Hospital pediatrics最新文献

Background and objectives: Infants with neonatal hyperbilirubinemia (NH) often require admission after their birth hospitalization for treatment with phototherapy. Our aim was to align local practice with updated national guidelines to promote efficiency and decrease length of stay (LOS) for this patient population by ∼ 10% over a 15-month period using quality improvement methodology.

Methods: Our improvement initiative included infants younger than age 14 days born at more than 35 weeks' gestation admitted to the hospital medicine service with an NH diagnosis. Baseline data were collected from November 2021 to December 2022. A current state analysis highlighted targets for interventions. Interventions included aligning the local practice pathway with 2022 American Academy of Pediatrics guidelines for NH, adding additional phototherapy lights, and leveraging the electronic health record to improve inter-provider communication over 3 Plan-Do-Study-Act (PDSA) cycles between January 2023 and March 2024. Statistical process control was used for analysis.

Results: There were 130 patients included during the 15-month intervention period. After 3 PDSA cycles, there was no special cause variation in the primary outcome measure, LOS. There was special cause variation in the primary process measure, total serum bilirubin at discharge. Readmissions for phototherapy, tracked as a balancing measure, did not change during the study period.

Conclusions: Successive interventions aimed at optimizing efficiency during NH admissions did not result in decreased LOS. It can be challenging to use LOS as an outcome measure given the influence of various systemic factors that may not be controlled or reasonably changed.

Pediatrics is an ever-evolving field, and clinicians focused on clinical care, including pediatric hospital medicine providers, are in an ideal position to develop research projects that advance evidence-based practice. However, clinical providers get pulled away from their research to deliver high-quality education and care at the bedside to children and families. The challenges of balancing these important goals are ones most faculty will face their entire career. This is most difficult for faculty taking on their first project, as they have yet to refine their research skills, learn their various institutional resources, and build a research team. The purpose of our manuscript is to offer 10 reflections to consider when developing your first research project. We intentionally focused on concepts we felt were highly relevant to first research project experiences. Our goal is to motivate talented clinicians and encourage the development of a solid project foundation to avoid the various pitfalls we have experienced.

Objective: To examine patient characteristics and resource utilization of hospitalized children and adolescents with somatic symptom and related disorders (SSRDs).

Patients and methods: This study included 173 patients who were aged 6 to 18 years and admitted to a single, tertiary academic children's hospital between April 2015 and December 2021 with a diagnosis of an SSRD. Sociodemographic information and clinical features were assessed as outcomes. Resource utilization was compared across diagnostic subgroups. Regression analysis was used to determine whether diagnosis predicted length of stay (LOS).

Results: Of the 173 patients included, presenting symptoms were primarily neurologic (n = 109, 63%); the most common diagnostic subgroup was functional neurologic symptom disorder (n = 65, 38%). Resource utilization was notable; the median laboratory studies ordered was 9 (IQR, 4.5-13), 119 of the 173 patients (69%) had at least 1 imaging study, and 124 (72%) had at least 1 physician consultation. The 14-day all-cause emergency department (ED) return rate was 20% (n = 35), and 14-day related ED return rate was 16% (n = 27). After adjustments, LOS was significantly associated with physician-ordered labs (β = 0.32; P = <.001) and consults (β = 0.41; P = <.001).

Conclusion: The findings of this study revealed significant variability in the management of hospitalized patients diagnosed with SSRDs. Future studies to assess the benefit of clinical pathways for SSRDs to standardize management and potentially reduce health care cost by limiting unnecessary evaluation are needed.

Background and objectives: How children prepare for magnetic resonance imaging (MRI) can help reduce the need for sedation and improve access to pediatric health care. Embedding virtual reality (VR) tools within routine preparation for MRI may support this process. The aim of this study was to qualitatively describe the process of preparing a child for MRI in a tertiary health care setting. We sought to understand the roles of health care workers, parents, and special equipment, such as VR, in preparing children for a successful and a high-quality diagnostic scan.

Patients and methods: There were 29 participants (13 children, 13 caregivers, and 3 health professionals). Children scheduled for clinically indicated noncontrast head MRI scans were recorded on video throughout routine MRI preparation with their parents and health care professionals, with VR included as part of standard care. Interviews with children and caregivers were completed on arrival, immediately before MRI, and post MRI. Using an interpretive description methodology, we integrated coded data from the audio and video to identify themes within an attachment theory framework.

Results: Our qualitative analysis of child MRI preparation strategies revealed 2 main categories: (1) strategies that support self-efficacy and (2) a sense of agency. Strategies employed by child life therapists and caregivers included providing opportunities for accomplishment, practicing sensations, and fostering relational connections through play and collaboration. VR tools enhanced the children's sense of agency and confidence and offer additional educational and coaching possibilities.

Conclusions: MRI preparation methods emphasized attachment between child, caregiver, staff, and MR environment by enhancing the child's self-efficacy and sense of agency. VR offers a platform for MR education and building trust between the child, staff, and MRI setting, with potential utility in underserved medical settings.