Hospital pediatrics最新文献

{"title":"Safety Officer: Hospitalist Support of Safety Practices on a Pediatric Surgical Unit.","authors":"Rachita Gupta, Lauren R Anderson, Heather J Bennett, Richele Koehler, Jonathan P Roach, Michelle Fennell, Jacquelyn Scarberry, Miriam Conant, Jason Zamkoff, Jessica Thysens, Justin M Lockwood","doi":"10.1542/hpeds.2024-008006","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008006","url":null,"abstract":"<p><strong>Introduction: </strong>A quality improvement initiative targeting emergency transfer (ET) rate reduction resulted in the development and implementation of the safety officer (SO) intervention. SO leveraged on-site pediatric hospitalists to promote institutional safety practices around care escalation for all patients admitted to the target unit, including those admitted to surgical subspecialty services.</p><p><strong>Methods: </strong>An interdisciplinary team developed the SO intervention, which included ad hoc support of communication algorithms and attendance at all Rapid Response Team (RRT) activations on the target unit. To evaluate SO implementation, we applied the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We obtained data through postimplementation surveys, manual case review, and electronic health record reporting. We analyzed survey data using descriptive statistics and clinical data using statistical process control charts.</p><p><strong>Results: </strong>Most SOs completed training (85%). The survey response rate was 30%; 40% were hospitalist clinicians, 24% were RRT participants, 18% were surgeons, and 18% were bedside nurses. Many respondents believed SO improved the unit's safety culture (56%). Nurses reported improved ability to escalate care (94%), and intensive care unit clinicians reported enhanced RRT practices. SO involvement in RRTs increased from 0% to 78%. Non-SO clinicians did not believe SO detracted from ownership of their patients (97%), and SOs felt they could effectively balance competing responsibilities (92%). We did not observe a change in ET rates.</p><p><strong>Conclusion: </strong>By implementing the SO intervention, we successfully integrated hospitalists for managing care escalations and improved perceived safety culture. Further study is needed to evaluate whether SO can improve rare adverse events like ETs.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972838","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":"Challenges and Solutions to Building Family-Staff Relationships in the NICU: A Qualitative Study.","authors":"Katherine Guttmann, Elise Belkin, Rachel Deming, Paul H Lerou, Victoria A Grunberg","doi":"10.1542/hpeds.2024-008304","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008304","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to understand factors that impact family-staff relationships in the neonatal intensive care unit (NICU) from the perspective of staff. Staff shared: (1) general challenges that impact family-staff relationships, (2) role-specific challenges (by discipline), and (3) solutions that could help improve family-staff relationships.</p><p><strong>Methods: </strong>We conducted this study at an urban hospital level IV NICU. In this qualitative study, we conducted 5 focus groups with a convenience sample of NICU healthcare staff (N = 22, 100% women, white/non-Hispanic; age: M = 45 ± 12 [29 - 65]). Focus groups included physicians and a nurse practitioner, unit leadership, nurses, social workers, and occupational therapists. We used a hybrid, inductive-deductive thematic approach to examine qualitative data.</p><p><strong>Results: </strong>Staff shared general and role-specific challenges that impact their interactions with parents. They reported that parental anxiety, parental decision-making, trust, and staff assumptions can strain relationship dynamics. Each discipline also shared specific challenges they face-some were universal (eg, limited time) and others were unique to their role (eg, stigma for social work). Staff offered potential solutions that can improve family-staff dynamics in the NICU (eg, interprofessional teamwork).</p><p><strong>Conclusions: </strong>Findings highlight the structural, cultural, and clinical changes needed to promote team-based care. Interprofessional communication skills trainings, training in trauma-informed care, primary intensivist models, and structured team and family meetings show promise for improving family-staff dynamics. More work is needed to improve family-centered communication, teamwork, and psychosocial resources. Focusing on these areas would help improve the family-staff interactions and enhance outcomes for families.