Hospital pediatrics最新文献_第7页

Reducing Serum Bilirubin Measurements in a Newborn Nursery Using Quality Improvement Methodology. 使用质量改进方法降低新生儿托儿所血清胆红素测量值。

IF 2.2

Hospital pediatrics Pub Date : 2026-09-24 DOI: 10.1542/hpeds.2026-009508

Juniper L Burch, Regina Joseph, Tamra Ouellette, Elena Luo, Leela Sarathy

{"title":"Reducing Serum Bilirubin Measurements in a Newborn Nursery Using Quality Improvement Methodology.","authors":"Juniper L Burch, Regina Joseph, Tamra Ouellette, Elena Luo, Leela Sarathy","doi":"10.1542/hpeds.2026-009508","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009508","url":null,"abstract":"Background: Transcutaneous bilirubin (TcB) screening in the newborn nursery (NBN) is noninvasive and appropriate for most infants; however, reported rates of total serum bilirubin (TSB) measurement remain at 17% to 30%.Objective: From January to December 2024, 17.2% of infants solely admitted to our NBN received any TSB test, but only 45.3% of TSB measurements were concordant with the American Academy of Pediatrics guidelines. Our aim was to decrease the percentage of infants receiving any TSB measurement from 17% to 12% within 6 months by increasing the percentage of guideline-concordant TSB measurements from 45% to 75%.Methods: Interventions included the following: (1) updated nursing protocol for bilirubin screening, (2) NBN physician manual chart review, (3) nursing education sessions, (4) NBN physician meeting to discuss ongoing barriers and potential practice changes, and (5) ongoing reinforcement of TSB indications. The outcome measure was the percentage of infants receiving any TSB test. Process measures included percentage of guideline-concordant TSB tests and TSB tests without a preceding TcB screen (unless on/post phototherapy). Balancing measures included readmissions for phototherapy and escalation of care on readmission. Data were analyzed using statistical process control.Results: The percentage of infants receiving any TSB test decreased from 17.2% to 11.2%. The percentage of guideline-concordant TSB tests increased from 45.3% to 85.1%, and TSB tests without a TcB screen decreased from 24.4% to 7.1%. There was no significant change in readmission rate.Conclusion: Using quality improvement methodology to increase guideline-concordant TSB tests decreased the percentage of infants receiving any TSB test. This outcome is beneficial for patient-centered care, with decreased painful procedures, and for resource use.","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":"149031706","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}

引用次数: 0

Perceptions of Secure Messaging and Patient Safety: Results of an Interprofessional Survey. 安全信息传递和患者安全的感知：一项跨专业调查的结果。

IF 2.2

Hospital pediatrics Pub Date : 2026-09-24 DOI: 10.1542/hpeds.2025-008535

Preston Simmons, Halley Ruppel, Alexis Tomlinson, Amina Khan, Kim Albanowski, Melissa McLoone, Meghan McNamara, Eric Shelov, Casey E Pitts, Brooke Luo

{"title":"Perceptions of Secure Messaging and Patient Safety: Results of an Interprofessional Survey.","authors":"Preston Simmons, Halley Ruppel, Alexis Tomlinson, Amina Khan, Kim Albanowski, Melissa McLoone, Meghan McNamara, Eric Shelov, Casey E Pitts, Brooke Luo","doi":"10.1542/hpeds.2025-008535","DOIUrl":"10.1542/hpeds.2025-008535","url":null,"abstract":"Background and objectives: Communication technology within pediatric health care systems is rapidly evolving and has the potential to affect safety culture. After implementing a secure messaging communication platform at our quaternary care hospital, we aimed to evaluate the new system across interprofessional groups to inform future quality improvement initiatives.Methods: A cross-sectional survey developed by quality and safety experts was distributed via email to physicians, advanced practice providers (APP), and nurses over 3 months at a single children's hospital. Descriptive statistics were used to summarize participant demographics. χ2 analysis with correction for multiple comparisons was used to analyze differences across clinician groups.Results: Four hundred and eleven respondents completed the survey, with nurses being the most common respondents (n = 166, 37.6%). When comparing physicians or APP and nurses, there was agreement that the new platform made it easy to communicate with the appropriate team member (P = .096). Practitioners reported feeling more overwhelmed by the number of messages received (P < .001) and being unable to review messages in a timely manner (P < .001) compared with nurses. When practitioner groups were stratified, trainees had the highest proportion of respondents reporting increased workload (n = 65, 94.2%) and being unable to review messages in a timely manner (n = 51, 73.9%).Conclusions: Although there was a consensus across clinical roles that the new communication system makes it easy to communicate with appropriate members of the care team, discrepancies exist in role-specific workload factors. These findings highlight the need for optimizing communication strategies with input from different clinical roles in the inpatient setting.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031688","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}

