Hospital pediatrics最新文献

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.

Objective: Hospitalizations in the United States for type 2 diabetes (T2D) diagnoses in youth increased precipitously in 2020 and 2021. The subsequent trend in hospitalizations for T2D in youth is unknown. We aimed to analyze this trend from 2018 to 2023 and determine frequencies of comorbidities.

Methods: We collected semiannual counts of hospitalizations over this period for patients aged 1 to 20 years with T2D-related principal discharge billing diagnoses from 40 children's hospitals in the Pediatric Hospital Information System. We stratified data by diagnoses, sociodemographics, and quintiles of Childhood Opportunity Index 3.0. We then performed trend analyses and examined frequencies of hypertension, mental health diagnoses, and renal disease.

Results: In 2023, hospitalizations for T2D were 13.1% higher than in 2018 (n = 1484 vs 1679) but declined 43% from their peak in 2021 (n = 2967). The percentage of these hospitalizations due to diabetic ketoacidosis (DKA) rose from 2018 (23.2%) to 2023 (31.8%). Although individuals aged 15 years or older accounted for the highest percentage of T2D-related hospitalizations (47.1%), the percentage of T2D-related hospitalizations for youth aged under 9 years rose significantly from 2018 (5.5%) to 2023 (8.5%). In 2022 and 2023, Hispanic individuals (34.1%) accounted for the highest percentage of T2D-related hospitalizations followed by non-Hispanic Black (30.8%) and non-Hispanic white (27.3%) individuals. Comorbid mental health diagnoses (25.8%) and hypertension (10.7%) were observed throughout the study period.

Conclusion: In 2023, T2D-related hospitalizations remained higher than pre-COVID-19 levels, and DKA accounted for a higher percentage of these hospitalizations, demonstrating increased hospital resource use for youth-onset T2D.

Objective: Screening rates and methods for health-related social needs (HRSNs) in the inpatient pediatric space vary across institutions. We aimed to understand caregiver perspectives regarding inpatient HRSN screening on a pediatric hospital medicine service.

Methods: This qualitative study used purposive and convenience sampling to recruit caregivers on a pediatric hospital medicine service after they were screened for food insecurity, housing concerns, and transportation limitations. A semistructured interview format using an interview guide driven by the health equity implementation framework was used. Topics that were discussed included thoughts on inpatient HRSN screening, experience with the screening process, and perspectives on screening format. Two-person transcript coding was completed via a hybrid inductive and deductive approach until sufficiency was reached, and themes were derived.

Results: Fourteen caregivers were interviewed. Three key themes were derived. First, screening shows families that the hospital cares about them. Second, who, how, where, and when screening happens matters. Most caregivers preferred private, in-person screening by the social work team to feel safe disclosing information. Many felt that the emergency department was not a good location to screen. Downtime during hospitalization was identified as a good time for screening, although day of discharge was not ideal. Finally, our inpatient screening approach employing family services associates made families feel comfortable and "more real."

Conclusions: Caregivers believe that inpatient HRSN screening is important, and screening is well received. Specific preferences included in-person screening by the social work team in the patient's room prior to day of discharge.

Background: Electronic health record (EHR) adoption at academic medical institutions has impacted patient care and trainee education; however, limited studies have examined its potential as an educational tool.

Objective: To explore attending and resident perceptions of current and potential impacts of EHR-based documentation as an education tool.

Methods: Using a constructivist approach and thematic analysis methods, an interview was developed through expert discussion and literature review. Purposive sampling of 15 pediatric and medicine-pediatrics residents and 7 pediatric hospitalist attendings promoted diverse responses. Reflexivity was managed using coders of different levels and backgrounds, with regular meetings for discussion and reflection. Interview analysis proceeded with multiple rounds of iterative coding, and underlying themes were constructed and analyzed.

Results: Three themes were constructed: (1) Writing and reviewing documentation facilitates learning clinical reasoning and building skills; (2) viewing documentation as service, with missed educational opportunities and inefficiencies, limits educational benefit; and (3) appreciating cultural perceptions of documentation in training promotes educational opportunities and may reduce low-yield activities. These themes, combined with existing literature, suggest areas for documentation-based educational interventions to improve quality, better direct effort, and incorporate documentation feedback into resident education. Similarly, reducing inefficiency in the EHR allows for more educational opportunities within the EHR and elsewhere, including bedside teaching. Finally, recognizing the impact of culture around documentation may improve awareness of educational opportunities.

Conclusions: Resident and attending perceptions highlighted areas of educational potential in EHR documentation. Combined with existing literature, these themes suggest interventions can increase educational value.

Objective: Children with medical complexity (CMC) are a high-risk population for many reasons including polypharmacy, which predisposes to medication errors. Parental comprehension of discharge medications is essential to reducing the risk for medication errors in CMC. The aim of this study was to determine whether parental health literacy is associated with comprehension of discharge medications among CMC.

Methods: This was an observational cross-sectional study of English- and Spanish-speaking parents (n = 60) of CMC younger than 18 years admitted to the pediatric intensive care unit or acute care floor of 2 affiliated hospitals. Surveys were self-administered at time of discharge. Newest vital sign is a validated tool that identifies patients at risk for low health literacy. A score less than or equal to 3 indicated low health literacy. Comprehension was a composite score encompassing 6 domains (medication name, indication, dose, frequency, duration, and side effects) and was measured as a continuous variable. Simple and multiple linear regression models assessed the association between health literacy and comprehension, accounting for covariates.

