Multisystem inflammatory syndrome in children (MIS-C) is an emerging disease described in children in association with infection or epidemiological link to severe acute respiratory syndrome coronavirus 2. Signs and symptoms include fever, rash, and cardiac dysfunction; US Centers for Disease Control and Prevention have put forth broad criteria for diagnosis. The illness is serious and […]
OBJECTIVE: To assess the frequency and completeness of adolescent psychosocial screening documentation for adolescents and young adults hospitalized to a pediatric hospitalist medicine service. METHODS: All patients 12 to 21 years old on the hospital medicine service in an urban, academic, free standing children’s hospital in the Mid-Atlantic United States from January 1, 2014, to […]
OBJECTIVES: Community mitigation measures were implemented to decrease the spread of severe acute respiratory syndrome coronavirus 2. In this study, we aimed to evaluate changes in pediatric emergency department (ED) visits, secondary to acute respiratory illnesses (ARIs) and trauma, before and during the pandemic. We hypothesized that the numbers of ED visits and ARIs would […]
Haddadin, Z., Blozinski, A., Fernandez, K., Vittetoe, K., Greeno, A. L., Halasa, N. B., Lovvorn, H. N.
BACKGROUND: Although plain language is recognized as essential for effective communication, research reveals that medical providers regularly use jargon terminology that may be misunderstood by patients. Little is known, however, about the types and frequency of jargon used in the pediatric inpatient setting. We aimed to quantify jargon use by medical team members during inpatient […]
Charpentier, V., Gotlieb, R., Praska, C. E., Hendrickson, M., Pitt, M. B., Marmet, J.
OBJECTIVES: We sought to examine whether sociodemographic differences, such as race and socioeconomic status, existed between patients in the PICU, pediatric cardiothoracic ICU (PCTU), and NICU who were identified as having ethical issues during interprofessional ethics rounds and all other patients admitted to these units and to characterize the primary ethical issues identified in this […]
Kana, L. A., Feder, K. J., Matusko, N., Firn, J. I.
BACKGROUND: Although intravenous insulin administration is the standard of care in diabetic ketoacidosis (DKA), subcutaneous insulin administration could be a suitable alternative in resource-limited settings, but pain caused by hourly insulin applications are limiting factors for using it, especially in children. We aimed to assess whether the use of a flexible subcutaneous catheter improves comfort […]
Beaudoin, M. L., Torrents, M., Tittarelli, M. F., Hamui, M., Ibarra, M., Ferraro, M., Ferreira, J. P.
OBJECTIVES: Progress notes communicate providers’ assessments of patients’ diagnoses, progress, and treatment plans; however, providers perceive that note quality has degraded since the introduction of electronic health records. In this study, we aimed to (1) develop a tool to evaluate progress note assessments and plans with high interrater reliability and (2) assess whether a bundled […]
Kelly, M. M., Sklansky, D. J., Nackers, K. A. M., Coller, R. J., Dean, S. M., Eickhoff, J. C., Bentley, N. L., Nacht, C. L., Shadman, K. A.
OBJECTIVES: Drug dosing recommendations for children with obesity remain limited. This may lead to variability in medication dosing among children with obesity. Therefore, our objective was to determine differences in the prevalence of guideline-nonadherent systemic corticosteroid orders by weight category in children hospitalized for asthma. METHODS: We performed a retrospective cross-sectional study of children aged […]
Kyler, K. E., Bettenhausen, J. L., Hall, M., Glynn, E. F., Hoffman, M. A., Shakhnovich, V., Smolderen, K., Davis, A. M.
BACKGROUND: Studies of seizure management in the pediatric inpatient setting are needed. Seizures recorded by video EEG provide an opportunity to quantitatively evaluate acute management. We observed variation in delivery of standardized seizure safety measures (seizure first aid) during epilepsy monitoring unit admissions at our hospital. Our goals were to increase consistency and speed of […]
Pavitt, S., Carley, A., Porter, B., Knowles, J. K.
