Emily C. Webber

Development and Implementation Results of a Venous Thromboembolism Prophylaxis Guideline in a Tertiary Care Pediatric Hospital.

OBJECTIVES Incidence of pediatric venous thromboembolism (VTE) is increasing due to increased survival of children with chronic diseases and use of interventions (eg, central venous lines), with VTE risk. Our objective was to create VTE prophylaxis guidelines with targeted identification of children at high risk to support appropriate mechanical and pharmacologic prophylaxis and integrate into the electronic medical record (EMR) as a hospital-wide quality improvement project. METHODS Patients aged 12 to 17 years were included. We evaluated institutional data regarding VTE incidence and risk factors. We evaluated literature for populations at high risk for VTE. Guidelines were formulated, and an EMR tool to assess risk and support the guidelines was created and implemented. RESULTS The EMR tool was used to screen 48% of qualified admissions for the first month and 81% in the final study month. On average, 69.1% of qualified admissions were screened monthly during the first 18 months of the program. No adverse events were reported due to pharmacologic prophylaxis. CONCLUSIONS Many risk factors are common between children and adults and certain pediatric populations warrant prophylactic consideration. Pediatric VTE prophylaxis guidelines can be successfully implemented into the EMR to identify high-risk populations. Future studies should assess the long-term impact of implementation.

Journal club blog for faculty paediatricians

taining small group size and the ‘take-home’ points. We plan to make a minor change for next year, based on one preceptor’s suggestion. During the final summation in stage 2, this preceptor visited each table and asked randomly selected ‘nonexpert’ students to summarise the ‘take-home’ points for each article. This may further encourage students to engage in stage 2, knowing they may be responsible for summarising the major points of the paper. Our traditional journal clubs involved up to a dozen small groups with a dozen preceptors. With this technique, using a smaller number of preceptors, we achieved a higher level of student engagement compared with traditional journal club exercises.

Multifaceted quality improvement initiative to decrease pediatric asthma readmissions

ABSTRACT Background: Asthma is the most common chronic disease of childhood and a leading cause of hospitalization in children. A primary goal of asthma control is prevention of hospitalizations. A hospital admission is the single strongest predictor of future hospital admissions for asthma. The 30-day asthma readmission rate at our institution was significantly higher than that of other hospitals in the Childrens Hospital Association. As a result, a multifaceted quality improvement project was undertaken with the goal of reducing the 30-day inpatient asthma readmission rate by 50% within two years. Methods: Analysis of our institutions readmission patterns, value stream mapping of asthma admission, discharge, and follow-up processes, literature review, and examination of comparable successful programs around the United States were all utilized to identify potential targets for intervention. Interventions were implemented in a stepwise manner, and included increasing inhaler availability after discharge, modifying asthma education strategies, and providing in-home post-discharge follow-up. The primary outcome was a running 12-month average 30-day inpatient readmission rate. Secondary outcomes included process measures for individual interventions. Results: From a peak of 7.98% in January 2013, a steady decline to 1.65% was observed by July 2014, which represented a 79.3% reduction in 30-day readmissions. Conclusion: A significant decrease in hospital readmissions for pediatric asthma is possible, through comprehensive, multidisciplinary quality improvement that spans the continuum of care.

Hemopneumothorax caused by vascularized bullae and a pulmonary hemangioma in an adolescent boy

Spontaneous hemopneumothorax is a rare, potentially life-threatening condition occurring in adolescence. In general, spontaneous hemopneumothorax has not been associated with other pulmonary vascular malformations in adolescents. We present a case of a 17-year-old adolescent boy with hemopneumothorax from vascularized pleural blebs who was also noted to have a pulmonary hemangioma.

Adherence to pediatric diabetic ketoacidosis guidelines by community emergency departments’ providers

BackgroundDiabetic ketoacidosis (DKA) is a common presentation of type I diabetes mellitus to the emergency departments. Most children with DKA are initially managed in community emergency departments where providers may not have easy access to educational resources or pediatric-specific guidelines and protocols that are readily available at pediatric academic medical centers. The aim of this study is to evaluate adherence of community emergency departments in the state of Indiana to the pediatric DKA guidelines.MethodsWe performed a retrospective chart review of patients, age 18 years of age or under, admitted to the pediatric intensive care unit with a diagnosis of DKA.ResultsA total of 100 patients were included in the analysis. Thirty-seven percent of patients with DKA were managed according to all six guideline parameters. Only 39% of patients received the recommended hourly blood glucose checks. Thirty percent of patients received intravenous insulin bolus, which is not recommended.ConclusionsNon-adherence to pediatric DKA guidelines still exists in the state of Indiana. Further, larger studies are needed to reveal the etiology of non-adherence to pediatric DKA guidelines and strategies to improve that adherence.

