Caroline Rassbach

Pediatric discharge content: a multisite assessment of physician preferences and experiences.

BACKGROUND AND OBJECTIVES Professional medical societies endorse prompt, consistent discharge communication to primary care providers (PCPs) on discharge. However, evidence is limited about what clinical elements to communicate. Our main goal was to identify and compare the clinical elements considered by PCPs and pediatric hospitalists to be essential to communicate to PCPs within 2 days of pediatric hospital discharge. A secondary goal was to describe experiences of the PCPs and pediatric hospitalists regarding sending and receiving discharge information. METHODS A survey of physician preferences and experiences regarding discharge communication was sent to 320 PCPs who refer patients to 16 hospitals, with an analogous survey sent to 147 hospitalists. Descriptive statistics were calculated, and χ² analyses were performed. RESULTS A total of 201 PCPs (63%) and 71 hospitalists (48%) responded to the survey. Seven clinical elements were reported as essential by >75% of both PCPs and hospitalists: dates of admission and discharge; discharge diagnoses; brief hospital course; discharge medications; immunizations given during hospitalization; pending laboratory or test results; and follow-up appointments. PCPs reported reliably receiving discharge communication significantly less often than hospitalists reported sending it (71.8% vs 85.1%; P < .01), and PCPs considered this communication to be complete significantly less often than hospitalists did (64.9% vs 79.1%; P < .01). CONCLUSIONS We identified 7 core clinical elements that PCPs and hospitalists consider essential in discharge communication. Consistently and promptly communicating at least these core elements after discharge may enhance PCP satisfaction and patient-level outcomes. Reported rates of transmission and receipt of this information were suboptimal and should be targeted for improvement.

Streptococcal Pyomyositis of the Psoas: Case Reports and Review

Abstract: We present two unusual cases of pyomyositis of the psoas muscle caused by Group A beta-hemolytic streptococcus (GABHS) in children presenting with fever, emesis and leg pain. Pyomyositis secondary to GABHS is rare in children and cases involving the psoas muscle have not been previously reported. In our discussion, we review the epidemiology, presentation, diagnosis and treatment of GABHS psoas myositis in comparison with staphylococcal pyomyositis. Prompt recognition of the signs and symptoms of GABHS psoas pyomyositis is essential for treatment of this life-threatening infection.

Exploring the Educational Value of Patient Feedback: A Qualitative Analysis of Pediatric Residents' Perspectives

From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford School of Medicine, Palo Alto, Calif (Ms Bogetz and Drs Rassbach, Chan, and Blankenburg); and Kaiser Permanente San Jose Medical Center, San Jose, Calif (Dr Chan) Conflict of Interest: The authors declare that they have no conflict of interest. Address correspondence to Alyssa L. Bogetz, MSW, Department of Pediatrics, Lucile Packard Children’s Hospital at Stanford School of Medicine, 725 Welch Rd, MC 5906, Palo Alto, CA 93404 (e-mail: abogetz@stanford.edu).

Outcomes of a Randomized Controlled Educational Intervention to Train Pediatric Residents on Caring for Children With Special Health Care Needs

Objective. To evaluate an innovative curriculum meeting new pediatric residency education guidelines, Special Care Optimization for Patients and Education (SCOPE). Methods. Residents were randomized to intervention (n = 23) or control (n = 25) groups. Intervention residents participated in SCOPE, pairing them with a child with special health care needs (CSHCN) and faculty mentor to make a home visit, complete care coordination toolkits, and participate in case discussions. The primary outcome was resident self-efficacy in nine skills in caring for CSHCN. Secondary outcomes included curriculum feasibility/acceptance, resident attitudes, and family satisfaction. Results. Response rates were ≥65%. Intervention residents improved in their self-efficacy for setting patient-centered goals compared with controls (mean change on 4-point Likert-type scale, 1.36 vs 0.56, P < .05). SCOPE was feasible/acceptable, residents had improved attitudes toward CSHCN, and families reported high satisfaction. Conclusion. SCOPE may serve as a model for efforts to increase residents’ self-efficacy in their care of patients with chronic disease.

Continuing Education Needs of Pediatricians Across Diverse Specialties Caring for Children With Medical Complexity

Objective. Care for children with medical complexity (CMC) relies on pediatricians who often are ill equipped, but striving to provide high quality care. We performed a needs assessment of pediatricians across diverse subspecialties at a tertiary academic US children’s hospital about their continuing education needs regarding the care of CMC. Methods. Eighteen pediatricians from diverse subspecialties were asked to complete an online anonymous open-ended survey. Data were analyzed using modified grounded theory. Results. The response rate was 89% (n = 16). Of participants, 31.2% (n = 5) were general pediatricians, 18.7% (n = 3) were hospitalists, and 50% (n = 8) were pediatric subspecialists. Pediatricians recognized the need for skills in care coordination, giving bad news, working in interprofessional teams, and setting goals of care with patients. Conclusions. Practicing pediatricians need skills to improve care for CMC. Strategically incorporating basic palliative care education may fill an important training need across diverse pediatric specialties.

