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  • What Are We Missing in Our Search for MIS-C? April 1, 2021
    Molloy, M., Jerardi, K., Marshall, T.
  • Murine Typhus in 5 Children Hospitalized for Multisystem Inflammatory Syndrome in Children April 1, 2021
    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 […]
    Dean, A., Asaithambi, R., Neubauer, H. C.
  • HEADSS Up! Missed Opportunity for Psychosocial Screening in Hospitalized Adolescents April 1, 2021
    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 […]
    Addison, J., Herrera, N., Tuchman, L., Bokor, B.
  • Changes in Pediatric Emergency Department Visits During the COVID-19 Pandemic April 1, 2021
    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.
  • Say What? Quantifying and Classifying Jargon Use During Inpatient Rounds April 1, 2021
    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.
  • Pediatric Interprofessional ICU Ethics Rounds: A Single-Center Study April 1, 2021
    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.
  • Use of a Flexible Catheter for the Administration of Subcutaneous Insulin in Diabetic Ketoacidosis: A Feasibility Controlled Clinical Trial April 1, 2021
    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.
  • Evaluation and Improvement of Intern Progress Note Assessments and Plans April 1, 2021
    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.
  • Obesity and Corticosteroid Dosing Guideline Adherence in Children Hospitalized With Asthma April 1, 2021
    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.
  • A Standardized Protocol to Improve Acute Seizure Management in Hospitalized Pediatric Patients April 1, 2021
    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.
  • Predictors of Prolonged Length of Stay in Suicidal Children Transferred to Psychiatric Facilities April 1, 2021
    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 […]
    Masciale, M., Dongarwar, D., Salihu, H. M.
  • Improving Isotonic Maintenance Intravenous Fluid Use at a Tertiary Childrens Hospital April 1, 2021
    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.
  • The Future of Inpatient Community Hospital Care: Is There One? April 1, 2021
    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 […]
    Krugman, S. D., Rauch, D. A.
  • Enough Is Enough: Quality Improvement to Deimplement High-Flow Nasal Cannula in Bronchiolitis April 1, 2021
    Treasure, J. D., Hubbell, B., Statile, A. M.
  • Parent Perspectives on the Eat, Sleep, Console Approach for the Care of Opioid-Exposed Infants April 1, 2021
    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 […]
    McRae, K., Sebastian, T., Grossman, M., Loyal, J.
  • Correlating Scores but Contrasting Outcomes for Eat Sleep Console Versus Modified Finnegan April 1, 2021
    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.
  • Newborns With Neonatal Abstinence Syndrome Are Concentrated in Poorer-Quality Hospitals April 1, 2021
    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.
  • Declaring Uncertainty: Using Quality Improvement Methods to Change the Conversation of Diagnosis April 1, 2021
    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.
  • Optimizing Oral Medication Schedules for Inpatient Sleep: A Quality Improvement Intervention April 1, 2021
    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.
  • Quality Initiative to Reduce High-Flow Nasal Cannula Duration and Length of Stay in Bronchiolitis April 1, 2021
    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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