引用次数: 0

Trends in Regionalization of Pediatric Inpatient and Critical Care by Medical Complexity. 基于医疗复杂性的儿科住院和重症监护区域化趋势

IF 2.2

Hospital pediatrics Pub Date : 2026-09-24 DOI: 10.1542/hpeds.2026-009661

Allan M Joseph, Manzilat Y Akande, Nadine Straka, Elizabeth C Lendrum, Robert J Graham, Elizabeth Y Killien, Mary E Hartman, Matthew Keller, Karen Segar, Julia A Heneghan

{"title":"Trends in Regionalization of Pediatric Inpatient and Critical Care by Medical Complexity.","authors":"Allan M Joseph, Manzilat Y Akande, Nadine Straka, Elizabeth C Lendrum, Robert J Graham, Elizabeth Y Killien, Mary E Hartman, Matthew Keller, Karen Segar, Julia A Heneghan","doi":"10.1542/hpeds.2026-009661","DOIUrl":"10.1542/hpeds.2026-009661","url":null,"abstract":"Background and objectives: Pediatric inpatient and critical care services are increasingly regionalizing: shifting from smaller hospitals to larger specialty centers. Children with medical complexity (CMC) and with technology dependence (TD) account for a disproportionate share of these services, but it is unknown whether regionalization has evolved differently for these groups compared with children without medical complexity.Methods: We conducted a retrospective cohort study of all pediatric inpatient and non-cardiac/neonatal intensive care unit encounters in 6 states from 2001 to 2022. We calculated the proportion of hospitals providing these services, the distribution of encounters across hospital types, the distance traveled for admission, and the concentration of encounters among hospitals.Results: We identified 1 427 565 hospitalizations, of which 210 398 involved critical care. Over time, fewer hospitals provided pediatric inpatient or critical care, and encounters became more concentrated in specialty hospitals. Median travel distance for inpatient care rose from 4.9 miles in 2001 to 8.3 miles in 2022 (an increase of 69.4%), with CMC and children with TD traveling farthest in all years. Critical care travel distances were generally stable over time. Concentration of encounters for children without medical complexity increased more rapidly than for CMC and children with TD.Conclusions: Between 2001 and 2022, regionalization most affected care for noncritical care inpatient encounters and for children without medical complexity. Care patterns for children without complexity converged with those for CMC and children with TD. These trends have important implications for family travel burden and efforts to maintain pediatric readiness outside of specialty centers.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031729","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}

引用次数: 0

Implementing a Hospital-Based Firearm Lock Distribution Program. 实施以医院为基础的枪支锁分发计划。

IF 2.2

Hospital pediatrics Pub Date : 2026-09-24 DOI: 10.1542/hpeds.2026-009371

Katlyn G McKay, Heather L Kreth, Stacey Pecenka, Glenda Weeks, Kelsey A B Gastineau

引用次数: 0

Engaging Secondary Caregivers in Research for Children With Medical Complexity. 参与二级护理人员在研究儿童的医疗复杂性。

IF 2.2

Hospital pediatrics Pub Date : 2026-09-24 DOI: 10.1542/hpeds.2026-009536

Makenzie Morgen, Nicole Werner, Casey O'Hare, Sophie Kooiman, James Feinstein, Michelle A Chui, Gemma Warner, Anna Jolliff, Brittany Storhoff, Kristan Sodergren, Danielle Gerber, Michelle M Kelly, Jens Eickhoff, Ryan J Coller

