Hospital pediatrics最新文献

Introduction: Health care professional (HCP) communication about influenza vaccination has been shown to positively impact parental vaccine acceptance for hospitalized children. Few studies have explored key components of this communication.

Methods: We conducted semistructured interviews of parents and HCPs (eg, nurses, nurse practitioners, and physicians) caring for children hospitalized at a quaternary care pediatric hospital during the 2018-2019 influenza season. English- and Spanish-speaking parents were eligible if their child was due for influenza vaccine at the time of admission. Interviews were audio recorded, transcribed, and, if applicable, translated into English. Transcripts were analyzed using thematic analysis.

Results: Parents (n = 23) were primarily female (87%), white (61%), and English speaking (91%). HCPs (nurses n = 15; nurse practitioners n = 5; physicians = 10) had worked in their profession for a median of 4.3 years. Major themes included parental and HCP openness to addressing influenza vaccination during hospitalization and the importance of tailoring vaccine communication for each patient and family. Many parents felt a strong recommendation would be motivating but noted that HCPs frequently missed opportunities to recommend vaccination. Many HCPs reported lacking the requisite knowledge, comfort, and skills for discussing vaccines. They felt easy access to vaccine information and scripted responses to common concerns would be helpful. Many thought institutional support of influenza vaccination (ie, via policies, statements) would build staff confidence in discussing vaccines.

Conclusions: These findings highlight an opportunity to engage families in influenza vaccine conversations during hospitalization and offer insights into how communication between patients, families, and HCPs could be optimized in this setting.

Background: Professional billing is an important component of division revenue and financial sustainability, yet billing knowledge for varied clinical scenarios is often lacking. Rapid Response Team (RRT) events for patient decompensation often require hospitalists to provide critical care services. However, the applicability of critical care codes to these events was underrecognized by our division. Our specific aim was to increase appropriate hourly critical care code use for eligible RRT events from 10% to 50% by July 1, 2024, and sustain for 6 months.

Methods: Daytime, weekday RRT events on the hospital medicine service between January 2023 and June 2025 were reviewed for critical care criteria, charges placed, and documentation meeting requirements for code use. Interventions occurred between October 2023 and August 2024. The process measure was critical care code use for eligible RRT events; the outcome measure was work relative value unit (wRVU) per patient day with an eligible RRT event, and the balancing measure was critical care code use for RRT events not meeting critical care criteria. Interventions included education sessions, a billing tip sheet, streamlined access to billing codes, and regular data updates.

Results: Critical care code use increased from 10% to 94% with special-cause variation observed, and wRVUs increased by 191% per patient day with an eligible RRT event and critical care code placed. Appropriate documentation for use of critical care codes increased from 13% to 90%.

Conclusions: Educational interventions, just-in-time resources, and regular feedback improved appropriate use of critical care codes, documentation, and revenue for RRT events.

Objective: The objective of this study was to determine the feasibility of a clinical trial to study a novel central venous access visual tool's impact on anxiety and decisional comfort in surrogate decision-makers during procedural consent.

Methods: This was a single-site, randomized pilot study. English- and Spanish-speaking parents of children requiring nonemergent central venous access in 1 of 3 pediatric intensive care units in an urban academic children's hospital were eligible. Parents were randomized 1:1 to central venous access procedural consent with or without the tool. Parents' and patients' characteristics were queried, including parental health literacy and anxious traits. Their anxiety and decisional comfort surrounding the procedure for their child were measured using modified validated scales (Low Literacy Decisional Conflict Scale, Amsterdam Preoperative Anxiety and Information Scale, and State-Trait Anxiety Inventory-Short). After data collection, all parents reviewed the tool, and feedback was elicited. Feasibility measures included enrollment/retention, randomization, and parental acceptability.

Results: A total of 28 parents (4 Spanish-speaking) were enrolled (20% of those eligible, 90% of those approached) and were well randomized to each intervention group. Parents found the tool and trial overwhelmingly acceptable. There was no difference in parental state anxiety or decisional comfort metrics.

Conclusions: This randomized pilot study demonstrated feasibility in enrollment/retention, randomization, and parental acceptability, but not preliminary efficacy in decreasing parental anxiety or decisional discomfort.

Objective: This qualitative study explores the experiences and perspectives of pediatric inpatient health care providers and interdisciplinary clinical staff members caring for children and families with lesbian, gay, bisexual, transgender, queer, and other nonheterosexual and noncisgender identities (LGBTQ+), with a focus on identifying common perspectives and patterns related to inclusive practices, barriers, and opportunities for improvement.

