Hospital pediatrics最新文献

{"title":"Responding Equitably to Patients and Families in Crisis.","authors":"Susan Wu, Michelle Knutson","doi":"10.1542/hpeds.2024-007775","DOIUrl":"10.1542/hpeds.2024-007775","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e154-e156"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693637","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":"Who Will Take Responsibility?","authors":"Robert M Kliegman","doi":"10.1542/hpeds.2024-007941","DOIUrl":"10.1542/hpeds.2024-007941","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e163-e164"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617528","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":"Inpatient Adolescent Sexual Health Services and Long-Acting Reversible Contraception Training.","authors":"Alice Zhao, Robin T Higashi, Shelby Edmondson, Catherine Wong, Nirupama DeSilva, Megan Gribbons, Jasmin A Tiro, Jenny K R Francis","doi":"10.1542/hpeds.2024-008016","DOIUrl":"10.1542/hpeds.2024-008016","url":null,"abstract":"<p><strong>Objective: </strong>Inpatient settings provide unique opportunities to deliver sexual health services, such as long-acting reversible contraception (LARC), including intrauterine devices and contraceptive implants, to adolescents. This study aimed to (1) characterize general inpatient screening and management of sexual health services by region and (2) assess clinician preferences about inpatient LARC training.</p><p><strong>Patients and methods: </strong>We conducted a convergent parallel mixed-methods study with a national online survey and semistructured interviews among pediatric residents, fellows, advanced practice providers, and midlevel clinicians. We analyzed survey data with descriptive and bivariate statistics with significance set at .05 to evaluate sexual health screening and management by region. We analyzed interview data using an iterative deductive and inductive approach and coupled quantitative and qualitative findings.</p><p><strong>Results: </strong>Overall, 669 clinicians completed the survey and 32 clinicians participated in interviews. Survey and interview findings supported one another. Southern participants reported less screening (χ2(5) = 16.7; P = .01) or management (χ2(5) = 17.0; P = .01) of sexual health needs than other regions. Qualitative findings included the following: (1) gaps in inpatient sexual health services and barriers to training; (2) successful implementation of inpatient sexual health training including contraceptive implants; and (3) clinician concerns about future implementation of inpatient LARC training and perceived solutions to improve feasibility.</p><p><strong>Conclusions: </strong>Contraceptive implant training might be prioritized by future programs given its feasibility. Future studies can design educational interventions for inpatient clinicians who work with adolescents to ensure adequate delivery of sexual health services tailored to the region of the country.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"325-333"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671338","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":"Sociodemographic Influences on Suicide Risk Screening and Management in Hospitalized Youths.","authors":"Alexandra L Johnson, Kelsey Porada, Sarah H Vepraskas","doi":"10.1542/hpeds.2023-007680","DOIUrl":"10.1542/hpeds.2023-007680","url":null,"abstract":"<p><strong>Background: </strong>Characterizing the relationship between sociodemographic factors and youth suicide risk is crucial for developing prevention strategies and targeted interventions.</p><p><strong>Objective: </strong>We aimed to describe the relationship between hospital-based suicide-risk screening and sociodemographics (race and ethnicity, sex, age, and neighborhood socioeconomic status), discharge disposition, and reuse rates in those with positive screens.</p><p><strong>Methods: </strong>This is a retrospective study of patients aged 10 to 17 years hospitalized between May 2021 and May 2022 at a freestanding children's hospital in Milwaukee, Wisconsin. Screening rates and results were compared across groups using chi-square tests and logistic regression.</p><p><strong>Results: </strong>Five thousand two hundred sixty-one encounters were included, and 83.2% (4375/5261) received suicide-risk screening. Of those screened, 19.3% (843/4375) had positive suicide-risk results. Screening rates were significantly higher among Black or African American patients (P < .001), girls (P = .01), and those aged 13 to 17 years (P < .001). Positive suicide-risk results were most frequent among Hispanic/Latino/Latinx patients (P = .01) and girls (P < .001). Patients aged 10 to 12 years were screened less frequently and had fewer positive suicide-risk results (P < .001). There were no differences based on neighborhood socioeconomic status. Black or African American patients were discharged home more often than white patients (P < .001). Patients with positive suicide-risk screens discharged home had a 6.1% emergency department revisit rate within 7 days of discharge compared with 2.4% of those transferred to inpatient psychiatry (P = .05).</p><p><strong>Conclusion: </strong>We found differences in screening incidence and result (Black or African American and Latinx, sex, and preteens), discharge disposition (Black or African American), and hospital reuse (discharge home) after a positive suicide-risk screen. Our findings call for increased consideration of social determinants when caring for hospitalized youth.