{"title":"Engaging Secondary Caregivers in Research for Children With Medical Complexity.","authors":"Makenzie Morgen, Nicole Werner, Casey O'Hare, Sophie Kooiman, James Feinstein, Michelle A Chui, Gemma Warner, Anna Jolliff, Brittany Storhoff, Kristan Sodergren, Danielle Gerber, Michelle M Kelly, Jens Eickhoff, Ryan J Coller","doi":"10.1542/hpeds.2026-009536","DOIUrl":"10.1542/hpeds.2026-009536","url":null,"abstract":"Objective: Primary caregivers (PCG; eg, often a parent or guardian) are central to caring for children with medical complexity (CMC). Secondary caregivers (eg, another parent, spouse/partner of the PCG, extended family members, friends, in-home or school-based professionals) also play an important role in caregiving and, presumably, CMC and family health, but are rarely represented in research. To address a critical need for strategies to engage these caregivers in research, this study described experiences recruiting and retaining secondary caregivers into a clinical trial.Methods: This was a descriptive study from the Meds@HOME randomized trial-a digital intervention to support medication administration at home for CMC. Eligible children were under 17 years, had at least 2 Complex Chronic Conditions, and were prescribed at least 1 high-risk medication. PCG identified and ordered secondary caregivers (SCG) by degree of medication delivery involvement. SCG were recruited for a CMC until up to 2 were enrolled. Data were analyzed with descriptive statistics.Results: Of 214 SCG approached, 182 (86%) enrolled, 99 control and 83 intervention. PCG preferred nearly all SCG (209; 95%) to receive the study information sheet directly from them vs study staff. Mean SCG age was 44 years and 53% were men. The mean (SD) time SCG spent caregiving was 8.3 (7.3) hours/d. SCG relationships varied, eg, grandparents (16%), in-home professionals (9%). Of those enrolled, 92% were retained through the study.Conclusion: These results demonstrate promising feasibility for including SCG in CMC research. Researchers and quality improvement leaders focused on caregiving could build upon these approaches to integrate SCG and better represent a comprehensive caregiving context in their programs.","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":"149031610","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}

引用次数: 0

Barriers to Implementing the 2022 Clinical Practice Guidelines for Neonatal Hyperbilirubinemia. 实施2022年新生儿高胆红素血症临床实践指南的障碍。

IF 2.2

Hospital pediatrics Pub Date : 2026-09-24 DOI: 10.1542/hpeds.2026-009498

Preeta A Kamat, Uma Thachapuzha, Joy M Koopmans, Malika D Shah

{"title":"Barriers to Implementing the 2022 Clinical Practice Guidelines for Neonatal Hyperbilirubinemia.","authors":"Preeta A Kamat, Uma Thachapuzha, Joy M Koopmans, Malika D Shah","doi":"10.1542/hpeds.2026-009498","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009498","url":null,"abstract":"Objective: To assess whether anticipated weekend follow-up and/or bilirubin rate of rise (ROR) were associated with subthreshold phototherapy (STP) following implementation of the 2022 American Academy of Pediatrics clinical practice guidelines (CPG).Patients and methods: A retrospective review of infants 35 or more weeks' gestational age who received inpatient phototherapy between 0 to 14 days of life across 5 hospitals (1 academic and 4 community) in 1 health system from February 2022 to January 2024 was performed. Cases were divided into pre-CPG (6 months before guidelines), washout (0-6 months after guidelines) and post-CPG (6-18 months after guidelines) and compared by hospital site. Cases were sorted by high vs low ROR (≥0.2 mg/dL/h or <0.2 mg/dL/h, respectively) based on the CPG categories and by weekday or weekend follow-up; associations with STP were examined using chi-square and logistic regressions in SPSS.Results: A total of 1520 cases were identified. Overall STP decreased post-CPG (51% post-CPG vs 64% pre-CPG; P < .001) with significant change only in community sites (74% pre-CPG vs 55% post-CPG; P < .01). Weekend follow-up among all sites was associated with STP both pre-CPG (weekend vs nonweekend, 76% vs 59%; P < .001) and post-CPG (60% vs 48%; P = .010). Infants receiving STP were more likely to have high ROR post-CPG (57% vs 47%; P = .035); when stratified, this difference was only in the academic site (60% post-CPG vs 29% pre-CPG; P = .004).Conclusions: CPG implementation was associated with overall decreased STP, driven by community hospitals. Weekend follow-up and high ROR were associated with STP postguideline. Real-world uptake of the revised CPG was influenced not only by new clinical thresholds but also by practice setting and anticipated weekend follow-up access.","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":"149031638","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}

