Hospital pediatrics最新文献

{"title":"Structural Violence in Transgender Health: Perspectives From Medical Students in the South.","authors":"Rachel Tanenbaum, Taylor Oberman, Lacretia Carroll","doi":"10.1542/hpeds.2024-008017","DOIUrl":"10.1542/hpeds.2024-008017","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e165-e168"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664908","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 the Percentage of Problem Lists Marked as Reviewed at Discharge.","authors":"Samantha Neumeier, Madeline Van Dorpe, Hillary H Voss, Jorde Spitler, Rachelle Musselman, Cheyanne Harshman, Abiodun Omoloja, Paige Hampton, Kathleen Matic, Heather Dyer","doi":"10.1542/hpeds.2024-007737","DOIUrl":"10.1542/hpeds.2024-007737","url":null,"abstract":"<p><strong>Objective: </strong>Problem lists (PLs) are key to ensuring patient safety, accuracy of documentation, and clear communication among providers within the electronic health record (EHR). However, PLs frequently remain out of date, lacking new diagnoses and retaining former or duplicate diagnoses. The aim of this project was to increase use of the PL by the pediatric hospital medicine (PHM) service by increasing the percentage of PLs marked as reviewed and updated at discharge while increasing accuracy of documentation in the PL.</p><p><strong>Methods: </strong>Weekly data on all patients discharged from the PHM service was collected, and medical record audits were performed by the clinical documentation integrity team for accuracy. Initial interventions focused on incorporating the PL into the standard discharge workflow using EHR tools (including SmartPhrases and wildcards in the discharge summary) as well as education. Later, data transparency and value incentives for attendings were incorporated for attending engagement. Data were reported and analyzed on statistical process control charts.</p><p><strong>Results: </strong>In 18 months, the centerline of the PL being marked as reviewed at discharge improved from 26% to 92%. For updating the PL at discharge, the centerline shifted from 44% to 91%. Accuracy increased from 40% to 64% during the first 8 months.</p><p><strong>Conclusion: </strong>PL use, including updating the PL, marking the PL as reviewed, and accuracy of the PL can be improved through education, EHR interventions, transparency of data, and emphasis on quality metrics. Incorporating the PL into the discharge process using existing EHR tools can optimize documentation and standardize workflow around the PL.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e134-e142"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598012","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":"\"Like a Hot Potato\": Breakdown of Clinician-Parent Communication About Newborn Toxicology Testing.","authors":"Gina Liu, Brianna J Wright, Leah N Schwartz, Ellis J Yeo, Sarah N Bernstein, Sharon Ostfeld-Johns, Davida M Schiff","doi":"10.1542/hpeds.2024-007963","DOIUrl":"10.1542/hpeds.2024-007963","url":null,"abstract":"<p><strong>Objective: </strong>Examine the perspectives of newborn clinicians and parents on communication around newborn toxicology testing.</p><p><strong>Methods: </strong>We conducted semistructured interviews from 2021 to 2022 with 15 newborn clinicians and 15 parents who experienced perinatal toxicology testing. Clinician interviews explored indications, perceptions of use, and attitudes toward parental consent for newborn toxicology testing. Parental interviews explored attitudes toward, knowledge of, and care team interactions related to perinatal toxicology testing. Researchers open coded transcripts for clinician and parent interviews separately to generate 2 codebooks. Transcripts were independently coded by 2 pairs of researchers. Codes involving communication and clinician-parent relationship from both groups were analyzed together using an inductive thematic analysis approach.</p><p><strong>Results: </strong>From both sets of interviews, we identified 4 themes: (1) lack of communication about the benefits and risks of newborn toxicology testing led to confusion and misperceptions about the purpose of testing among parents, (2) fear of damaging the clinician-parent relationship and discomfort discussing potential Child Protective Services involvement impacted clinician communication around testing, (3) both clinicians and parents expressed a desire for more transparent communication around newborn toxicology testing, and (4) participants suggested structured consent conversations and improved coordination across prenatal and perinatal care teams.</p><p><strong>Conclusion: </strong>Newborn clinicians rarely discussed clinical benefits of newborn toxicology testing with parents. Both parents and clinicians offered suggestions for improving the transparency and structure of toxicology testing discussions.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"334-341"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587601","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 Practical Guide to Assessing and Addressing Context in Quality Improvement.","authors":"Amy Tyler, Michael Perry, Ashleigh Slemmer, Kathryn Westphal, Laura Chavez","doi":"10.1542/hpeds.2024-007745","DOIUrl":"10.1542/hpeds.2024-007745","url":null,"abstract":"<p><p>This article highlights the often underestimated influence of context in improving the quality of inpatient pediatric care. Context includes environmental, social, cultural, and systemic factors that surround and influence health care service delivery and intervention outcomes. Underappreciation for context can be responsible for the lack of intervention success in improving patient outcomes and can lead to differences in outcomes when initiatives are replicated or spread across health care settings. We draw from the field of implementation science (IS) to highlight essential concepts for measuring context, emphasizing the need for a comprehensive, multifaceted approach to address context effectively. Quality improvement (QI) and IS