Assessing Immediate Bed Availability and Barriers to Discharge in a United States Children’s Hospital

ABSTRACT Objectives: The aim of this study was to quantify immediate bed availability (IBA) in a United States children’s hospital and treatment needs of hospitalized patients whose needs could be met outside a traditional hospital setting. Methods: Using a novel tool to capture census, scheduled discharges, and resource needs for hospitalized patients, we surveyed our hospital’s 5 non-neonatal inpatient pediatric units on 4 d over 1 y. Results: Median ward occupancy was 81% (range, 58-79), median intensive care unit occupancy was 80% (range, 7-19), and median IBA was 42% (range, 34-59). A median of 14 patients per day (13% of total capacity) had treatment needs that could be met by providing limited support in a nontraditional setting; the most common reason for requiring ongoing hospitalization in this group of patients was a safe discharge plan. Conclusions: Our median IBA of 42% exceeds federal recommendations, but varies widely between days surveyed. Even on days when IBA percentage is high, our total number of available beds is unlikely to meet pediatric population needs in a large-scale public health emergency.

Download Full-text

Passy-Muir Speaking Valve Use in a Children's Hospital: An Interdisciplinary Approach

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd18.2.76 ◽

2008 ◽

Vol 18 (2) ◽

pp. 76-86 ◽

Cited By ~ 2

Author(s):

Lauren Hofmann ◽

Joseph Bolton ◽

Susan Ferry

Keyword(s):

Tracheostomy Tube ◽

Pediatric Population ◽

Interdisciplinary Approach ◽

Extended Period ◽

Speech Development ◽

Tube Placement ◽

Background Information ◽

Speaking Valve ◽

Children's Hospital ◽

Children’S Hospital

Abstract At The Children's Hospital of Philadelphia (CHOP) we treat many children requiring tracheostomy tube placement. With potential for a tracheostomy tube to be in place for an extended period of time, these children may be at risk for long-term disruption to normal speech development. As such, speaking valves that restore more normal phonation are often key tools in the effort to restore speech and promote more typical language development in this population. However, successful use of speaking valves is frequently more challenging with infant and pediatric patients than with adult patients. The purpose of this article is to review background information related to speaking valves, the indications for one-way valve use, criteria for candidacy, and the benefits of using speaking valves in the pediatric population. This review will emphasize the importance of interdisciplinary collaboration from the perspectives of speech-language pathology and respiratory therapy. Along with the background information, we will present current practices and a case study to illustrate a safe and systematic approach to speaking valve implementation based upon our experiences.

Download Full-text

1367. Reduced Ceftaroline Susceptibility Among Invasive MRSA Isolates at a Tertiary Children’s HospitalReduced Ceftaroline Susceptibility Among Invasive MRSA Isolates at a Tertiary Children’s Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1549 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S693-S694

Author(s):

Lauren Sommer ◽

Jesus G Vallejo ◽

Kristina G Hulten ◽

Sheldon L Kaplan ◽

Jonathon C McNeil

Keyword(s):

