Hospital pediatrics
-
Hospital pediatrics · Jul 2016
Family Perspectives on Whiteboard Use and Recommendations for Improved Practices.
To explore pediatric family perspectives and preferences regarding whiteboard use, as well as recommendations for using whiteboards as tools for patient-centered communication and care. ⋯ Of all families, approximately one-half were not informed about whiteboards and one-third did not use them. Reasons for nonuse were largely modifiable. Parents made aware of their whiteboard by their care teams demonstrated increased likelihood of active whiteboard use, highlighting the importance of education and suggesting a gap in harnessing the full potential of whiteboards as communication tools. Families' recommendations can help inform whiteboard practices to strengthen communication and care.
-
Hospital pediatrics · Jul 2016
The Creation of a Pediatric Hospital Medicine Dashboard: Performance Assessment for Improvement.
Leaders of pediatric hospital medicine (PHM) recommended a clinical dashboard to monitor clinical practice and make improvements. To date, however, no programs report implementing a dashboard including the proposed broad range of metrics across multiple sites. We sought to (1) develop and populate a clinical dashboard to demonstrate productivity, quality, group sustainability, and value added for an academic division of PHM across 4 inpatient sites; (2) share dashboard data with division members and administrations to improve performance and guide program development; and (3) revise the dashboard to optimize its utility. ⋯ PHM dashboards have the potential to guide program development, mobilize faculty to improve care, and demonstrate program value to stakeholders. Dashboard implementation at other institutions and data sharing across sites may help to better define and strengthen the field of PHM by creating benchmarks and help improve the quality of pediatric hospital care.
-
Hospital pediatrics · May 2016
Following the (Clinical Decision) Rules: Opportunities for Improving Safety and Resource Utilization With the Bacterial Meningitis Score.
The Bacterial Meningitis Score accurately classifies children with cerebrospinal fluid (CSF) pleocytosis at very low risk (VLR) versus not very low risk (non-VLR) for bacterial meningitis. Most children with CSF pleocytosis detected during emergency department evaluation are hospitalized despite the high accuracy of this prediction rule and the decreasing incidence of bacterial meningitis. The lack of widespread use of this rule may contribute to unnecessary risk exposure and costs. ⋯ The VLR patients admitted to the hospital were exposed to risk and costs despite their low risk stratification. Systematic application of the Bacterial Meningitis Score could prevent these exposures and costs.
-
Concerns about alarm fatigue prompted The Joint Commission to issue a Sentinel Event Alert urging hospitals to minimize alarms. We previously conducted a quality improvement project on a single unit that reduced time on continuous pulse oximetry, a common source of physiologic monitor alarms, for patients with wheezing (ie, asthma and bronchiolitis, wheezing-associated respiratory infections). ⋯ Reducing continuous pulse oximetry use alone may not make substantial reductions in overall alarm counts. Even on our intervention unit, alarm burden remained quite high.
-
Hospital pediatrics · Mar 2016
Retrospective Comparison of Intranasal Dexmedetomidine and Oral Chloral Hydrate for Sedated Auditory Brainstem Response Exams.
Satisfactory conditions for auditory brainstem responses (ABR) screening tests for pediatric hearing loss are usually achieved with oral chloral hydrate (CH) sedation. When the US manufacture of this drug was discontinued for business reasons, we developed an alternative sedation regimen using intranasal dexmedetomidine (IN DEX) 4 μg/kg. This institutional review board-approved retrospective study compared the efficacy and adverse effect profiles of these 2 sedative regimens. ⋯ This retrospective study found that IN DEX provides effective sedation for ABR examinations, with the benefits of an ability to begin the test sooner and complete the examination with a single dose, in addition to a decreased incidence of hypoxemia. A randomized controlled trial should test the hypothesis that the IN DEX technique is superior to the well-established standard oral CH regimen.