are complementary disciplines that share a common goal of improving health outcomes. They often engage the same stakeholders in similar environments, addressing overlapping challenges. Whereas QI is usually an \"inside job\" with practitioners deeply embedded in the context they seek to improve, IS seeks to understand how to implement evidence-based practices across varied contexts unfamiliar to those leading the implementation. This lack of familiarity with the context makes measuring and adapting to context a primary focus in IS. Recognizing that context influences how well interventions work, implementation scientists use frameworks to conceptualize, measure, and adapt to diverse contexts effectively. These frameworks help ensure interventions are appropriately tailored to the specific environments to achieve the desired outcomes. In this article, we introduce one such framework, the Practical Robust Implementation and Sustainability Model (PRISM). Organized by PRISM domain, we outline a multifaceted approach for improvers to address context comprehensively, which, at a minimum, includes clinical and community partner engagement, diverse QI team composition, and iterative data-driven adaptations to dynamic contextual factors. Addressing context should improve QI success, patient outcomes, and the replication of initiatives.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e173-e178"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573769","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":"Evaluation of Influenza Vaccine Clinical Decision Support Systems Bundle for Hospitalized Children.","authors":"Swaminathan Kandaswamy, Erin Masterson, Reena Blanco, Patricia Lantis, Thomas E Dawson, Edwin Ray, Christy Bryant, Srikant Iyer, Andi L Shane, Stephanie Jernigan, Evan W Orenstein","doi":"10.1542/hpeds.2024-008099","DOIUrl":"10.1542/hpeds.2024-008099","url":null,"abstract":"<p><strong>Background: </strong>Hospitalized children are at increased risk of influenza-related complications; however, influenza vaccine coverage remains low among this group. We aim to evaluate the effectiveness of a suite of clinical decision support (CDS) strategies to improve inpatient influenza vaccination in children.</p><p><strong>Methods: </strong>We conducted this retrospective cohort study among hospitalized children eligible for the seasonal influenza vaccine. We evaluated the influence of various CDS strategies on influenza vaccine administration rates from September 1, 2018, through May 1, 2022, using mixed-effects logistic regression adjusting for influenza season and demographic factors. In addition to our original CDS (prechecked influenza vaccine order in admission order sets), we designed and implemented 2 additional novel CDS tools, ie, vaccine status notifications and a conditional discharge alert on a patient who had an order without influenza vaccination administration, which were implemented using a sequential crossover design from control to intervention.</p><p><strong>Results: </strong>There were 46 706 eligible hospitalizations across the 4 influenza seasons. In multivariable analysis, all 3 CDS interventions significantly improved influenza vaccine rates compared to those who did not receive any intervention (influenza vaccine order group: adjusted odds ratio [aOR] 2.28, 95% CI: 2.14-2.42; conditional discharge alert: aOR 1.82, 95% CI: 1.56-2.12; vaccine status notifications: aOR 1.19, 95% CI: 1.04-1.37). Vaccination was highest in the 2019 to 2020 influenza season, with falling rates in the subsequent years (2021-2022 season: aOR 0.34, 95% CI: 0.28-0.40).</p><p><strong>Conclusions: </strong>CDS improved influenza vaccination rates in hospitalized children. However, decreased rates over time may indicate waning CDS effectiveness or external factors such as COVID-19, as well as increased vaccine hesitancy.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"351-359"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558320","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 Emergency Care Before and During the Late Pandemic Period: A National Perspective.","authors":"Jay Pershad, Trang Ha, James Chamberlain, Kenneth Mckinley","doi":"10.1542/hpeds.2024-008197","DOIUrl":"10.1542/hpeds.2024-008197","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e160-e162"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568495","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":"iSPOT: Creation and Implementation of a National Peer Observation and Feedback Program.","authors":"Erin King, Nicole Webb, Joanne Nazif, Cherie Ginwalla, Priti Bhansali","doi":"10.1542/hpeds.2024-008104","DOIUrl":"10.1542/hpeds.2024-008104","url":null,"abstract":"<p><strong>Background and objectives: </strong>Peer observation and feedback (POF) enables clinicians to observe one another and learn concrete strategies for improvement. In a 2019 national study, pediatric hospitalists endorsed a desire for POF. We describe a national POF faculty development program designed to formalize, standardize, and normalize POF in pediatric hospital medicine (PHM), along with lessons learned.</p><p><strong>Methods: </strong>Participants and site leads were recruited via the American Academy of Pediatrics Section on Hospital Medicine listserv and offered maintenance of certification (MOC) part 4 credit. Participants submitted a self-assessment with personal goals and attended webinars during which education was provided and data reviewed. Participants completed at least 2 observations in a calendar year. Site leaders collected data and implemented interventions to increase POF events. Baseline and quarterly data were collected for 12 months and subsequently 6 months post implementation. Data presented include site characteristics, facilitators of project completion, and outcomes.