Results: The unadjusted parental comprehension score was 1.16 higher (SE 0.33) in caregivers with appropriate health literacy (P < .01). Health literacy explained 17% of the variance in comprehension. Once adjusting for income, the association between health literacy and comprehension was no longer significant (P = .05).

Conclusion: Low parental health literacy is associated with worse comprehension of discharge medications for parents of CMC, but the relationship is confounded by income. Initiatives to improve medication comprehension with special attention to health literacy and social determinants of health may help address this problem.

Objective: Pediatric hospitalists manage increasing volumes of complex patients. Large language models (LLMs) may offer opportunities to reduce clinician workload through clinical documentation summarization. The objective of this study was to assess the quality of unedited LLM-generated discharge summaries compared with the quality of physician-authored discharge summaries.

Methods: Our study provided an anonymized, comparative evaluation of 35 unedited LLM-generated and 35 physician-authored discharge summaries graded by pediatric hospitalists and primary care pediatricians. Hospitalists used the validated Physician Documentation Quality Instrument (PDQI)-9, and primary care pediatricians used a shortened version of the instrument. Clinical Risk Group (CRG), length of stay, and primary documentation author training level were collected for each summary. Total and subdomain scores were compared along with the association of scores and clinical factors.

Results: Baseline encounter and documentation characteristics were similar between groups. LLM-generated discharge summaries were significantly longer than physician-authored discharge summaries (mean word count 403 vs 329, P < .001). Pediatric hospitalists rated the physician-authored summaries higher in overall score (27.4 vs 23.7, P < .001) and in all 9 PDQI subdomains. Primary care pediatricians rated physician-authored summaries higher in overall score (18.1 vs 15.6, P < .0001) and in 5 of 6 PDQI subdomains, with no significant difference in internal consistency. Spearman correlation showed an associated decrease in physician-authored score with increased CRG (ρ = -0.24, P = .01).

Conclusions: Physicians outperformed LLMs in creating discharge summaries. Future studies should focus on the quality of physician-modified LLM-generated documentation and the effects on documentation quality, physician workload, and overall physician well-being.

Objectives: Recognizing the impact of social needs on childhood health outcomes, hospitals have implemented successful screening programs but struggle with connecting patients to community resources. We aimed to understand the barriers families face in getting help for their social needs after hospital discharge.

Methods: We conducted semistructured interviews with English- and Spanish-speaking caregivers of hospitalized children with social needs at a quaternary care hospital between October 2024 and January 2025 to understand caregivers' experiences in being referred from the hospital for social needs to community organizations including barriers they experienced in connecting with resources and their recommendations on overcoming these barriers. Fluent Spanish speakers interviewed the caregivers and recorded the interviews; interviews were professionally transcribed and analyzed thematically.

Results: Twenty-five participants were majority mothers and Spanish speaking with Medicaid insurance. Themes were grouped into (1) barriers families experienced in connecting with resources for their social needs after hospital discharge, including feeling overwhelmed, slow resource access, poor communication, and referrals and resources that do not match the families' needs, and (2) recommendations for overcoming barriers to resource connection including providing social needs care that is humanistic, longitudinal, and timely and matches the families' needs. Spanish-speaking caregivers recommended matching their need to overcome language barriers through providing hands-on and in-person support.

Conclusion: Families with social needs desired continued support after hospital discharge to overcome barriers to resource connection, and Spanish-speaking caregivers recommended more hands-on and in-person support. Findings inform understanding around providing the appropriate degree of social needs support to facilitate resource connection after hospital discharge.

Objectives: In this study, we hypothesize that significant variation in clinical practice and adherence to the 2022 American Academy of Pediatrics (AAP) hyperbilirubinemia guidelines exists, including for direct antiglobulin test (DAT)-positive newborns.

Methods: This study was conducted through the Better Outcomes through Research for Newborns Network. Participants completed a 58-item survey inquiring about hospital demographics, screening, and management practices for neonatal hyperbilirubinemia.

Results: One hundred twenty-three birthing hospitals were contacted, with 67 participants (55% response rate). Variation existed throughout the clinical decision-making process, from bilirubin screening to management and follow-up practices. For universal screening, 76% of centers obtained a screening bilirubin between 24 and 48 hours of age, per the AAP guidelines. Sixty-nine percent of centers screen newborn of antibody-positive birthing parents for DAT positivity. Seventy-six percent of responding centers utilized the guideline recommendation to stop phototherapy at 2 mg/dL below the level where phototherapy was initiated, regardless of DAT status. Despite the higher risk for developing rebound hyperbilirubinemia, only 66% of respondents obtained a rebound bilirubin in DAT-positive infants and 49% in infants younger than 48 hours. Despite the guideline's statement, only 24% of respondents utilized a transcutaneous bilirubin measurement at least 24 hours after phototherapy discontinuation.

Conclusion: Significant practice variation and relatively low adherence to the 2022 AAP hyperbilirubinemia guidelines existed, even for DAT-positive newborns. More research is necessary to better understand the barriers to implementation of these guidelines.