"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}