Getting the Word Out: Disseminating Scholarly Work in the Technology Age

From the Department of Pediatrics, University of Southern California Keck School of Medicine, Children’s Hospital Los Angeles, Los Angeles, Calif (Dr Trost); Department of Pediatrics, Riley Hospital at IU Health, Indiana School of Medicine, Indianapolis, Ind (Dr Webber); and Department of Pediatrics, Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (Dr Wilson) Conflict of Interest: The authors declare that they have no conflict of interest. Address correspondence to Margaret J. Trost, MD, Department of Pediatrics, University of Southern California Keck School of Medicine, Children’s Hospital Los Angeles, 4650 Sunset Blvd #94, Los Angeles, CA 90027 (e-mail: mtrost@chla.usc.edu).

Population Health and Pediatric Informatics

Applications of health information technology (health IT) are now widespread in the form of electronic medical records (EMRs), greatly reshaping the practice of clinical pediatrics. Population health stands to benefit greatly from the data produced by the alignment of pediatrics with other social determinants of health: medical care, genetics, individual behavior, social and physical environment. Before this potential can be realized, population health information models must be integrated into the design and evolution of EMRs and other data sources.

Before the Flood: Impact of Coordination of Care and Direct Admissions on Emergency Department Volumes

Background Transfers of pediatric patients occur to access specialty and subspecialty care, but incur risk, and consume resources. Direct admissions to medical and surgical wards may improve patient experience and mitigate resource utilization. Objective We sought to identify common elements for direct admissions, as well as the pattern of disposition for patients referred to our emergency department (ED). Design A retrospective qualitative analysis of patients transferred to our pediatric hospital for 12 months was performed. Different physician groups were evaluated for use of direct admissions or evaluation in the ED. Patients referred to the ED were additionally tracked to evaluate their eventual disposition. Results A total of 3982 transfers occurred during the 12-month analysis period. Of those, 3463 resulted in admission, accounting for 32.55% of all admissions. Transfers accepted by nonsurgical services accounted for 82% of the transfers, whereas 18% were facilitated by one of the surgical services. Direct admissions accounted for 1707 (44.8%) of all referrals and were used more often by nonsurgical services. Of patients referred to the ED (2101 or 55.2% of all referrals), most patients were admitted and 343 (16% of those referred to the ED) were discharged home. Conclusions The direct admission process helped avoid ED assessments for some patients; however, some patients referred to the ED were able to be evaluated, treated, and discharged. Consistent triage of the patients being transferred as direct admissions may improve ED throughput and potentially improve the patients experience, reduce redundant services, and expedite care.

Social media and pediatric hospital medicine: how our discipline benefits from a virtual community and why it matters for our future.

Social media, defined as Internet-based applications that support the collaborative creation and exchange of user-generated content,1 is now part of our culture. Facebook, Twitter, LinkedIn, Doximity, blogs, and wikis are pervasive means of communication and information dissemination in our society. For physicians, this transparent way of communicating affects patient expectations, engagement, and education.2,3 Whether these methods are being used to network professionally, advocate for public health, or to provide patient outreach and education, physician use and awareness of social media influence their clinical practice and professional engagement. At the Pediatric Hospital Medicine (PHM) conference in 2012, the planning committee and conference attendees dedicated resources to social media. The primary objective for the use of Facebook was to publicize conference events and content. The primary objective for the use of Twitter was to increase conference participants’ engagement and satisfaction, as well as reach a larger audience on topics pertinent to PHM. At the PHM conference in 2013, social media faculty again supported Twitter and Facebook activity. In addition, the conference hashtag (#PHM2013) was registered with the Symplur (Upland, CA) Healthcare Hashtags Project (http://www.symplur.com/healthcare-hashtags/). Between 2012 and 2013, participants using social media on both platforms increased (Fig 1). The overall number of impressions for Tweets tagged #PHM2013 was 903 797, nearly 10 times higher than the smaller sampling of #PHM2012 the previous year. FIGURE 1 Social media activity on Facebook and Twitter for PHM conferences. Objectives in 2012, the first year of a dedicated social media presence at the PHM conference, were to enhance conference attendees’ experiences and to share the ideas at PHM with an audience beyond the actual conference attendees. Given the positive qualitative responses by those participating actively in social media platforms and the fact that …