</p><p><strong>Results: </strong>POF events increased by 149% from the overall baseline and improvement was sustained by 6 sites. Twenty of 21 sites achieved one Specific/Measurable/Achievable/Relevant/Time Bound aim. Self-reported confidence in delivering feedback and measures of peer connection improved significantly. Seventy-four percent of enrollees completed the program and 92% recommended ongoing participation. One hundred percent of site leads responding to a postprogram survey were satisfied with the program.</p><p><strong>Conclusions: </strong>A national MOC program for faculty development through POF provided incentives and infrastructure to increase POF across diverse institutions. This program serves as a model for other national collaboratives in education and faculty development initiatives.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e148-e153"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626365","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":"Standardization of the Child Physical Abuse Evaluation in a Pediatric Emergency Department.","authors":"Karen Yaphockun, Danielle Hatt, Shalon Nienow, Kathryn Hollenbach, Amy W Bryl","doi":"10.1542/hpeds.2024-007837","DOIUrl":"10.1542/hpeds.2024-007837","url":null,"abstract":"<p><strong>Background: </strong>Child abuse is the third leading cause of death in children aged 4 years and younger. In children aged 24 months or younger with suspected nonaccidental trauma (NAT), a skeletal survey (SS) to evaluate for occult fracture is recommended. Laboratory testing and cranial imaging are recommended in specific ages and scenarios. Before this initiative, there was no standardized guideline for NAT evaluation in our pediatric emergency department (ED).</p><p><strong>Methods: </strong>A team of ED nurses and physicians and child abuse pediatricians reviewed data and identified barriers to obtaining laboratory testing, SS, and head computed tomography in cases of suspected NAT. Interventions included education on implicit bias and abuse recognition, creation of an age-based NAT guideline, the launch of an electronic health record order-set, and physician specific feedback. Primary aims were to increase the proportion of patients aged 24 months or younger with suspected NAT with (1) a SS ordered or planned in the ED from 74% to greater than 95% and (2) required laboratory testing completed from 13% to greater than 60% in 7 months. Results were stratified by race/ethnicity. We used statistical process control charts to examine changes in measures over time.</p><p><strong>Results: </strong>From October 2020 to September 2021, the proportion of patients aged 24 months or younger in the ED with SS ordered/planned increased from 74% to 91%, and those with required laboratory testing increased from 13% to 71%. There were no differences in testing stratified by race/ethnicity.</p><p><strong>Conclusion: </strong>We improved adherence to the recommended medical work-up for suspected NAT in patients aged 24 months or younger across racial and ethnic groups by implementation of an ED guideline with accompanying order-set, education, and individualized physician feedback.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"291-299"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651087","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":"Lost in Translation: Teenagers' Understanding of Common Medical Jargon.","authors":"Aarabhi S Rajagopal, Marissa A Hendrickson, Michael B Pitt, Michelle M Kelly, Scott Lunos, Sage Marmet, Brett Norling, Madeline Suk, Katherine A Allen, Emily Hause, Zachary M Linneman, Rheanne Maravelas, Alexis Quade, Jordan Marmet","doi":"10.1542/hpeds.2024-008076","DOIUrl":"10.1542/hpeds.2024-008076","url":null,"abstract":"<p><strong>Background: </strong>In health care conversations, clinicians continue to use medical jargon despite assuming they are communicating clearly, causing confusion for patients. Prior studies have evaluated adults' perception of medical jargon, but few studies have evaluated how teenagers perceive it.</p><p><strong>Objectives: </strong>To characterize teenagers' comprehension of common phrases used in medical settings via a cross-sectional, survey-based investigation.</p><p><strong>Methods: </strong>A total of 71 teenagers aged between 13 and 17 years were recruited at the 2023 Minnesota State Fair to participate in an anonymous survey assessing their understanding of common phrases a doctor might say or write. Responses were coded as correct, partially correct, or incorrect by 2 independent researchers, with a third reconciling discrepancies. Secondary analyses evaluated the associations between participant demographics and understanding.</p><p><strong>Results: </strong>Teenagers demonstrated a poor understanding of many phrases evaluated. While 97% knew that \"negative cancer screening\" results meant they did not have cancer, fewer (69%) understood that \"the tumor is progressing\" was unwelcome news. More teenagers understood \"your blood test shows me you do not have an infection in your blood\" (89%) vs \"your blood culture was negative\" (52%). Only 10% understood that \"bugs in the urine\" conveyed a urinary tract infection, with 37% expressing a literal interpretation. None knew what was meant by an \"occult infection\" nor by \"febrile,\" with 13% believing that it was related to fertility or sexual activity.</p><p><strong>Conclusions: </strong>Teenagers frequently misunderstood common phrases used within a medical context, with interpretations, at times, representing the opposite of what a health care provider intended.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"204-209"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383821","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":"Strategies Used by Children's Hospitals During the 2022 Viral Respiratory Surge.","authors":"Amanda L Adler, Larry K Kociolek, Nicolaus Glomb, Lynn Ramírez-Àvila, Helen Kest, Michelle Niescierenko, Doneen West, Danielle M Zerr","doi":"10.1542/hpeds.2024-008152","DOIUrl":"10.1542/hpeds.2024-008152","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e105-e107"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415627","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}