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972790","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":"Unpacking the Unreliability of Interrater Reliability of Pediatric Auscultation.","authors":"Chris A Rees, Jacques D du Toit, Kristina Keitel","doi":"10.1542/hpeds.2025-008588","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008588","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972822","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":"Interrater Reliability of Pediatric Respiratory Auscultation Findings.","authors":"Sriram Ramgopal, Jennifer K Saper, James R Rudloff, Alexandra T Geanacopoulos, Andrea Rivera-Sepulveda, Theresa Timm, Deborah R Liu, Jane K Soung, Lichuan Liu, Todd A Florin","doi":"10.1542/hpeds.2025-008510","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008510","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the interrater reliability of pediatric auscultatory findings as assessed by pediatric emergency medicine (PEM) physicians.</p><p><strong>Methods: </strong>We conducted a multicenter survey of physicians in 6 academic PEM divisions in the United States. Respondents listened to 15 audio clips of pediatric auscultatory sounds and classified them as normal or as having 1 or more adventitious sounds. We calculated Fleiss' κ to evaluate interrater reliability of auscultatory findings among respondents. We stratified results based on study site and years of experience.</p><p><strong>Results: </strong>Surveys were distributed to 128 physicians, with responses from 106 (83% response rate). Only the identification of normal breath sounds (κ = 0.46, 95% CI, 0.45-0.47) met threshold criteria for reliability. Other findings did not reach this threshold, including stridor (κ = 0.32, 95% CI, 0.31-0.33), wheeze (κ = 0.25, 95% CI, 0.24-0.25), crackles (κ = 0.15, 95% CI, 0.15-0.16), and rhonchi (κ = 0.15, 95% CI, 0.14-0.15). Some sites demonstrated greater intrarater reliability compared with others. Stratified by years of experience, only interpretation of normal breath sounds and stridor among physicians with 0 to 4 years of experience and the interpretation of normal breath sounds among physicians with 15 or more years of experience reached acceptable reliability. Compared with a reference standard, highest accuracy was noted in the interpretation of normal breath sounds (Accuracy =  0.85, 95% CI, 0.83-0.87).</p><p><strong>Conclusion: </strong>We found poor interrater reliability in the interpretation of most pediatric breath sounds, except in the identification of normal breath sounds. These findings support a need for more robust approaches toward the accurate identification of respiratory pathology in children.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972797","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":"Institutional Review Board Insights: Tips for Submission to the Institutional Review Board.","authors":"Allison M Wiedeman, Benjamin Rocky Byington, Saima Deen, Hadley Sauers-Ford","doi":"10.1542/hpeds.2025-008403","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008403","url":null,"abstract":"<p><p>The institutional review board (IRB) is an essential collaborator in the pediatric research process. Research must be scientifically and ethically sound to produce meaningful results, and it is the IRB's responsibility to review and approve human subjects' research while protecting the subjects' rights, minimizing research risks, and maximizing the benefits. Understanding the research approval process is important for any clinician investigator hoping to conduct human subjects' research. Although IRB requirements can, and often do, vary by site, there are important overarching requirements that apply to all institutions. We aim to provide general, practical guidance on how to navigate a study through the IRB process in 3 sections: what to consider before starting your study documents, what to consider while drafting documents, and what happens after you submit. Our hope is that these helpful hints lead to efficient IRB review of proposed research and successful science.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972795","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":"Increasing Pasteurized Donor Human Milk Use in a Level 1 Newborn Nursery.","authors":"Giuseppina Romano-Clarke, Ananya Jain, Georgia Dey-Lawson, Tyese Aldrich, Tracy Ramondi, Janet Bell, Leela Sarathy","doi":"10.1542/hpeds.2025-008450","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008450","url":null,"abstract":"<p><strong>Background and objectives: </strong>Supplementation with pasteurized donor human milk (PDHM) instead of formula can help to preserve breastfeeding exclusivity. At our institution, up to 50% of term breastfeeding newborns admitted to the well nursery used formula supplementation during birth admission, impacting our discharge breastfeeding exclusivity and potentially long-term breastfeeding success. The primary outcome measure of our project was to increase by at least 10% the number of well newborns receiving PDHM instead of formula each month. Our secondary outcome measure was to increase overall breastfeeding exclusivity at hospital discharge.