引用次数: 0

Hospital-Based Secure Firearm Storage Programs: How Can We Go Further? 基于医院的安全枪支储存计划：我们如何能走得更远？

IF 2.2

Hospital pediatrics Pub Date : 2026-09-24 DOI: 10.1542/hpeds.2026-009781

Vivek A Ashok, Maya I Ragavan, F Joseph Real

引用次数: 0

Building and Financing Infrastructure for NICU Family Engagement and Care Continuity. 为新生儿重症监护室家庭参与和护理连续性建设和融资基础设施。

IF 2.2

Hospital pediatrics Pub Date : 2026-09-21 DOI: 10.1542/hpeds.2026-009641

Marcus P Mosley, Hannah R Ellen

引用次数: 0

Voices From the Community: How Inpatient Clinicians Experience Caring for Deteriorating Children. 来自社区的声音：住院医生如何照顾病情恶化的儿童。

IF 2.2

Hospital pediatrics Pub Date : 2026-09-21 DOI: 10.1542/hpeds.2026-009288

Daniela Hochreiter, Jordan Silberg, Lara Batey, Alanah Armstead, Magna Dias, Corrie E McDaniel

{"title":"Voices From the Community: How Inpatient Clinicians Experience Caring for Deteriorating Children.","authors":"Daniela Hochreiter, Jordan Silberg, Lara Batey, Alanah Armstead, Magna Dias, Corrie E McDaniel","doi":"10.1542/hpeds.2026-009288","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009288","url":null,"abstract":"Background: National initiatives to improve care for children in community emergency department settings have demonstrated improved quality with decreased pediatric mortality. In contrast, pediatric readiness for inpatient care in community hospitals remains poorly defined. Caring for a child whose condition deteriorates unexpectedly requires timely recognition, communication, escalation, stabilization, and transfer when needed. As such, we aimed to understand the experience of inpatient clinicians caring for clinically deteriorating children with evolving acute care needs in community hospitals.Methods: We conducted a qualitative study, utilizing an inductive approach, from November 2023 to May 2024. Using purposive sampling, we conducted semi-structured interviews with pediatric hospitalists, nurses, and respiratory therapists from 16 community hospitals in the Northeastern United States. Data were analyzed using thematic analysis.Results: Twenty-three clinicians participated. We identified 4 themes: (1) Trust-based collaborative decision-making; (2) Adaptive clinical decision-making strategies; (3) Building pediatric-specific capability; (4) The invisible labor of isolated pediatric expertise and its emotional toll. A framework linking clinician experiences to individual and hospital-level consequences was derived, and 14 components for a future pediatric inpatient readiness toolbox were identified.Conclusion: Community clinicians caring for deteriorating children rely on trusted relationships, ongoing decision-making under resource constraints, and locally developed preparedness systems. Future pediatric inpatient readiness frameworks should incorporate these contextual factors alongside traditional measures of staffing, equipment, medications, and clinical capability.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013086","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}

引用次数: 0

Making the Case: Demonstrating the Value of Pediatric Hospital Medicine to Hospital Leadership. 案例论证：展示儿科医院医学对医院领导的价值。

IF 2.2

Hospital pediatrics Pub Date : 2026-09-21 DOI: 10.1542/hpeds.2026-009296

Hunaid Gurji, Elizabeth C Kuhn, Magna Dias

引用次数: 0