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"342-350"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659138","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":"Guideline-Concordant Antibiotic Use in Children With Community-Acquired Pneumonia.","authors":"James W Antoon, Hui Nian, Jessica Todd, Krow Ampofo, Yuwei Zhu, Laura Sartori, Jakobi Johnson, Donald H Arnold, Justine Stassun, Andrew T Pavia, Carlos G Grijalva, Derek J Williams","doi":"10.1542/hpeds.2024-007994","DOIUrl":"10.1542/hpeds.2024-007994","url":null,"abstract":"<p><strong>Background: </strong>Despite national guidelines on appropriate antibiotic therapy, there is wide variation in antibiotic decision-making for children with community-acquired pneumonia. This study sought to determine prevalence and factors associated with guideline-concordant antibiotic use in children presenting with pneumonia to the emergency department (ED).</p><p><strong>Methods: </strong>We enrolled children aged younger than 18 years presenting to the ED at 2 US children's hospitals between September 2017 and May 2019 with clinical and radiographic pneumonia. The primary outcome was guideline-concordant antibiotic use as defined by the 2011 Infectious Diseases Society of America pediatric pneumonia guideline and local expert consensus. Outcomes included proportion of antibiotic use and proportion of guideline-concordant treatment. We used multivariable logistic regression models to determine associations of comorbidities and functional limitations, clinical findings, and radiographic characteristics with overall antibiotic use and guideline-concordant treatment.</p><p><strong>Results: </strong>Among 772 included children, 573 received antibiotics (74.2%), and 441 (57.1%) received guideline-concordant antibiotic treatment. Antibiotic initiation was less likely in those with interstitial findings on chest radiograph (adjusted odds ratio [aOR], 0.14; 95% CI, 0.07-0.25) and negative results or nonperformance of viral testing (aOR, 0.39; 95% CI, 0.24-0.65). Guideline-concordant treatment was more likely in those with chest indrawing (aOR, 2.22; 95% CI, 1.34-3.66) and less likely in those with clinically significant effusion (aOR, 0.21; 95% CI, 0.06-0.76).</p><p><strong>Conclusions: </strong>Among children presenting to the ED with pneumonia, more than 40% received treatment inconsistent with guideline recommendations. These observations underscore opportunities to improve appropriate antibiotic use in this population.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"300-308"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543874","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":"Variability in Treatment of UTIs in Children With Genitourinary Anomalies in Children's Hospitals.","authors":"Catherine S Forster, Alexis C Wood, Stephanie Davis-Rodriguez, Sanyukta Desai, Pearl W Chang, Michael J Tchou, John M Morrison, Rana F Hamdy, Vijaya Vemulakonda, Patrick W Brady, Cynthia Abou Zeid, Sowdhamini S Wallace","doi":"10.1542/hpeds.2024-007914","DOIUrl":"10.1542/hpeds.2024-007914","url":null,"abstract":"<p><strong>Objective: </strong>In children with urinary tract anomalies, febrile urinary tract infections (UTIs) are associated with increased risks of sepsis, hospitalization, and kidney injury. However, the best treatment strategies are unknown. We aimed to describe antibiotic treatment practices and outcomes for UTIs in children with urinary tract anomalies and evaluate whether variability in UTI treatment exists between hospitals.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study of children seen in emergency departments (EDs) in 6 free-standing US children's hospitals from January 1, 2017, through December 31, 2018. We included children aged 0-17 years with an anatomic or functional urinary tract anomaly and a physician diagnosis of febrile or hypothermic UTI. Outcomes included intravenous (IV) antibiotic administration practices, hospitalization rates, length of stay, and return ED visits. Multivariable logistic and linear regression were performed, adjusting for differences in patient and illness characteristics.</p><p><strong>Results: </strong>Among the 510 children included, anomaly types, presence of home catheterization regimens, and baseline glomerular filtration rates varied between sites. In the adjusted analyses, sites differed in several treatment practices: IV antibiotic administration before ED discharge (P = .007), IV antibiotic spectrum (P = .003), IV antibiotic duration (P < .001), and hospital length of stay (P < .001). No statistically significant differences existed with bacteremia (P = .24) or intensive care stays (P = .08). Returns to the ED within 30 days did not significantly differ by site (P = .68).</p><p><strong>Conclusions: </strong>Children's hospitals vary in their treatment of UTIs in children with urinary tract anomalies, yet ED revisits are similar across sites, highlighting the opportunity to promote high-value care in treatment of UTIs in this population.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"309-317"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701821","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 Benefits of Care Team Assistants in the Changing Context of Pediatric Residency Education.","authors":"Elizabeth Halvorson, Laura Generale","doi":"10.1542/hpeds.2024-008262","DOIUrl":"10.1542/hpeds.2024-008262","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e157-e159"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639514","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":"Care Team Assistants as a Strategy to Reduce Physicians' Administrative Task Burden.","authors":"Akhila Vasthare Shapiro, Tatiana Londoño Gentile, Hannah Dickens, Christopher P Bonafide, Evan Fieldston","doi":"10.1542/hpeds.2024-008072","DOIUrl":"10.1542/hpeds.2024-008072","url":null,"abstract":"<p><strong>Objective: </strong>Physicians increasingly perform administrative tasks that can lead to inefficiencies in care and reduced joy in work. Care Team Assistants (CTAs) are nonclinical team members who address inpatient administrative tasks. This report aims to quantify the task load performed by CTAs and measure CTA impact on inpatient experiences of residents and hospitalists as it relates to their administrative burden, job satisfaction, and delivery of care.