Hospital pediatrics最新文献

{"title":"The Essential Role of Pediatric Trainees in Developing Ethical Artificial Intelligence Tools.","authors":"Regan Hill, Haniyah Syed, Nicholas Porter, Logan Pearson","doi":"10.1542/hpeds.2026-009471","DOIUrl":"10.1542/hpeds.2026-009471","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e809-e811"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550730","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 Pediatric Hospitalist: A Survey of What We Do and Where We Are Going.","authors":"Kelsey Jackson, H Barrett Fromme, Elizabeth Nguyen, Kristen Wroblewski, Thomas B Mike","doi":"10.1542/hpeds.2025-009175","DOIUrl":"10.1542/hpeds.2025-009175","url":null,"abstract":"<p><strong>Background: </strong>Pediatric hospital medicine (PHM) is undergoing structural transitions, including the discontinuation of the practice pathway to board certification and changes to pediatric resident training, decreasing inpatient exposure. In this context, understanding the composition, roles, and sustainability of the current PHM workforce is critical. This study describes (1) the scope of clinical and nonclinical roles of pediatric hospitalists, (2) factors correlating with differences in teaching, scholarship, and leadership roles, and (3) workforce sustainability.</p><p><strong>Methods: </strong>A cross-sectional survey, adapted from the 2021 PHM workforce survey, was distributed from July to September 2024 to individual emails obtained from societal lists and a list of division/group leaders. Participants identifying as a physician or advanced practice provider currently practicing PHM were included. Trainees were excluded.</p><p><strong>Results: </strong>The survey was sent to 2932 individuals and 1060 responded (response rate 36.2%). Participants were from all US geographic regions and worked in various employment models. Most respondents worked full time (88.6%) and provided direct patient care (99.6%). Respondents engaged in nonclinical activities, including teaching (92.9%), research and scholarship (62.3%), and administration (53.6%), although participation varied by employment model, academic appointment, board status, gender, and career stage. Many planned to decrease clinical time (43.8%) and night or evening shifts (36.5%).</p><p><strong>Conclusion: </strong>PHM is characterized by broad professional engagement, yet nonclinical responsibilities and perceptions of sustainability vary. As certification and training structures evolve, continued workforce planning and monitoring will be important to support the workforce.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"823-830"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809284","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":"\"At Some Point, You Have to Cut the Cord\": Physician Perceptions of NICU-to-PICU Transfers.","authors":"Phillip D Cohen, Madonna Enwe, Jennifer K Fitzgerald, Sapna R Kudchadkar","doi":"10.1542/hpeds.2026-009518","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009518","url":null,"abstract":"<p><strong>Objective: </strong>Patients undergoing nonemergent neonatal intensive care unit (NICU) to pediatric ICU (PICU) transfer in the United States have complex medical needs and high relative mortality, but there are no best practices guiding these transfers. This qualitative study was designed to address this gap by characterizing facilitators and barriers to effective NICU-to-PICU transfer among physicians.</p><p><strong>Patients and methods: </strong>Semistructured individual interviews were conducted with pediatric intensivists and neonatologists purposively sampled from previous national surveys on transfer processes. Interviews were recorded, transcribed, and qualitatively analyzed using an iterative process to elicit themes until thematic saturation was reached.</p><p><strong>Results: </strong>A total of 21 interviews were conducted among pediatric intensivists (n = 12) and neonatologists (n = 9). Three major themes emerged integral to effective transfer: ICU mutual trust, multidisciplinary presence, and clinician-family partnership. Subthemes of ICU mutual trust were (1) setting patient goals and caregiver expectations and (2) bridging inter-ICU clinical differences, both of which were tied to regular NICU-PICU touchpoints and early communication with families. Tied to the theme of multidisciplinary presence were (3) identifying continuity, in which care overlap was a facilitator and (4) leveraging collective expertise, in which nursing and allied health professionals' knowledge of long-stay patients are a major asset. Clinician-family partnership was linked to subthemes of (5) prioritizing patient needs and (6) addressing culture shock while not overstating the NICU-PICU differences.