Pediatric Population ◽

Staphylococcal Infection ◽

Healthcare Associated Infections ◽

Accessory Gene ◽

Children's Hospital ◽

Children’S Hospital ◽

Mrsa Infection ◽

Group Ii ◽

Healthcare Associated ◽

Research Grant

Abstract Background The emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) in the late 1990s-early 2000s complicated the empiric management of suspected staphylococcal infection in children. Rising clindamycin resistance rates in many communities adds further to management challenges. Ceftaroline, an anti-MRSA cephalosporin, represents an attractive therapy option. Little data are available, however, regarding the frequency of reduced susceptibility (RS) to ceftaroline among MRSA isolates from a general pediatric population. Methods Isolates were selected from an ongoing S. aureus surveillance study at Texas Children’s Hospital. Invasive MRSA isolates from 2015-2018 were included. Isolates were initially screened for ceftaroline RS with E-test; all isolates with a ceftaroline E-test MIC ≥ 1.5µg/ml underwent ceftaroline broth dilution. Ceftaroline RS was regarded as an MIC ≥ 2 µg/ml; full ceftaroline resistance was defined as an MIC ≥ 8 μg/ml. Accessory gene regulator (agr) groups were characterized by PCR. Results 201 viable isolates were included. The ceftaroline MIC50 and MIC90 were 0.5 and 1 µg/ml, respectively (Figure 1). Six isolates had MIC ≥ 2 µg/ml (2.9%) with two having MIC ≥ 8 µg/ml (0.9%). All ceftaroline RS isolates were from healthcare associated infections. Ceftaroline RS isolates were more often associated with clindamycin-resistance and agr group II (Figure 2). Infections with ceftaroline RS were associated with central venous lines, recent ICU admission, preceding antibiotic exposure (specifically cephalosporins) and prior MRSA infection. One subject with MRSA CLABSI had a ceftaroline susceptible MRSA infection followed < 1 month later by a ceftaroline resistant infection (MIC =32 μg/ml); the isolates were identical by PFGE. Only 3 subjects had previously received ceftaroline, none of which subsequently developed a ceftaroline RS isolate. Figure 1. Ceftaroline MIC Distribution Figure 2. Clinical And Microbiologic Associations with Reduced Ceftaroline Susceptibility Conclusion Ceftaroline RS occurs in 2.9% of invasive MRSA isolates in children and is most prominent among healthcare-associated infections. These isolates were associated with clindamycin resistance and agr group II. While ceftaroline RS is rare among invasive MRSA infections, the lack of preceding ceftaroline exposure is concerning and warrants careful surveillance. Disclosures Sheldon L. Kaplan, MD, Allergan (Research Grant or Support)Pfizer (Grant/Research Support) Jonathon C. McNeil, MD, Allergan (Research Grant or Support, Allergan provided ceftaroline powder for use in studies described in this abstract)

Download Full-text

The effects of traffic light labelling versus cartoon labelling on food and beverage purchases in a children's hospital setting

Pediatric Obesity ◽

10.1111/ijpo.12232 ◽

2017 ◽

Vol 13 (4) ◽

pp. 265-268 ◽

Cited By ~ 4

Author(s):

O. R. Whitt ◽

S.B. Jilcott Pitts ◽

A. P. Rafferty ◽

C. R. Payne ◽

S. W. Ng

Keyword(s):

Hospital Setting ◽

Traffic Light ◽

Children's Hospital ◽

Food And Beverage ◽

Children’S Hospital

Download Full-text

DIAGNOSTIC INERTIA

PEDIATRICS ◽

10.1542/peds.28.5.695 ◽

1961 ◽

Vol 28 (5) ◽

pp. 695-696

Author(s):

R. J. MCKAY

Keyword(s):

United States ◽

Patient Care ◽

The United States ◽

Interim Report ◽

Children's Hospital ◽

Medical Centers ◽

Pediatric Education ◽

Children’S Hospital ◽

Pediatric Services

In this issue of Pediatrics the article entitled "A New Design for Patient Care and Pediatric Education in a Children's Hospital: An Interim Report," by Green and Segar, represents a challenging approach to problems that are of increasing concern to pediatric educators and pediatric services of medical centers throughout the United States. It should be emphasized that the authors' plan is a proposed solution to the problems involved, and that the question as to whether it will constitute an answer will have to await analysis not only of their results but of the results of other approaches to the same problems.

Download Full-text

Primary and Metastatic Lung Tumors in the Pediatric Population: A Review and 25-Year Experience at a Large Children's Hospital

Archives of Pathology & Laboratory Medicine ◽

10.5858/2008-132-1079-pamlti ◽

2008 ◽

Vol 132 (7) ◽

pp. 1079-1103 ◽

Cited By ~ 36

Author(s):

Megan K. Dishop ◽

Supriya Kuruvilla

Keyword(s):

Medical Literature ◽

Pediatric Population ◽

Case Series ◽

Lung Tumors ◽

Malignant Neoplasms ◽

Primary Tumors ◽

Children's Hospital ◽

Pathologic Features ◽

Metastatic Lung ◽

Children’S Hospital

Abstract Context.—Primary lung neoplasms are rare in children, but they comprise a broad and interesting spectrum of lesions, some of which are familiar from other tissue sites, and some of which are unique to the pediatric lung. Objective.—To determine the relative incidence of primary and metastatic lung tumors in children and adolescents through a single-institution case series, to compare these data to reports in the medical literature, to discuss the clinical and pathologic features of primary tumors of the tracheobronchial tree and lung parenchyma in children, and to provide recommendations for handling pediatric lung cysts and tumors. Data Sources.—A 25-year single institutional experience with pediatric lung tumors, based on surgical biopsies and resections at Texas Children's Hospital from June 1982 to May 2007, an additional 40 lung tumors referred in consultation, and a review of the medical literature. Conclusions.—A total of 204 pediatric lung tumors were diagnosed at our institution, including 20 primary benign lesions (9.8%), 14 primary malignant lesions (6.9%), and 170 secondary lung lesions (83.3%). The ratio of primary benign to primary malignant to secondary malignant neoplasms is 1.4:1:11.6. The common types of lung cancer in adults are exceptional occurrences in the pediatric population. The most common primary lung malignancies in children are pleuropulmonary blastoma and carcinoid tumor. Other primary pediatric lung tumors include congenital peribronchial myofibroblastic tumor and other myofibroblastic lesions, sarcomas, carcinoma, and mesothelioma. Children with primary or acquired immunodeficiency are at risk for Epstein-Barr virus–related smooth muscle tumors, lymphoma, and lymphoproliferative disorders. Metastatic lung tumors are relatively common in children and also comprise a spectrum of neoplasia distinct from the adult population.

