Hospital pediatrics
-
Hospital pediatrics · Jan 2015
ReviewVenous thromboembolism in hospitalized adolescents: an approach to risk assessment and prophylaxis.
Pediatric hospital-acquired venous thromboembolism (VTE) is an increasingly prevalent and morbid disease. A multidisciplinary team at a tertiary children's hospital sought to answer the following clinical question: "Among hospitalized adolescents, does risk assessment and stratified VTE prophylaxis compared with no prophylaxis reduce VTE occurrence without an increase in significant adverse effects?" ⋯ On the basis of the best available evidence, we propose a strategy for risk assessment and stratified VTE prophylaxis for hospitalized adolescents. This strategy involves assessing risk factors and considering prophylactic measures based on level of risk. We believe this strategy may reduce risk of VTE and appropriately balances the adverse effect profile of mechanical and pharmacologic prophylactic methods.
-
Hospital pediatrics · Jan 2015
Rate of preventable early unplanned intensive care unit transfer for direct admissions and emergency department admissions.
Appropriate patient placement at the time of admission to avoid unplanned transfers to the ICU and codes outside of the ICU is an important safety goal for many institutions. The objective of this study was to determine if the overall rate of unplanned ICU transfers within 12 hours of admission to the inpatient medical/surgical unit was higher for direct admissions compared with emergency department (ED) admissions. ⋯ Rates of unplanned ICU transfers within 12 hours of admission to an inpatient unit are not higher for direct admissions compared with ED admissions. Further studies are required to determine clinical risk factors associated with unplanned ICU transfer after admission, thus allowing for more accurate initial patient placement.
-
Hospital pediatrics · Jan 2015
Pain Outcomes in a US Children's Hospital: A Prospective Cross-Sectional Survey.
Pain in hospitalized children may be underrecognized and undertreated. The objective of this survey was to benchmark pain prevalence, intensity, assessment, and pharmacologic as well as integrative treatment of pain in inpatients in a US children's hospital. ⋯ Despite existing hospital policies and a pain consult team, significant room for improvement in pain management was identified. A hospital-wide, 3-year Lean quality improvement initiative on reducing pain was commenced as a result of this survey.
-
Hospital pediatrics · Nov 2014
Comparison of dexmedetomidine with pentobarbital for pediatric MRI sedation.
Intravenous pentobarbital has been used in the past to sedate pediatric patients in preparation for MRI; however, the drug has unpredictable sedation time. Dexmedetomidine, because of its short half-life, is gaining popularity for pediatric MRI sedation in settings where the use of propofol is restricted for nonanesthesiologists. The objective was to compare induction time, recovery time, total sedation time, sedation failure rate, and adverse outcomes of patients sedated with pentobarbital and dexmedetomidine in preparation for pediatric MRI. ⋯ Dexmedetomidine and pentobarbital can both be used successfully for MRI sedation in children. However, dexmedetomidine had a significantly shorter recovery time and total sedation time in our population.
-
Communication errors during handoffs are a leading cause of sentinel events. The Accreditation Council for Graduate Medical Education 2011 duty hour standards (DHS) increase the frequency of handoffs. ⋯ A multidisciplinary group of residents and charge nurses and a handoff bundle was associated with improved resident perceptions of handoffs and communication within the 2011 DHS.