Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Randomized Controlled Trial
Changes in hospitals' credentialing requirements for board certification from 2005 to 2010.
In 2005, we conducted a study of the prevalence of board certification requirements for hospital privileging and found that one-third of hospitals did not require pediatricians to be board certified. In 2010, the American Board of Pediatrics implemented the Maintenance of Certification (MOC) program. To examine changes in the policies of hospitals regarding requirements for board certification, we surveyed privileging personnel at hospitals across the country. ⋯ In the 5 years since our previous study, a larger proportion of hospitals now require pediatricians to be board certified, although the proportion of hospitals that make exceptions to this policy has increased twofold. Hospitals appear to be incorporating the MOC program into their privileging policies.
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Randomized Controlled Trial
Beyond statistical prediction: qualitative evaluation of the mechanisms by which pediatric early warning scores impact patient safety.
Early warning scores (EWSs) assign points to clinical observations and generate scores to help clinicians identify deteriorating patients. Despite marginal predictive accuracy in retrospective datasets and a paucity of studies prospectively evaluating their clinical effectiveness, pediatric EWSs are commonly used. ⋯ Although pediatric EWSs have marginal performance when applied to datasets, clinicians who recently experienced score failures still considered them valuable to identify deterioration and transcend hierarchical barriers. Combining an EWS with a clinician's judgment may result in a system better equipped to respond to deterioration than retrospective data analyses alone would suggest. Future research should seek to evaluate the clinical effectiveness of EWSs in real-world settings.
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Randomized Controlled Trial
A trial of a real-time alert for clinical deterioration in patients hospitalized on general medical wards.
With limited numbers of intensive care unit (ICU) beds available, increasing patient acuity is expected to contribute to episodes of inpatient deterioration on general wards. ⋯ Real-time alerts were highly specific for clinical deterioration resulting in ICU transfer and death, and were associated with longer hospital length of stay. However, an intervention notifying a nurse of the risk did not result in improvement in these outcomes.
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Randomized Controlled Trial
Utility, charge, and cost of inpatient and emergency department serum folate testing.
Serum folate levels are commonly ordered for multiple indications in the inpatient and emergency department settings. Since mandatory folic acid fortification in 1998, there has been a decreasing prevalence of folate deficiency in the United States. ⋯ In folic acid fortified countries, serum folate testing has low utility and poor cost effectiveness for all indications in inpatients and emergency department patients.
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Randomized Controlled Trial Comparative Study
Development of a score to predict clinical deterioration in hospitalized children.
Identification of the characteristics that put hospitalized children at high risk of deterioration may help to target patients whose physiologic status should be intensively monitored for signs of deterioration, and reduce unnecessary monitoring in patients at very low risk. Previous studies have evaluated vital sign-based early warning scores to detect deterioration that has already begun. ⋯ We identified a set of characteristics associated with clinical deterioration in children. Used in combination as a score, these characteristics may be useful in triaging the intensity of monitoring and surveillance for deterioration that children receive while hospitalized on non-ICU units.