Patients and methods: We conducted an inductive qualitative study at a 290-bed children's hospital in the Mountain West region of the United States. Transcripts from 19 semistructured individual interviews were analyzed in 2 coding cycles. Methodological rigor was maintained via team discussions and reflexivity.

Results: Thematic analysis revealed both challenges and opportunities in the collection and use of SOGI information in inpatient pediatric care. Three overarching themes were identified and explored: (1) confusion and discomfort in the context of anti-LGBTQ+ culture, (2) regret and variable awareness regarding harm and missed opportunities, and (3) hope for growth through education and protocol.

Conclusions: This study addresses a gap in the current literature on LGBTQ+ care in an inpatient setting and highlights opportunities to enhance inclusivity and patient-centered care. Addressing these areas can foster a more inclusive and equitable inpatient environment for LGBTQ+ pediatric patients and families.

FC is a 3-month-old female infant referred from her local hospital emergency department for evaluation of a persistent rash and a failure to track in her right eye since birth. FC and her family are from a rural area approximately 4 hours from the nearest children's hospital, and, despite multiple attempts by her family and their primary care pediatrician (PCP), they were unable to secure pediatric subspecialty appointments for further evaluation of her symptoms because of availability constraints. She was ultimately transferred to a quaternary care pediatric center where she was diagnosed with a rare histiocytic syndrome. Her family continues to struggle to access appropriate subspecialty care after hospital discharge and ultimately travels far from home frequently to receive care. We examine FC's case using the socioecological model to highlight the disparities in access to subspecialty pediatric care for geographically isolated children and provide tangible steps to support high-quality and equitable health care for rural families and children.

Background and objectives: Although evidence supports the use of point-of-care ultrasonography (POCUS) in many clinical settings, pediatricians have not widely adopted POCUS. Our objective is to illustrate the impact of POCUS within a children's hospital by describing a registry of cases in which POCUS guided or changed management.

Methods: This is an observational study of a pediatric POCUS registry in an academic children's hospital. Patient cases were included if POCUS guided or changed diagnostic or procedural management. Cases were identified by the physicians performing the examination, and encounters were separately reviewed. We summarize characteristics of POCUS encounters, including our categorization of diagnostic or procedural changes made as a result.

Results: We identified 66 patients (median age, 5.5 years [interquartile range, 1-15]) who had 76 POCUS encounters during which ultrasonography changed management or guided a procedure. There were 31 diagnostic POCUS encounters performed on 29 patients. Diagnostic POCUS encounters led to a change in primary diagnosis (48%), changed disposition by facilitating or preventing discharge or transfer to higher levels of care (36%), prompted a procedure (29%), expedited specialist consultation (26%), or obviated additional imaging (19%). There were 45 procedural POCUS encounters performed on 37 patients. Procedural POCUS led to salvaged procedures (49%), prevented placement of unnecessary central venous catheters (16%), and avoided unnecessary procedures (4%).

Conclusions: This study describes the impact of POCUS in the care of patients in a children's hospital. Our results may serve as an impetus for further study, training, and adoption of POCUS within hospital pediatrics.

Objective: Data exploring family-centered rounds (FCR) participation for caregivers who prefer a language other than English (LOE) are limited. We sought to characterize baseline rates of LOE-preferring caregiver FCR participation and reasons for not participating as part of the current-state analysis for a QI initiative.

Methods: From July 1, 2023, to April 19, 2024, rounding data were recorded, including caregiver presence at bedside and caregiver participation in rounds, for patients admitted to general pediatrics resident teams at a free-standing children's hospital. For LOE-preferring caregivers, we documented reasons for not joining rounds. We used logistic regression to compare FCR participation rates by preferred language and team; we used statistical process control P-charts to visualize participation over time.

Results: Data were recorded for 7586 rounding encounters. This included 6781 encounters with English-preferring caregivers and 805 encounters with LOE-preferring caregivers, representing 231 patients with LOE-preferring caregivers. LOE-preferring (70.3%, n = 566) and English-preferring (69.7%, n = 4725) caregivers were present at bedside with equal frequency. Of caregivers present at bedside, LOE-preferring caregivers participated in 55.6% (n = 315) of rounding encounters compared with 88.1% (n = 4165) for English-preferring caregivers (P < .001). The most-common reason that LOE-preferring caregivers did not participate in FCR was not being invited to join (82%, n = 251). LOE-preferring caregiver participation varied over time (27%-81%), by care team (39%-91%), and by individual LOE (27%-83%).

Conclusions: LOE-preferring caregivers participated in FCR less often than English-preferring caregivers despite similar bedside presence, largely because they were not invited to join. Identifying opportunities to improve LOE-preferring caregiver participation in FCR is essential to ensure the provision of equitable care.