</p><p><strong>Conclusions: </strong>In this qualitative study, pediatric intensivists and neonatologists have collectively identified actionable aspects of nonemergent NICU-to-PICU transfer that, if addressed, may benefit patients, families, and providers.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070226","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":"Predictive Performance of Screening Methods for Neonatal Opioid Withdrawal Syndrome.","authors":"Courtney W Tam, Olivia Venvertloh, Megan Witsoe, Sara C E Rossi, Laura Cogua, Jenna Kasten, Vanuyen Pham, Maria Concepcion Mendoza, Paul Kang, Amy Yeh, Rowena Cayabyab, Hemananda Muniraman","doi":"10.1542/hpeds.2025-009186","DOIUrl":"https://doi.org/10.1542/hpeds.2025-009186","url":null,"abstract":"<p><strong>Background: </strong>Routine urine substance screening (USS) in pregnant women for perinatal substance exposure is associated with bias and has limited evidence supporting its use. We evaluated agreement between maternal disclosure, maternal and neonatal USS, and their predictive abilities for neonatal opioid withdrawal syndrome (NOWS) admission.</p><p><strong>Methods: </strong>In this single-center retrospective study, we included pregnant women with gestational substance use and their neonates (February 2018 to December 2022). Agreement between screening tests was assessed using κ. Predictive abilities of the screening were evaluated using logistic regression and area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>We analyzed 1161 paired maternal USS and maternal disclosure of substance use and 907 paired maternal and neonatal USS results. Self-disclosure and maternal USS showed moderate agreement for opioids (κ = 0.54) and substantial agreement for methadone (κ = 0.80). Maternal and neonatal USS demonstrated moderate agreement for opioids (κ = 0.67) and almost perfect agreement for methadone (κ = 0.88). Among 952 infants born during the study period, 277 (29%) were admitted for NOWS and 176 (18.4%) required pharmacotherapy. Odds ratio (OR) for NOWS admission for self-disclosure, maternal USS, and neonatal USS were 9.9, 8.5, and 6.2, and the AUC for the same were 0.75, 0.74, and 0.71, respectively. Combined maternal history and maternal USS provided the strongest prediction (OR, 12.0; AUC, 0.78), whereas combined maternal disclosure, maternal USS, and neonatal USS had an OR of 10.8 and AUC of 0.75.</p><p><strong>Conclusions: </strong>Maternal self-disclosure demonstrated moderate agreement with maternal USS for perinatal opioid exposure. Although combining maternal self-disclosure with maternal USS provided the highest predictive ability for neonatal admission with NOWS, maternal self-disclosure alone remained a reliable predictor.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070286","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":"Built at the Speed of Trust: Lessons for Multicenter Pediatric Collaboration.","authors":"David Mahoney, Cameron Grant, Patricia Li, Corrie McDaniel, Richard McGee, Damian Roland, Marisa Van Arragon, Nassr Nama","doi":"10.1542/hpeds.2026-009521","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009521","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070292","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":"Geospatial Links Between Pediatric LRTI Acute Care Use and the Child Opportunity Index.","authors":"Kailey A Remien, Tyler J Gorham, Rejuan Haque, Jonathan H Pelletier, Todd Karsies","doi":"10.1542/hpeds.2026-009442","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009442","url":null,"abstract":"<p><strong>Background and objectives: </strong>Neighborhood social determinants influence pediatric acute care (AC) use, but their role in lower respiratory tract infections (LRTIs), the leading cause of pediatric hospitalization, is unclear. We mapped LRTI AC utilization and examined whether census tract-level Child Opportunity Index (COI) 3.0 scores were associated with LRTI hotspots, overall AC use, and pediatric intensive care unit (PICU) admission.</p><p><strong>Methods: </strong>In this retrospective single-center study, we identified children younger than 2 years receiving AC for LRTI from 2018 to 2023 in Franklin County, Ohio, and neighboring counties. Patient addresses were geocoded and linked to COI by census tract. Kulldorff's spatial scan statistic was used to identify the most likely cluster of tracts with significantly elevated AC utilization. Sociodemographic characteristics were compared between patients residing in hotspot and non-hotspot tracts.