Hospital pediatrics最新文献

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.

Objective: Our objective was to characterize parent and clinician perceptions of suctioning in hospitalized children with bronchiolitis in a multicenter study.

Patients and methods: We included parents of hospitalized children younger than 2 years with bronchiolitis and clinicians (physicians, advanced practice clinicians, respiratory therapists, and nurses) who care for hospitalized children with bronchiolitis at 4 children's hospitals. We excluded patients with a tracheostomy, ventilator dependence, hemodynamically significant cardiac disease, or neuromuscular disease. We used a general qualitative framework with an inductive thematic analysis approach and semistructured interviews. All interviews were conducted by a trained research coordinator with coding by 2 trained professionals for the first 25%, with the remainder of the interviews coded by a primary coder. Interviews continued until sufficient information power was obtained.

Results: We conducted 14 parent and 25 clinician interviews from January 2024 through May 2024. Most parent interviews were completed by mothers of hospitalized children (71%). Clinician interviews were completed by 7 (28%) nurses, 10 (40%) physicians or advanced practice clinicians, and 8 (32%) respiratory therapists with a wide range of experience. We identified clear parent and clinician themes and themes in which parents and providers held conflicting views. Parents felt that suctioning helped feeding and sleeping and led to faster overall recovery from illness, whereas clinicians often cited the time-oriented nature of bronchiolitis. Clinicians felt that suctioning carried the potential for harm and generally felt that suctioning was overused.

Conclusions: Families generally had favorable views of suctioning, whereas clinicians' views were much more guarded.

Objective: Eating disorders are a common diagnosis requiring hospitalization in children and adolescents. The purpose of this database study is to better define the pediatric population admitted to children's hospitals with eating disorders and to explore socioeconomic factors related to length of stay (LOS) and readmission.

Methods: This is a retrospective multicenter cohort study of patients aged 9-21 years discharged between January 1, 2016, through June 30, 2023, using the Pediatric Health Information System database and International Classification of Diseases, Tenth Edition codes indicating eating disorders to evaluate demographic, clinical characteristics, LOS, and readmission rate in relationship to their payor source.

Results: The study included 6806 encounters, with a median LOS of 7 days and a 14.3% 30-day readmission rate. There were no significant differences in LOS or readmission rates in relation to their primary payor source. Higher median household income was significantly correlated with longer LOS. There was a wide variation in the median LOS between hospital sites.

Conclusions: Although this study found no impact of payor source on LOS and readmission rate, this highlights the necessity to determine the systemic factors impacting the LOS and readmission rates. Community-level interventions are an area where further research is needed to guide both health care professionals and community leaders in resource allocation.

Objective: In phototherapy for neonatal hyperbilirubinemia, the use of covers placed between the newborn and the phototherapy source is variable. Guidelines often recommend a cover for the phototherapy blanket pad. Because covers could affect illumination levels, we assessed phototherapy irradiance levels from an overhead phototherapy system and a phototherapy blanket, with and without commercial covers.

Methods: In this nonclinical study, the overhead phototherapy system used calibrated radiometer measurements from 420 to 500 nm at 2 distances below the light source; the phototherapy blanket used measurements from 400 to 520 nm. We measured irradiance in 4 different variations using 2 types of covers (a mesh swaddle and a phototherapy blanket pad).

Results: For the overhead system, at 30.5 cm below the light source and with a mesh swaddle covering the meter, the irradiance was 29.5 μW/cm2/nm, which was 14% lower than the value without covering (34.4 μW/cm2/nm). The mean irradiance at 15 cm from the light source with the mesh covering the meter (38.5 μW/cm2/nm) was 15% lower than without a cover (45.4 μW/cm2/nm). The irradiance under the zipper of the mesh swaddle was substantially lower at either distance. For the phototherapy blanket, the irradiance measured in all the posterior covering variations ranged from 61.1 (nest plus swaddle) to 98.5 μW/cm2/nm (no covering).

Conclusions: Clinicians should be aware that commercial phototherapy coverings affect irradiance; however, optimal irradiance can be achieved and may even exceed current American Academy of Pediatrics (AAP) recommendations of 25 to 35 μW/cm2/nm.