Mona L. McPherson

Pediatric tracheostomies: a recent experience from one academic center.

Objectives: To describe the indications, surgical timing, length of stay, hospital charges, and discharge disposition of pediatric tracheostomy patients. Design: Retrospective case series. Setting: Large urban academic pediatric hospital. Patients: Seventy children and adolescents undergoing tracheostomy placement over a 24-month period. Interventions: None. Measurements and Main results: Hospital database records were used to determine demographics and readmission rates, tabulate charges, and confirm deaths. Indications for tracheostomies included airway obstruction, inadequate airway protection, chronic lung disease, neuromuscular weakness, and central hypoventilation. Surgical timing of the tracheostomy was grouped into three categories: prolonged mechanical ventilation, elective, or emergent. The overall median hospital stay was 46 days (range 14–254) with a median hospital charge of

Development of a survey to measure parent satisfaction in a pediatric intensive care unit.

136,718 (range

Children With New Tracheostomies : Planning for Family Education and Common Impediments to Discharge

36,237–

Institutional policies on determination of medically inappropriate interventions: use in five pediatric patients.

913,934). The prolonged mechanical ventilation group underwent a tracheostomy after a median of 26 days (mean 37.5 days) on the ventilator. Eighty-one percent of children were discharged home; 63% of children were readmitted within 6 months, with 11% requiring four or more admissions. The six-month mortality rate was 13%; no deaths were related to the tracheostomy. Conclusions: Children with tracheostomies are a heterogeneous population. Children who require tracheostomy for long-term mechanical ventilation have longer hospital stays than children who receive a tracheotomy on an elective or emergent basis. Hospital readmissions should be anticipated in this complex group of patients.

Speed isn't everything in pediatric medical transport.

ObjectiveTo use classic survey methodology to develop a specific survey tool that can assess parent satisfaction with medical care in a pediatric intensive care setting. DesignApplication of survey design methodology to develop and analyze a parent satisfaction survey. SettingA pediatric intensive care unit (PICU) in a large teaching hospital. SubjectsSixty-six parents of children admitted to a PICU. ResultsA four-stage process of item selection, item reduction, pretesting, and test analysis was used to create a 23-item parent satisfaction survey that was statistically analyzed and developed specifically for the PICU setting. The survey tool was developed with the input of parents of children admitted to a PICU, and it was administered to parents in the PICU. The resultant survey was analyzed for validity and reliability. Both test-retest and internal consistency reliability were evaluated. This design yielded a survey with acceptable reliability, as demonstrated by a reliability coefficient of 0.8275. Test-retest reliability also showed good correlation of answers. Validity was partially established by including parents in the identification of survey topics. ConclusionsClassic survey design methodology was applied to develop a specific satisfaction survey in a pediatric inpatient setting. This stepwise method yielded a parent survey specific to one type of inpatient unit, and the resultant survey tool reliably measured levels of parent satisfaction with medical care in that area. This study demonstrates the feasibility of applying classic survey methodology to develop a statistically analyzed parent satisfaction survey for an inpatient setting.

A decade of pediatric tracheostomies: Indications, outcomes, and long-term prognosis

To describe an educational program and timeline for the discharge of children with a new tracheostomy and identify common impediments to the education and discharge process.

Implementation of a Standard Verbal Sign-Out Template Improves Sign-Out Process in a Pediatric Intensive Care Unit.

Objective: To describe recent experience using the Texas Advance Directives Act to facilitate care of terminally ill children managed in the two tertiary pediatric hospitals of the Texas Medical Center, Houston, TX. Design: Retrospective chart review. Setting: Two multidisciplinary pediatric intensive care units in Houston, TX. Patients: Five terminally ill children whose parents were unable to acquiesce to comfort or palliative care. Interventions: Implementation of the Texas Advanced Directives Act of 1999. Results: Suspension of interventions thought to be medically inappropriate by the physicians of record in four of the five cases, with transfer of care in one instance. Conclusions: Use of institutional policies in accordance with the Texas Advance Directives Act may assist in the care of terminally ill children and their families.

Noncompliance With Medical Follow-up After Pediatric Intensive Care

Aesop’s familiar children’s fable about the turtle and hare tells the story of an improbable race between these 2 animals. The highly favored, speedy, overconfident hare rushes ahead but then becomes distracted and pauses before finishing the race. The turtle plods along, slow and steady, passes the hare, and wins the race, proving that faster is not always better. In this issue of Pediatrics, Orr et al1 offer convincing evidence to dispute the premise that speed is what matters on transport. Their study offers support for what many pediatric practitioners have always suspected: taking pediatric intensive care to the child is better than rushing the child to the PICU. Their findings build on an earlier study that demonstrated improved survival in septic shock when appropriate therapy was initiated before PICU arrival.2 A more important determinant of survival is probably the initiation of appropriate care, not a specific location.

Sutured Securement of Peripherally Inserted Central Catheters Yields Fewer Complications in Pediatric Patients

To define the mortality and long‐term outcomes of children undergoing tracheostomy.

A validated pediatric transport survey: How is your team performing?

Abstract: Sign-out of patient data at change of shifts is vulnerable to errors that impact patient safety. Although sign-outs are complex in intensive care units (ICU), a paucity of studies exists evaluating optimal ICU sign-out. Our prospective interventional study investigated the use of a standard verbal template in a Pediatric ICU to improve the sign-out process. We designed and validated a survey tool to measure 10 items of optimal sign-out. The survey and analysis of sign-out information exchanged was performed pre- and postintervention. Forty-eight clinicians participated, with a survey response rate of 88% and 81% in the pre- and postintervention phases, respectively. Seventy-nine percent clinicians identified the need for sign-out improvement. Clinician satisfaction with sign-out increased postintervention (preintervention survey scores: 3.26 (CI: 3.09–3.43), postintervention 3.9 (CI: 3.76–4.04) [p < .01]). Three scorers analyzed the verbal and written sign-out content with good inter-rater reliability. After the intervention, sign-out content revealed increased patient identification, background description, account of system-based clinical details [p = .001] and notation of clinical details, code status, and goals [p < .002]. Interruptions decreased [p = .04] without any change in sign-out duration [p = .86]. The standard verbal template improved clinician satisfaction with sign-out, augmented the amount of information transferred and decreased interruptions without increasing the duration of sign-out.