Training health care professionals for 21st-century practice: a systematic review of educational interventions on chronic care.

Purpose To systematically review the evidence for high-quality and effective educational strategies to train health care professionals across the education continuum on chronic disease care. Method A search of English-language publications and conference proceedings was performed in November 2013 and updated in April 2014. Studies that evaluated a newly developed curriculum targeting chronic disease care with learner outcomes were included. Two primary reviewers and one adjudicating reviewer evaluated the studies and assessed their quality using the validated Medical Education Research Study Quality Instrument (MERSQI). Studies were also mapped onto elements of Wagner’s chronic care model (CCM) to evaluate their use of established evidence-based models for chronic care delivery. Miller’s classification of clinical competence was used to assess the quality of learner achievements for each educational intervention. Results A total of 672 articles were found for this review. Twenty-two met criteria for data extraction. The majority of studies were of moderate quality according to MERSQI scoring. Only three studies reported both learner and patient outcomes. The highest-quality studies incorporated more elements of Wagner’s CCM and showed high-level learner competence according to Miller’s classification. Successful interventions redesigned health care delivery systems to include team-based care, emphasized training of health care professionals on patient self-management, and included learner-based quality improvement initiatives. Conclusions The growing number of children and adults with chronic disease necessitates improved educational interventions for health care professionals that involve evidence-based models for restructuring chronic care delivery, aim for high-level learner behavioral outcomes, and evolve through quality improvement initiatives.

A 6-year-old girl with extensive bullous skin lesions.

6-year-old previously healthy girl presented with extensive bullous skin lesions involving approximately 25% of her total body surface area (TBSA). She initially presented 9 days earlier with low-grade fever, bilateral non-exudative conjunctival injection, cough, and rash. Her rash appeared as raised, erythematous target lesions that began behind her ears and then progressed to involve her face and body. Her symptoms at first presentation were attributed to erythema multiforme and she was treated with hydroxyzine and olopatadine eye drops. Five days later, fluid-filled bullae developed at the centers of the target lesions and increased in number and size up to the time of admission. Physical examination on admission revealed a nontoxic-appearing girl with extensive fluid-filled bullous lesions of varying sizes behind her ears, around her eyes and mouth, and on her neck, trunk, back, axillae, and perineum (Figures 1 and 2). Mucous membrane involvement included small bullae in her nares, hard palate, and perianal region. She had scattered bullae on her wrists and ankles, although her extremities were relatively spared. The skin at the base of the bullae was erythematous, slightly raised, and pruritic. Initial work-up included a normal complete blood count and electrolytes, clear chest radiograph, and negative herpes simplex virus antigen swab from one of her lesions. She was admitted to the hospital for wound care, pain control, nutritional support, and diagnostic evaluation. She continued to develop bullae during her initial hospital days until approximately 60% of her TBSA was affected (Figure 3, see page 230). Her palms and soles also developed lesions. Further testing and a skin biopsy revealed the diagnosis.

Development of a Curricular Framework for Pediatric Hospital Medicine Fellowships

PHM fellowship directors have developed a standardized curricular framework for 2-year fellowship in PHM. Pediatric Hospital Medicine (PHM) is an emerging field in pediatrics and one that has experienced immense growth and maturation in a short period of time. Evolution and rapid expansion of the field invigorated the goal of standardizing PHM fellowship curricula, which naturally aligned with the field’s evolving pursuit of a defined identity and consideration of certification options. The national group of PHM fellowship program directors sought to establish curricular standards that would more accurately reflect the competencies needed to practice pediatric hospital medicine and meet future board certification needs. In this manuscript, we describe the method by which we reached consensus on a 2-year curricular framework for PHM fellowship programs, detail the current model for this framework, and provide examples of how this curricular framework may be applied to meet the needs of a variety of fellows and fellowship programs. The 2-year PHM fellowship curricular framework was developed over a number of years through an iterative process and with the input of PHM fellowship program directors (PDs), PHM fellowship graduates, PHM leaders, pediatric hospitalists practicing in a variety of clinical settings, and other educators outside the field. We have developed a curricular framework for PHM Fellowships that consists of 8 education units (defined as 4 weeks each) in 3 areas: clinical care, systems and scholarship, and individualized curriculum.