Hospital pediatrics最新文献

Jane is a 2-year-old Black girl who presented to the emergency department after lacerating her tongue while jumping on a trampoline. She was seen several times before this encounter for previous lacerations, episodes of epistaxis, and severe ecchymoses, all of which were not completely investigated. Despite her fragmentary treatment, Jane's parents continued to advocate for her health by raising concerns to providers in the hopes of determining the cause of her recurrent bleeding; however, these concerns were often dismissed and absent from documentation. Although Jane presented to many different providers, rendering her multiple opportunities for diagnosis, her medical history was not completely explored and her care was discontinuous, resulting in a delayed diagnosis of von Willebrand disease. Jane's story brings attention to the intersectionality of health disparities and the discrimination that persists in the medical system. Her delayed diagnosis represents many others who have also been inadequately treated based on their race, gender, or socioeconomic status, and provides an opportunity to uncover where the medical system falters. Jane's story opens the discussion about (1) racism as it exists systemically, historically, and within medicine; (2) the intersectionality of gender and race, as well as the place this holds in medicine; (3) the clinical factors leading to her missed diagnosis; and (4) future strategies proposed to mitigate racism's role in medicine.

The process of gathering, appraising, and synthesizing evidence takes many forms across a variety of disciplines with the shared goal of informing both day-to-day practice and research efforts. Scoping reviews and systematic reviews are prevalent in pediatrics and, when adhering to methodological standards, have the potential to answer questions using existing evidence while minimizing bias. This article highlights the key similar characteristics (transparency, comprehensive search, minimal bias, team-based) and differences (purpose, approach, question, data collection) and includes interactive quizzes with recommendations both for researchers seeking to conduct reviews and for clinicians appraising and applying publications.

Background: Audit and feedback can prompt clinician improvements. The benefit of this approach in pediatric emergency department (PED) systems is unclear. We evaluated the feasibility of a multisite, monthly automated report card and its effect on quality performance within and across emergency department sites.

Methods: We conducted a stepped-wedge randomized trial across 4 academic and 3 affiliated PEDs in the Pediatric Emergency Care Applied Research Network between January 2013 and April 2016. The intervention consisted of monthly site-level quality performance reports featuring bar charts with benchmarks, visit counts, and 12-month trends derived from electronic health record (EHR) data. Measures included initial care documentation (weight, vital signs) and throughput (time to clinician, time to imaging results, left without being seen rate, and length of stay). We evaluated the intervention's effect on performance measures and slope changes at implementation.

Results: We included 1 426 109 encounters (864 940 during the preintervention period, 561 169 during the postintervention period). We observed improved performance for 4 measures: weight for all visits (+0.2%), documentation of all vitals (+10.1%), time to vitals documentation (-12.0%), and time to plain film radiology report (-3.5%). We observed a decline in performance measures related to throughput, with increases in time to clinician, mean length of stay, and the proportion of patients leaving without being seen.

Conclusions: We demonstrate the feasibility of providing quality performance report cards to hospital leaders using EHR data. We found mixed results in terms of the effectiveness of improving site-level metrics. Future efforts may facilitate further refinement of these interventions prior to dissemination.

Objective: Resident psychological safety (PS) during family-centered rounds (FCR), thought to be important for learning, remains understudied. Furthermore, it is uncertain whether resident concerns that learning on rounds impedes family trust are corroborated by families. The study objectives were to (1) describe pediatric residents' experiences with PS during FCR and (2) explore families' perspectives on learning and trust during FCR.

Methods: Informed by PS as a theoretical construct, we performed a qualitative study using grounded theory methodology to conduct focus groups/interviews during the 2022-2023 academic year with 25 pediatric residents who completed a pediatric hospital medicine rotation and 15 family members of hospitalized children. Sampling continued until it reached thematic saturation. Three coders analyzed data with the constant comparative method. Codes were built using an iterative approach and organized into 6 themes. Discrepancies were resolved by consensus.

Results: Residents described PS as comfort proposing a plan and asking questions and being wrong without feeling judged. Residents worried about losing the trust of families. Supervisor support of resident autonomy and team dynamics (eg, showing respect) influenced PS. Families recognized the value of experiential learning for trainees during FCR. Residents' interpersonal skills were the principal drivers of family trust, as families were reassured by attending physician oversight.

Conclusions: Pediatric residents have varied levels of PS during FCR. Support of resident autonomy promotes PS. Resident concerns that expressions of uncertainty negatively impact family perceptions of their competence are not corroborated by families. Instead, resident interpersonal skills are a primary driver of family trust.

Background: Handwipe nicotine (HN) levels can serve as biomarkers of children's exposure to thirdhand smoke (THS) and may be an innovative smoking cessation tool. The objective was to assess health concerns of parental smokers and their readiness to quit after being given hypothetically high and low child HN levels.

Methods: Participants were parental smokers/vapers (N = 89) who lived with their 0- to 11-year-old children and who were participating in a THS observational trial. Parents were presented with hypothetical child HN levels: high result of more than 200 ng/wipe and low result of less than 10 ng/wipe. After being presented with each result, parents reported their readiness to quit smoking (range = 0-10) and general concern about the results, concern that smoking would affect their child's health, and perception of how often their child would get sick (ranges = 0-3). t tests were performed to compare sample means.

Results: Parents had higher readiness to quit (mean = 7.0, SD = 3.1, P = .003) and higher general concern (mean = 2.3, SD = 0.9, P < .001) when presented with the high result compared with the low result (mean = 6.4, SD = 3.1; and mean = 2.0, SD = 1.0, respectively). Parents had higher concern that smoking would affect their child's health (mean = 2.4, SD = 0.9, P < .001) and how often their child would get sick (mean = 2.0, SD = 1.1, P = .006) when presented with the high result compared with the low result (mean = 2.0, SD = 1.0; and mean = 1.8, SD = 1.1, respectively).

Discussion: Higher hypothetical child HN levels influenced parents' concerns about their child's health and chances of getting sick. Future tobacco cessation interventions should consider providing parents with their child's actual HN levels to potentially increase their readiness to quit.