</p><p><strong>Methods: </strong>We conducted a process analysis and nursing and newborn provider surveys to better understand barriers to PDHM use in our level 1 nursery. Interventions included staff and provider education, discussion of supplementation options with families on admission, and improvement of access to PDHM within our unit. Using cycles of plan-do-study-act, we refined our PDHM use plan to a standard workflow.</p><p><strong>Results: </strong>We observed a 70% increase in PDHM use in our level 1 nursery, which was sustained over a 12-month period. Breastfeeding exclusivity also demonstrated a sustained increase from 49.2% to 57.2%. In addition, 54.5% of babies receiving PDHM during the birth hospitalization for whom we could obtain follow-up information remained exclusively breastfed at 2 months.</p><p><strong>Conclusions: </strong>Understanding and addressing the local barriers to providing PDHM in the level 1 nursery and including the main stakeholders in designing solutions was key to our practice change. As shown in prior studies, PDHM use during birth hospitalization can improve longer breastfeeding exclusivity.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972761","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":"Identifying Shifts in the Pediatric Hospital Medicine Job Market.","authors":"Katherine Salada, Matthew Hazle, Harlan McCaffery, Niko Kaciroti, H Barrett Fromme","doi":"10.1542/hpeds.2024-008277","DOIUrl":"10.1542/hpeds.2024-008277","url":null,"abstract":"<p><strong>Objective: </strong>To describe potential differences in pediatric hospital medicine (PHM) hiring practices based on board certification/board eligibility (BC/BE) status.</p><p><strong>Methods: </strong>Following the literature review, an electronic survey was developed by investigators, with feedback from division leaders representing 4 divisions and 3 institutions. The survey was administered nationally to PHM leaders via PHM listservs in the spring of 2023 and inquired about institution demographics, division characteristics, and hiring practices for the 2022 to 2023 recruitment season. Subanalysis was completed by BE status: (1) fellowship trained, (2) practice pathway eligible, and (3) non-BC/BE.</p><p><strong>Results: </strong>A total of 76 division leaders responded, representing community (41%), university (37%), and combined (22%) sites. Division directors interviewed a median of 5 (IQR, 3-8) physicians to fill a median of 1.9 (IQR, 1-3) available full-time equivalent. There was no difference in interviews extended, jobs offered, or candidates hired based on BE status. BC/BE candidates had lower odds of being hired at community sites (odds ratio [OR], 0.26; P = .01) and higher odds of receiving academic rank (OR, 2.05; P = .01) compared with non-BC/BE candidates. There was no difference in salary, time on teaching services, or time on faculty-only services based on BE status.</p><p><strong>Conclusion: </strong>Non-BC/BE candidates continue to have a diverse array of job opportunities in PHM. However, some variability in PHM job characteristics has emerged among candidates from different BC/BE pathways. Further study is required to understand how shifting trends in hiring impact learner training, faculty compensation, and academic productivity of PHM divisions.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"637-644"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054872","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":"Inequities in Length of Stay for Pediatric Patient Families Using Languages Other Than English for Care.","authors":"Paula E Lopez-Perez, Elyse N Portillo, Michael Silver, Alexandra Coria","doi":"10.1542/hpeds.2024-008050","DOIUrl":"10.1542/hpeds.2024-008050","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the correlation between use of language other than English (LOE) for care and length of stay (LOS) in children admitted to the hospital.</p><p><strong>Methods: </strong>Single-center retrospective cohort study at an urban children's hospital including medical and surgical patients aged 0 to 17 years admitted to our pediatric inpatient floor or pediatric intensive care unit between January 1, 2018 and January 1, 2020. LOE families were defined as those with documented use of language interpretation and/or who identified as using LOE for care during registration. LOS in hours and numbers of nights was compared across LOE and English-speaking groups with a Mann-Whitney U test, and across language groups using a Kruskal-Wallis Test. LOS analyses of the surgical population were done using Mann-Whitney U test. A multivariable linear regression model was fit to predict the relationship between LOE and LOS in hours and a negative binomial model was fit to predict number of nights in the hospital, controlling for social work consults, medical consults and acuity at presentation.