OBJECTIVES: To determine if sociodemographic factors or underlying mental health conditions serve as predictors for prolonged length of stay (pLOS) in children hospitalized for suicidal ideation (SI) or suicide attempt (SA) requiring transfer to psychiatric facilities. We hypothesized an association between certain patient and hospital characteristics and pLOS. METHODS: For this retrospective cross-sectional study, we […]
OBJECTIVES: Maintenance intravenous fluids (IVFs) are routinely used in the care of hospitalized children. The American Academy of Pediatrics (AAP) published clinical practice guidelines in November 2018 that recommended the use of isotonic maintenance IVF. Our primary aim was to increase the proportion of hospital days pediatric inpatients were exclusively administered isotonic maintenance IVF to […]
Nordstrom, M., Landman, G., Pfaff, N., Kaiser, S. V.
Community hospital inpatient pediatric programs face a variety of challenges including financial instability, variable censuses, difficulty maintaining qualified staff, and a lack of focus for the hospital. With the addition of new payment models, such as bundled payments and global budgets, along with a global pandemic, the future of community hospital pediatric inpatient care is […]
BACKGROUND: At our institution, the treatment of infants with neonatal abstinence syndrome (NAS) is guided by a function-based assessment called the Eat, Sleep, Console (ESC) approach. Infants room in with their parent(s) on the inpatient units, and most infants are treated exclusively with nonpharmacologic interventions. The experience of parents of infants with NAS treated with […]
OBJECTIVES: The Modified Finnegan Neonatal Abstinence Scoring System (M-FNASS) and the newer Eat, Sleep, and Console (ESC) model guide the clinical management of neonatal opioid withdrawal syndrome (NOWS). In this study, we evaluate how the M-FNASS and ESC model directly compare in inpatient practice. We hypothesized that ESC scores would correlate with M-FNASS scores, whereas […]
Ryan, K., Moyer, A., Glait, M., Yan, K., Dasgupta, M., Saudek, K., Cabacungan, E.
OBJECTIVES: To determine the extent to which newborns with neonatal abstinence syndrome (NAS) are concentrated in some hospitals as compared with newborns without NAS and whether care quality and safety differed among these hospitals. We hypothesized that newborns with NAS would be cared for in poorer-quality hospitals. METHODS: Secondary analysis of 3 2016 data sets: […]
Lake, E. T., French, R., Clark, R. R. S., ORourke, K., Lorch, S.
BACKGROUND: Diagnostic uncertainty may be a sign that a patient’s working diagnosis is incorrect, but literature on proactively identifying diagnostic uncertainty is lacking. Using quality improvement methodologies, we aimed to create a process for identifying patients with uncertain diagnoses (UDs) on a pediatric inpatient unit and communicating about them with the interdisciplinary health care team. […]
Ipsaro, A. J., Patel, S. J., Warner, D. C., Marshall, T. L., Chan, S. T., Rohrmeier, K., Richardson, D., Kammer, A., Luksic, E., Bell, K. D., Hagedorn, P. A.
OBJECTIVES: Hospitalized children experience frequent nighttime awakenings. Oral medications are commonly administered around the clock despite the comparable efficacy of daytime administration schedules, which promote sleep. With this study, we evaluated the effectiveness of a quality improvement initiative to increase the proportion of sleep-friendly antibiotic administration schedules. METHODS: Interprofessional stakeholders modified computerized provider order entry […]
Mozer, C. L., Bhagat, P. H., Seward, S. A., Mason, N. R., Anderson, S. L., Byron, M., Peirce, L. B., Konold, V., Kumar, M., Arora, V. M., Orlov, N. M.
OBJECTIVES: High-flow nasal cannula (HFNC) use in bronchiolitis may prolong length of stay (LOS) if weaned more slowly than medically indicated. We aimed to reduce HFNC length of treatment (LOT) and inpatient LOS by 12 hours in 0- to 18-month-old patients with bronchiolitis on the pediatric hospital medicine service. METHODS: After identifying key drivers of […]
Charvat, C., Jain, S., Orenstein, E. W., Miller, L., Edmond, M., Sanders, R.
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