Download Full-text

Comparison of minor head trauma management in the emergency departments of a United States and Italian Children’s hospital

Italian Journal of Pediatrics ◽

10.1186/s13052-019-0615-0 ◽

2019 ◽

Vol 45 (1) ◽

Author(s):

Brittany M. Stopa ◽

Stefano Amoroso ◽

Luca Ronfani ◽

Elena Neri ◽

Egidio Barbi ◽

...

Keyword(s):

United States ◽

Head Trauma ◽

Emergency Departments ◽

Trauma Management ◽

Minor Head Trauma ◽

Children's Hospital ◽

Children’S Hospital

Download Full-text

The Squibb Travelling Fellowship

Bulletin of the Royal College of Psychiatrists ◽

10.1192/pb.12.10.449 ◽

1988 ◽

Vol 12 (10) ◽

pp. 449-451

Author(s):

Carol Fitzpatrick

Keyword(s):

United States ◽

Trinity College ◽

Medical Center ◽

Emotional Adjustment ◽

The United States ◽

Children's Hospital ◽

Trinity College Dublin ◽

Future Paper ◽

Children’S Hospital ◽

The Subject

In 1986 I was awarded the Squibb Travelling Fellowship by the Royal College of Psychiatrists. The funding this provided, combined with funding provided by the Henry Hutchinson Stewart Scholarship in Psychiatry awarded by Trinity College, Dublin, enabled me to spend a three month period in the summer of 1987 at the Children's Hospital Medical Center, Boston, doing research in the area of emotional adjustment in adolescents with chronic physical illnesses. The research will be the subject of a future paper. The purpose of this communication is to outline some of the steps en route between winning the Fellowship and starting on the project at Children's Hospital. The amount of paperwork involved was time consuming, confusing and, at times, overwhelming, and I hope that other doctors planning to travel to the United States to carry out research will benefit from my expeience.

Download Full-text

Readiness for an Increase in Congenital Zika Virus Infections in the United States: Geographic Distance to Pediatric Subspecialist Care

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2018.77 ◽

2018 ◽

Vol 13 (03) ◽

pp. 476-486 ◽

Cited By ~ 1

Author(s):

Jeanne Bertolli ◽

Joseph Holbrook ◽

Nina D. Dutton ◽

Bryant Jones ◽

Nicole F. Dowling ◽

...

Keyword(s):

United States ◽

Zika Virus ◽

Full Range ◽

Geographic Distance ◽

Virus Transmission ◽

The United States ◽

Travel Distance ◽

Mosquito Vector ◽

Children's Hospital ◽

Children’S Hospital

ABSTRACTObjectiveThe study’s purpose was to investigate readiness for an increase in the congenital Zika infection (CZI) by describing the distribution of pediatric subspecialists needed for the care of children with CZI.MethodsWe applied county-level subspecialist counts to US maps, overlaying the geocoded locations of children’s hospitals to assess the correlation of hospital and subspecialist locations. We calculated travel distance from census tract centroids to the nearest in-state children’s hospital by state (with/without > 100 reported adult Zika virus cases) and by regions corresponding to the likely local Zika virus transmission area and to the full range of the mosquito vector. Travel distance percentiles reflect the population of children < 5 years old.ResultsOverall, 95% of pediatric subspecialists across the United States are located in the same county or neighboring county as a children’s hospital. In the states where Zika virus transmission is likely, 25% of children must travel more than 50 miles for subspecialty care; in one state, 50% of children must travel > 100 miles.ConclusionThe travel distance to pediatric subspecialty care varies widely by state and is likely to be an access barrier in some areas, particularly states bordering the Gulf of Mexico, which may have increasing numbers of CZI cases. (Disaster Med Public Health Preparedness. 2019;13:476-486)

Download Full-text