</p><p><strong>Results: </strong>4755 patients were included. Median LOS in the LOE group was 64 hours, 6 hours longer than the English group (P < .001). The LOE group stayed in the hospital a median of one night longer (P < .001) than the English group. Families who spoke a Chinese dialect had the longest LOS (median 70 hours) among language subgroups. LOS was longer for LOE patients in both medical (66 hours vs 60 hours, P < .001) and surgical (48 hours vs 42 hours, P < .001) subgroups. LOS was longer for patients with LOE when controlling for social and medical complexity and acuity at presentation.</p><p><strong>Conclusions: </strong>Use of LOE for care was associated with longer LOS, including a higher median number of hospital overnights. Findings were particularly pronounced in Chinese-speaking families and extended to surgical patients. An extra hospital night is a clinically significant difference that could increase the risk of hospital-acquired infections, raise costs, and decrease patient satisfaction.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"645-651"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576583","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":"Practical Approaches for Navigating Authorship Conflict.","authors":"Paul Michel, Priti Bhansali, Lisa E Herrmann, Neha Shah, Steven Marek","doi":"10.1542/hpeds.2025-008326","DOIUrl":"10.1542/hpeds.2025-008326","url":null,"abstract":"<p><p>Authorship confers both credit and responsibility for original scientific research. It is a highly prized, currency-like resource in academic medicine, and discussing it transparently with colleagues can feel as uncomfortable as talking about salaries. Junior researchers especially need to feel confident in their approach to navigating contentious authorship scenarios because they arise so commonly in academic research. Fortunately, there are simple tools researchers can employ to successfully prevent and navigate most authorship conflict. With these tools, researchers can systematically identify authors, outline author roles, recognize common forms of authorship conflict, and escalate conflict to appropriate channels for resolution.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e416-e419"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709278","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":"Defining the Hospitalist Workforce in the Care of Newborns.","authors":"Neha S Joshi, Arun Gupta, Rakhi Gupta Basuray, Krista Birnie, Allison Markowsky, Shimona Thakrar, Sandra Motta, Juliann L Kim","doi":"10.1542/hpeds.2024-008295","DOIUrl":"10.1542/hpeds.2024-008295","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric hospital medicine is a rapidly growing new subspecialty. Although many practice newborn care, this subset of hospitalists has not been described. The objective of this study was to define the hospitalist workforce in the care of newborns during the birth hospitalization, including describing job characteristics of newborn hospitalists and nursery sites for clinical practice.</p><p><strong>Methods: </strong>An 81-question web-based survey was distributed to a convenience sample of 418 hospitalists taking care of newborns during the birth hospitalization in September and October 2024. We performed descriptive statistics and tests of association.</p><p><strong>Results: </strong>We had 336 respondents, for a response rate of 80%. Among 336 respondents, 451 nursery sites were described. Hospitalists at nearly all sites independently managed infants in level I nurseries (n = 436, 97%), with 38% (n = 170) managing infants in level II special care nurseries. Hospitalists attended deliveries at 45% (n = 203) of sites and were more likely to attend at community sites (P < .001), in rural settings (P < .001), and at sites with lower annual delivery volumes (P < .001). Hospitalists at most sites spent most of their daily clinical time on the care of newborns (n = 378, 84%) with 47% (n = 210) spending more than 90% of daily clinical time on newborn care.</p><p><strong>Conclusions: </strong>Among surveyed hospitalists who provide care for newborns during the birth hospitalization, newborn care presented most of their clinical workload. Nearly all independently managed infants in level I nurseries, with a subset managing infants in level II special care nurseries. This survey is the first characterization of hospitalists and their care of newborns and serves as a primer for further understanding of this workforce.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"630-636"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040355","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}