GUIDELINE TITLE: Clinical Practice Guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 Guideline on Diagnosis and Management of Acute Bacterial Arthritis
RELEASE DATE: January 1, 2024
PRIOR VERSION(S): n/a
DEVELOPER: Pediatric Infectious Diseases Society (PIDS), Infectious Diseases Society of America (IDSA)
FUNDING SOURCE: PIDS and IDSA
TARGET POPULATION: Children with suspected or confirmed acute bacterial arthritis
We examined the impact of a hospital medicine medical procedure service (MPS) on hospital length of stay (LOS), postprocedure LOS, and completion of procedures on weekends. We included 4952 patients admitted to our large academic hospital between July 1, 2021 and July 31, 2023 who underwent thoracentesis, paracentesis, or lumbar puncture (LP). MPS performed 30% (1499) of these procedures. After adjusting for age, sex, body mass index, Charlson comorbidity score, and procedure type, procedure performance by MPS was associated with a shorter total hospital LOS (incidence rate ratio [IRR]: 0.93; 95% confidence interval [CI]: 0.87–0.99) and postprocedure LOS (IRR: 0.82; 95% CI: 0.76–0.88). Also, MPS-performed procedures were twice as likely to occur on weekends compared to non-MPS-performed procedures (odds ratio [OR]: 2.05; 95% CI: 1.75–2.41). These findings support the beneficial impact of MPS on operational efficiency, an important outcome for both patients and hospitals.
Medical trainees are at the forefront of end-of-life care provision in the hospital setting but often feel unprepared to manage the complex emotions after patient death.
To systematically identify and synthesize the published literature on interventions to support medical trainees dealing with patient death.
Searches were conducted in MEDLINE, Scopus, Embase, Psych Info, Cochrane Database of Systematic Reviews, CINAHL, and ERIC from inception to June 30, 2023. English language peer-reviewed publications of interventions to support medical students and residents/fellows dealing with patient death. Studies of practicing clinicians and nonphysician healthcare trainees were excluded. Two reviewers independently determined study eligibility. Discrepancies were resolved through consensus and a third reviewer served as a tiebreaker if needed.
Of the 9107 articles retrieved, 973 underwent full-text review, and 50 studies met inclusion criteria. Most interventions targeted residents (n = 32; 64%) and were conducted in North America (n = 45, 90%). Types of interventions included preventive measures involving educational lectures and workshops (n = 19; 38%), clinical placements (n = 10; 20%), and postventions (n = 16; 32%), including debriefing and memorial services. Several interventions incorporated the arts (n = 5; 10%), including movies, drama, and artwork, and most incorporated reflective narratives (n = 16; 32%). Most interventions were limited in frequency and duration.
This review identified several interventions to support trainees through the experience of patient death but also highlighted areas for improvement. Strengthening support for medical trainees will foster emotionally resilient physicians who are better equipped to deliver high-quality, empathetic care to dying patients and their families.
Asthma, pneumonia, and bronchiolitis are the top causes of childhood hospitalization in the United States, leading to over 350,000 hospitalizations and ≈$2 billion in costs annually. The majority of these hospitalizations occur in general/community hospitals. Poor guideline adoption by clinicians contributes to poor health outcomes for children hospitalized with these illnesses, including longer recovery time/hospital stay, higher rates of intensive care unit transfer, and increased risk of hospital readmission. A prior single-center study at a children's hospital tested a multicondition clinical pathway intervention (simultaneous implementation of multiple pathways for multiple pediatric conditions) and demonstrated improved clinician guideline adherence and patient health outcomes. This intervention has not yet been studied in community hospitals, which face unique implementation barriers.
To study the implementation and effectiveness of a multicondition pathway intervention for children hospitalized with asthma, pneumonia, or bronchiolitis in community hospitals.
We will conduct a pragmatic, hybrid effectiveness-implementation, cluster-randomized trial in community hospitals around the United States (1:1 randomization to intervention vs. wait-list control). Our primary outcome will be the adoption of two to three evidence-based practices for each condition over a sustained period of 2 years. Secondary outcomes include hospital length of stay, ICU transfer, and readmission.
This hybrid trial will lead to a comprehensive understanding of how to pragmatically and sustainably implement a multicondition pathway intervention in community hospitals and an assessment of its effects. Enrollment began in July 2022 and is projected to be completed in September 2024. Primary analysis completion is anticipated in March 2025, with reporting of results following.
Continuous pulse oximetry (cSpO2) monitoring use outside established guidelines is common in children hospitalized with bronchiolitis. We analyzed clinicians' real-time rationale for continuous monitoring in stable children with bronchiolitis not requiring supplemental oxygen. Data for this study were collected as part a multicenter deimplementation trial for cSpO2 in children hospitalized with bronchiolitis. We analyzed 371 clinician responses across 36 hospitals; 258 (70%) responses did not include a clinical reason for monitoring (“nonclinical”; e.g., respondent forgot to discontinue monitoring, did not know why the patient was monitored, or was following an order). The remaining 113 (30%) responses contained a clinical reason for monitoring (“clinical”; e.g., recently requiring oxygen, physical exam concerns, or concerns relating to patient condition or history). Strategies to reduce unnecessary monitoring should include changes in workflow to facilitate shared understanding of monitoring goals and timely discontinuation of monitoring.
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