</p><p><strong>Methods: </strong>To gather observational data on CTA activities, a CTA supervisor shadowed an embedded CTA on 15 shifts on a resident team in real time using a macros-enabled Microsoft Excel time and motion tracker. Assessment surveys through research electronic data capture were distributed to evaluate the impact of CTAs on the provider's experience.</p><p><strong>Results: </strong>On average, CTAs devoted about 6 hours daily to rounding and care coordination, specifically spending an average of 173 minutes/day with family-centered rounding and an average of 196 minutes/day on care coordination. Survey results highlight that the percentage of respondents spending less than 1 hour on administrative tasks increased from 20% when a CTA is not present to 93% when a CTA is present. A total 99% of respondents reported that CTAs allow them to spend more time caring for patients, and 99% reported overall improved job satisfaction as a result of having a CTA on the care team.</p><p><strong>Conclusion: </strong>This report highlights that as embedded team members, CTAs have enough elasticity in daily activities to absorb multiple short-term tasks that reduce team task burden, ensuring physicians can practice at the top of their license.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e143-e147"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639512","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":"Behavioral Emergency Response Team Alert Disparities in a Single-Site Pediatric Hospital.","authors":"Rachel Peterson, Edward Kim, Angela Amaniampong, Katherine Krause, Kristin Fauntleroy, Audrey Todd, Julia E LaMotte, Anthony Perkins, Sarah Johnson, Brownsyne Tucker-Edmonds, Elaine Cox","doi":"10.1542/hpeds.2023-007520","DOIUrl":"10.1542/hpeds.2023-007520","url":null,"abstract":"<p><strong>Background and objectives: </strong>A Behavioral Emergency Reponse Team (BERT) is a rapid response team for behavioral emergencies, which include clinical psychiatric emergencies, coping/stress reactions and physical or verbal conflicts.1 Use of BERT activations (\"alerts\") in inpatient pediatric populations is understudied. The objective of this study is to determine any differences by race for individuals receiving BERT alerts at a single pediatric hospital.</p><p><strong>Methods: </strong>A cross-sectional retrospective review of all inpatient BERT alerts was conducted between January 1, 2018, and December 31, 2020. Primary outcome was presence or absence of a BERT alert during a single hospital admission (Financial Identification Number). A mixed-effects logistic regression model was conducted to test the association between race and BERT alert as well as physical restraint (PR) use, adjusting for age, gender, ethnicity, payor, and mental health diagnosis (MHD) and clustering at the patient level.</p><p><strong>Results: </strong>A total of 683 alerts occurred between the years 2018 and 2020. Admissions for Black patients had higher odds (adjusted odds ratio [aOR], 2.1; 95% CI, 1.6-2.8; P < .001) of having a BERT alert. Admissions with private insurance had lower odds (aOR, 0.4; 95% CI, 0.3-0.5; P < .001) of any BERT alert. Having an MHD was associated with higher rates of BERT alert (46.7% vs 15.0%; P < .001) and PR use (aOR, 16.7; 95% CI, 5.1-55.0; P < .001).</p><p><strong>Conclusion: </strong>Patients with Black race, government insurance, and MHD had a disproportionate number of BERT. MHD and BERT alerts are associated with increased PR use.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"283-290"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693634","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":"Cloud Care: A Feasibility Study of Cloud-Based Care Plans for Children With Medical Complexity.","authors":"Arti D Desai, Dylan Kinard, Katherine D Hawley, Nathan Goldbloom, Ciauna Tran, Steven Lundgren, Brett D Leggett, Sherri Adams, Julia Orkin, Mayumi Willgerodt","doi":"10.1542/hpeds.2024-008110","DOIUrl":"10.1542/hpeds.2024-008110","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cloud-based information systems can support team-based content management of care plans for children with medical complexity (CMC), yet we have limited knowledge of the feasibility of these systems. We aimed to examine the feasibility of Cloud Care, a novel cloud-based longitudinal care plan system, among a diverse group of caregivers and health care providers caring for CMC.</p><p><strong>Methods: </strong>We conducted a 3-year, prospective, feasibility study between May 2019 and July 2022 in which caregivers and health care providers of CMC received access to Cloud Care for 4 to 32 months. We assessed the practicality, acceptability, demand, integration, and adaptation of the system using a combination of web analytics and survey data.</p><p><strong>Results: </strong>Of those invited, 29 of 43 (67%) CMC/caregivers and 459 of 462 (99.5%) providers enrolled in the study. Among enrolled participants, 90% of primary caregivers and 47% of providers accessed the system at least once (ie, adoption rate), and 59% of primary caregivers and 11% of providers edited content at least once. Of the 11 caregivers and 42 providers who accessed Cloud Care and completed a survey, over 82% of caregivers and 45% of providers perceived the system was easy to use.</p><p><strong>Conclusions: </strong>Study adoption rates highlight the desire for a curated, dynamic care plan for CMC. Engagement in collaborative management of care plan information in a cloud-based system was promising among caregivers, but low among providers. Optimizing the design, accessibility, and usability of existing information systems to create and collaboratively maintain care plans warrants continued exploration.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"360-368"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711499","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}