</p><p><strong>Results: </strong>We had 18 219 children contributing 22 977 AC encounters; 8.4% required PICU care. COI was negatively associated with LRTI AC utilization rates (R2 = 0.094; F1,477 = 49.48; P < .001). Lower-opportunity census tracts had higher LRTI AC and ICU-level encounter rates in tract-level negative binomial models; the social/economic and education domains showed the strongest associations. Patients in the primary LRTI hotspot were more likely to be Black, publicly insured, born prematurely, and residing in lower-opportunity neighborhoods. Hotspot tract residence was not associated with clinical severity, suggesting geographic clustering reflects structural disadvantages.</p><p><strong>Conclusions: </strong>Neighborhood opportunity was strongly associated with LRTI AC-use clustering. Equity-informed, place-based strategies that address structural drivers of health may reduce disparities in pediatric LRTI care.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070245","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":"Agitation Care Practices at US Children's Hospitals in a Multicenter Research Collaborative.","authors":"Evan M Dalton, Jennifer A Hoffmann, Matt Hall, Sofia Chaudhary, Anna Cushing, Adrienne DePorre, Cori Grant, Meghan J Fennell, Alexandria G Georgadarellis, Ankita T Gupta, Holly R Hanson, Bijan Ketabchi, Divya Mirchandani, Paul C Mullan, Katherine A Nash, Andrew W Osten, Nicole Penwill, Raymond Pitetti, Samantha Severson, Gunjian Tiyyagura, Neil G Uspal, Wendi Wendt, Melissa Wood-Katz, Stephanie K Doupnik, Ashley A Foster","doi":"10.1542/hpeds.2026-009703","DOIUrl":"10.1542/hpeds.2026-009703","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13667919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070261","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":"Improving the Timeliness of Test Result Management After Hospital Discharge.","authors":"Meenu Krishnasamy, Rhiya Sharma, Lydia Nashed, Khoa Luong, Courtney Port","doi":"10.1542/hpeds.2026-009339","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009339","url":null,"abstract":"<p><strong>Background: </strong>Failure to follow up on test results pending at discharge (TPAD) is a well-documented patient safety issue, affecting 20% to 61% of hospitalized patients. At our institution, TPAD management practices varied, and no standardized process existed.</p><p><strong>Objective: </strong>To increase the percentage of TPAD managed within 36 hours of resulting for patients discharged by the pediatric hospital medicine (PHM) service from 53% to 95% in 3 months and sustain improvement over 9 additional months.</p><p><strong>Methods: </strong>We used the Model for Improvement methodology. All TPAD for PHM patients were routed to a shared electronic health record in-basket. We delegated daily result management to the admitting physician, with defined timing expectations and backup coverage. TPAD were categorized into 4 groups based on result type, urgency, and impact on care to help standardize management. Newly created documentation templates, instructional guides, and written agreements with subspecialists supported workflow implementation. Project measures were analyzed using statistical process control charts and differences between groups using appropriate statistical testing.</p><p><strong>Results: </strong>Of 5912 TPAD (1307 baseline; 4605 postintervention), results managed within 36 hours increased from a mean of 53% to 96%. Mean time to manage TPAD decreased from 195.4 hours to 11.6 hours. No disparities in timely result management were observed by race, ethnicity, language, or insurance. Per self-report, physicians spent an average of 10 minutes per shift on result management. Postintervention surveys showed high clarity, physician wellness, and high satisfaction.</p><p><strong>Conclusions: </strong>This workflow successfully improved TPAD management, with high physician satisfaction. Next steps include improving documentation, quarterly audits, and involving trainees.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070233","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":"Disparities in Reporting of Violent Events by Patients at a US Children's Hospital.","authors":"Adrienne G DePorre, Emily Cramer, Shelby Chesbro, Christopher J Russell, Alec M Bernstein, Mallory Netz, Cy Nadler","doi":"10.1542/hpeds.2026-009351","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009351","url":null,"abstract":"<p><strong>Background: </strong>Violence toward health care workers is increasing, yet patient risk factors for having a reported violent event (VE) are unknown. Understanding patient risk factors associated with reported VEs is needed to inform equitable approaches to VE reporting and guide resource delivery.