Hospital pediatrics最新文献

{"title":"Improving Sleep by Minimizing Unnecessary Overnight Vital Signs in Hospitalized Patients.","authors":"Lauren M McDaniel, Hannah Benjamin, Kristy Carlin, Arti D Desai, Shawn L Ralston","doi":"10.1542/hpeds.2024-008105","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008105","url":null,"abstract":"<p><strong>Background: </strong>The sleep of hospitalized children is frequently interrupted by vital sign (VS) measurements. We aimed to increase the proportion of patient-nights with 1 or fewer overnight VS measurements.</p><p><strong>Methods: </strong>This study included all patients admitted to general medicine services at a university-affiliated free-standing children's hospital. Iterative interventions included rounding checklist and VS order changes within the electronic health record. Our primary outcome measures were a composite of all overnight VS measurements, as well as blood pressure (BP) measurements individually. Balancing measures included rapid responses and intensive care unit (ICU) transfers. We used statistical process control charting to analyze outcomes over time and assessed for inequities based on race, ethnicity, and language of care using a generalized linear mixed-effects model.</p><p><strong>Results: </strong>Our preintervention period included 4292 patients and 15 721 patient-nights between January 1, 2022, and February 15, 2023, and our postintervention period included 4354 patients and 18 584 patient-nights between February 16, 2023, and March 15, 2024. Patient-nights with 1 or fewer composite VS measurements increased from 11% to 18% but ultimately regressed to baseline. Patient-nights with 1 or fewer BP measurements increased from 36% to 69%. There were no increases in rapid responses or ICU transfer postintervention. Non-Hispanic white patients had higher odds of 1 or fewer overnight VS measurements (odds ratio [OR], 1.21; 95% CI, 1.07-1.37) as did patients with English as their language of care (OR, 1.28; 95% CI, 1.06-1.54).</p><p><strong>Conclusion: </strong>Iterative interventions resulted in fewer overnight BP measurements but changes in the composite VS measure were not sustained. The disparities noted in overnight VS measurements warrant attention.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":"15 5","pages":"387-397"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057223","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":"Exploring Intersectionality in the Medical Care of a Latino Child With Autism.","authors":"Aisha James, Carlos Torres, Erin Carroll, Hanna Elmongy, Gregory Fricker, Olivia Larkin, Samantha Martin, Jessica Pierre Francois","doi":"10.1542/hpeds.2024-007928","DOIUrl":"10.1542/hpeds.2024-007928","url":null,"abstract":"<p><p>Felix is a boy aged 10 years with autism and attention-deficit/hyperactivity disorder who presents to the pediatric emergency department for acute behavior change, including decreased interactivity, decreased speech, bruxism, and new urinary incontinence. He is admitted during the weekend, and scheduling of magnetic resonance imaging is delayed. Eventually, he has a computed tomography scan of his head, which shows an abnormal diffuse hypodensity involving the frontal lobe with extension into the cortex, all concerning for ischemia, and he is ultimately diagnosed with Moyamoya disease complicated by stroke. Felix and his family self-identify as Latino and Black and prefer to use a language other than English for medical discussions. Through this case, we (1) reflect on the barriers to clinical care faced by patients with autism; (2) define intersectionality and explore how neurodivergence, race, ethnicity, and parental-provider language discordance can augment and inhibit the provision of equitable care; and (3) discuss strategies that may mitigate the impact of oppression on clinical care.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":"15 5","pages":"442-448"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988705","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 Financial Performance of PHM Programs Through Appropriate Critical Care Billing.","authors":"Paul Scalici, Erin E Shaughnessy","doi":"10.1542/hpeds.2024-008385","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008385","url":null,"abstract":"<p><strong>Introduction: </strong>Children meeting Centers for Medicare and Medicaid Services (CMS) criteria for critical care billing are often cared for by pediatric hospital medicine teams outside the intensive care unit (ICU). Current CMS guidance allows for billing of critical care codes outside of an ICU. These codes have substantially higher relative value units (RVU) attached to them and reimburse at higher rates than the usual evaluation and management codes. Several efforts to optimize use of critical care billing has been described in emergency medicine literature, though few efforts have been described with hospitalists.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048701","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 Effect of a Brief Medical Huddle on Patient and Family Experience During Rounds.","authors":"Rachel Osborn, Henna Boolchandani, Aaron D Bennett, Rebecca Beagan, Lyubina Yankova, Nirali Butala, Heather Collette","doi":"10.1542/hpeds.2024-007998","DOIUrl":"10.1542/hpeds.2024-007998","url":null,"abstract":"<p><strong>Background: </strong>Initial studies of patient- and family-centered rounds (PFCR) in pediatrics used parental interest in participating as the primary outcome. There are mixed results of family satisfaction with the process when compared with standard rounding. To date, there are limited data examining hybrid models of rounding and communication.</p><p><strong>Objective: </strong>We sought to assess the effect of the addition of a standardized interdisciplinary medical huddle before the formal family-centered rounding encounter on patient and family satisfaction with communication and experience on rounds.</p><p><strong>Methods: </strong>Using a quasi-experimental design, we compared family experience for hospitalized children with rounding before and after the introduction of an interdisciplinary medical huddle preceding the PFCR encounter. Family experience was assessed using a 5-question Likert scale survey. The primary outcome measure was self-reported family experience compared between the pre-intervention period (February-June 2017) and postintervention periods (March-July 2021).</p><p><strong>Results: </strong>Mean scores for family experience in the postintervention period were significantly better in \"the doctors used language I could understand\" (3.51 in 2017 compared with 3.71 in 2021; P = .005) and \"the doctors addressed my concerns and questions\" (3.58 in 2017 compared with 3.79 in 2021; P = .009). Overall, the top box response in aggregate was 56% in the pre-intervention period compared with 76% in the postintervention period (P < .001). Rounding time was significantly longer in the postintervention period (17.6 minutes compared with 13.9 minutes; P < .001).</p><p><strong>Conclusions: </strong>Using a prerounds medical huddle in real time was associated with improved family experience on rounds in the general inpatient setting. The development of a shared understanding for all team members, as well as communication planning, likely contributed to these results.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"318-324"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606564","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701821","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}