Pediatrics
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Recognition and treatment of evolving critical illness is a fundamental element of hospital care. Hospital systems should triage patients to receive appropriate levels of care. We describe here the levels of care, the frequency of near or actual cardiopulmonary arrest (code-blue events), identification mechanisms, and responses to evolving critical illness in hospitalized children. ⋯ Currently, the organization of Canadian and American pediatric hospitals includes dedicated areas to match patient acuity and additional personnel to stabilize and facilitate transfer. The functioning of these systems of care results in calls for immediate medical assistance for ward patients approximately 5000 times annually.
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The importance of patient-centered care and the role of families in decision-making are becoming more recognized. Starting with a single acute care unit, a multidisciplinary improvement team at Cincinnati Children's Hospital developed and implemented a new process that allows families to decide if they want to be part of attending-physician rounds. ⋯ Despite initial concerns of staff members, family-centered rounds has been widely accepted and spread throughout the institution. Here we report our experiences as a potential model to improve family-centered care and teaching.
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The goal was to identify criteria that would allow low-risk infants presenting with an apparent life-threatening event to be discharged safely from the emergency department. ⋯ Our study suggests that >30-day-old infants who have experienced a single apparent life-threatening event may be discharged safely from the hospital, which would decrease admissions by 38%.
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Despite the recommendation of the American Academy of Pediatrics, just 53 of the approximately 3500 juvenile justice residential facilities in the United States have received voluntary accreditation for facility health care from the National Commission on Correctional Health Care. This suggests either that facilities do not meet the standards of care or do not seek accreditation. This study describes whether and under what conditions juvenile detention facilities (a narrowly defined subset of all facility types) adhere to some of the standards outlined by the National Commission on Correctional Health Care and promoted by the American Academy of Pediatrics. ⋯ Juvenile facilities have been provided a single set of standards for a diverse system with tremendous variation across and within facility types. Detention centers are just one specialized type. Very few detention centers meet a minimum standard of care, which suggests that standards are simply not being met (hence the low levels of accreditation). The findings of this study call into question whether detention facilities with little in the way of health care infrastructure can benefit from National Commission on Correctional Health Care standards as they are currently packaged, regardless of whether accreditation is the ultimate goal.
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Comparative Study
Preterm birth-associated cost of early intervention services: an analysis by gestational age.
Characterizing the cost of preterm birth is important in assessing the impact of increasing prematurity rates and evaluating the cost-effectiveness of therapies to prevent preterm delivery. To assess early intervention costs that are associated with preterm births, we estimated the program cost of early intervention services for children who were born in Massachusetts, by gestational age at birth. ⋯ Compared with their term counterparts, preterm infants incurred higher early intervention costs. This information along with data on birth trends will inform budget forecasting for early intervention programs. Costs that are associated with early childhood developmental services must be included when considering the long-term costs of prematurity.