</p><p><strong>Objective: </strong>To identify patient and hospitalization characteristics associated with reported VEs at a US children's hospital.</p><p><strong>Methods: </strong>This case-control retrospective study included children aged 5 to 18 that were hospitalized between January 1, 2019 and December 31, 2023 at a 390-bed children's hospital. We identified reported VEs by querying a form in our electronic health record form, which documents violent behaviors by patients. Odds of a reported VE occurrence were modeled as a function of patient and hospitalization characteristics using a multivariable logistic regression model.</p><p><strong>Results: </strong>Among 28 052 youth with 43 991 hospitalizations, 199 youth (0.7%) and 242 hospitalizations (0.6%) had a reported VE. Higher rates of restraint use were observed among children with reported VEs (37.6%) compared with those without reported VEs (0.3%). Age, race, and mental or behavioral health (MBH) diagnosis were associated with adjusted odds of reported VEs. After controlling for other covariates, Black children were at increased adjusted odds ratio (aOR) of reported VEs (aOR 3.64; 95% CI, 2.51-5.27) compared with white children. Many MBH conditions were significantly associated with increased aORs for VEs, with disruptive, impulse control, and conduct disorders (aOR 6.25; 95% CI, 4.17-9.36) conveying the highest risk. We saw similar patterns of disparities when analyzing just those children with an MBH diagnosis.</p><p><strong>Conclusion: </strong>Racial disparities in VE reporting highlight the need for applying an equity lens as institutions evaluate and improve reporting practices.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070283","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":"Adapting an EHR-Based Intervention to Reduce Preprocedural Fasting in Hospitalized Children.","authors":"Taylor Merritt, Averi E Wilson, Jami Miller, Divya Rajan, Christoph U Lehmann, Sofia Babool, Lasya Challa","doi":"10.1542/hpeds.2025-009203","DOIUrl":"https://doi.org/10.1542/hpeds.2025-009203","url":null,"abstract":"<p><strong>Introduction: </strong>Prolonged preprocedural fasting in hospitalized children persists despite American Society of Anesthesiologists (ASA) guidelines permitting clear liquids up to 2 hours before anesthesia. Prior work demonstrated that an electronic health record (EHR) order with ASA-aligned defaults reduces fasting duration; however, evidence regarding replication and sustainability in complex inpatient settings is limited. We evaluated the replication, local adaptation, and clinical impact of a standardized EHR-based nothing-by-mouth order within a quaternary pediatric hospital medicine (PHM) service.</p><p><strong>Methods: </strong>We conducted a quasi-experimental interrupted time series (ITS) analysis from January 1, 2023 through April 23, 2025. Eligible encounters included PHM patients aged 0 to 21 years with an active nothing-by-mouth order who underwent anesthesia. The intervention replaced the existing midnight-default order with an ASA guideline-aligned EHR nothing by mouth order. Reach, Effectiveness, Adoption, Implementation, and Maintenance and Practical, Robust Implementation and Sustainability Model frameworks were applied post hoc to contextualize implementation outcomes and characterize contextual determinants, respectively. Segmented regression evaluated changes in monthly mean clear liquid fasting duration.</p><p><strong>Results: </strong>Among 1407 encounters (659 preintervention, 748 postintervention), mean clear liquid fasting duration decreased by 30.5%, from 708.6 minutes (11.8 hours) to 492.5 minutes (8.2 hours). ITS demonstrated an immediate reduction in fasting duration of 184 minutes (95% CI, -236.9 to -131.2), with no significant postintervention slope change, indicating sustained improvement over 15 months. Nothing-by-mouth violations and periprocedural emesis did not increase.</p><p><strong>Conclusion: </strong>A standardized EHR-based nothing-by-mouth order was associated with a sustained reduction in fasting duration without increases in measured safety outcomes. Structural EHR modification may represent a scalable strategy to improve alignment with guidelines.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031580","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}