scholarly journals 43 COVID Crisis: A Burn Approach

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S32-S32
Author(s):  
Jamie Heffernan ◽  
James Gallagher
Keyword(s):  
Patient Care ◽  
Pediatric Patients ◽  
Care Hospital ◽  
Burn Patients ◽  
Strict Adherence ◽  
Children's Hospital ◽  
Burn Care ◽  
Large Patient ◽  
Children’S Hospital ◽  
To Receive

Abstract Introduction The net effect of the COVID-19 pandemic on this northeastern, urban healthcare system during March, April and May 2020 was the redirection of virtually all resources to the care of the affected population. Conversion of the majority of the hospital’s assets, including staff and infrastructure, to COVID care created a large reduction in resources for other clinical problems. The burn service was among those few essential disciplines that continued to receive acutely affected individuals during the crisis. The preservation of the burn center’s ability to continue its mission within the walls of a COVID hospital is the subject of this review. Methods All of the hospital’s ICU rooms, including all those on the burn unit, post anesthesia care units, some step-down units, and over 90% of the operating rooms (ORs) converted to COVID care ICUs. These vital actions by hospital administration enabled an increase in ICU beds from 114 to 270. Staff were redeployed to cover the massive influx of critical COVID patients. Burn inpatients during the transition were categorized by severity and age for disposition consideration. Of the 17 inpatients, 4 pediatric patients discharged home and 1 transferred to our associated children’s hospital; 7 adults discharged home, 2 transferred to our associated inpatient psychiatric hospital, 1 to inpatient rehab, and 2 transferred to a neighboring orthopedic hospital converted into an adult acute care hospital. The commitment to keep the burn center operational for both children and adults was facilitated by protecting the burn ICU hydrotherapy room, a large patient care space in the center of the burn ICU. Children, initially admitted and cared for in the hydrotherapy room until stable, transferred to our network Children’s hospital for continued care. Critical adult burns were admitted to the inpatient ICU with the COVID patients, acute burns were housed on the few remaining medical surgical units. Burn care was performed in the patients’ rooms to keep the hydrotherapy room “clean”. Results During the 3-month period described the burn service admitted and cared for 92 adult and 25 pediatric patients while maintaining a full ICU census. Although 3 admitted burn patients were COVID +, no burn patients housed in the ICU became COVID + during their stay. Conclusions The commitment to protect the burn hydrotherapy space for burn triage and care from the top level of administration was critical and notable given the widespread conversion of the subspecialty ICUs and most other patient care areas to COVID care units. Strict adherence to infection prevention guidelines and protection of the hydrotherapy room allowed burn patients to receive timely and appropriate care during a pandemic.

590 Is There a Burn Center Community Standard on How to Best Manage Pediatric Burn Patients?

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S137-S137
Author(s):  
Emily Helmold ◽  
Niknam Eshraghi
Keyword(s):  
Pediatric Patients ◽  
Multidisciplinary Care ◽  
Standard Of Care ◽  
Teaching Hospitals ◽  
Burn Patients ◽  
Burn Centers ◽  
Children's Hospital ◽  
Burn Center ◽  
Children’S Hospital ◽  
Community Standard

Abstract Introduction A burn center is defined by the American College of Surgeons as a program that facilitates the provision of specialized multidisciplinary care in a designated setting. The Children’s Hospital Association states that pediatric patients need age specific health care delivered by specialty trained clinicians in an environment designed just for kids. When these two different specialty areas within one organization cross paths, how does the organization determine all the factors that go into determining the standard of care? One burn center found itself at the heart of this question when asked to determine the best location and how to care for pediatric burn patients. Methods An email survey was sent to burn centers verified with the American Burn Association (ABA) to care for both adult and pediatric patients and located within their region or with a similar volume. The questions included: Results Thirteen burn centers responded. Nine of the thirteen were located within the western region, two in the mid-west, one each in the south and northeast regions. Eight burn centers were categorized as academic and the other five as teaching hospitals. Bed size ranged from 8–44 with an average of 18 beds. Eighty-five percent of the respondents stated they admitted most if not all pediatric burn patients to the burn unit with two of those centers being the only location within their hospital for pediatric patients. Over seventy-five percent provided 24/7 provider coverage. There was more variability in answers regarding rate of pediatrician consultation, code blue team response, and geographic proximity to a children’s hospital however pediatric consultation was obtained in the majority of cases. Conclusions The survey responses were helpful to communicate some degree of burn center community standard although more centers and increased specificity would have strengthened the argument for a burn center remaining the preferred location for all pediatric burn admissions. Applicability of Research to Practice Sharing of our experience and recommendation that the ABA establish a burn community standard, especially one that takes how to manage competing specialties into consideration, will be helpful to all burn centers who could face this same challenge.

scholarly journals 1957. Impact of β-Lactam Antibiotic Allergy on Antimicrobial Use, Clinical Outcomes, and Costs for Hospitalized Children

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S61-S62
Author(s):  
Trahern Wallace Jones ◽  
Nora Fino ◽  
Jared Olson ◽  
Lauri Hicks ◽  
Katherine E Fleming-Dutra ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Pediatric Patients ◽  
Antimicrobial Use ◽  
Hospitalized Children ◽  
Antibiotic Selection ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Lactam Antibiotic ◽  
The Impact ◽  
To Receive

Abstract Background Most β-lactam antibiotic allergies (BLA) are incorrectly diagnosed and could be de-labeled. Adult patients with BLA are more likely to receive broader-spectrum antimicrobials and experience worse health outcomes than nonallergic patients. Similar studies on the impact of BLA on antimicrobial use and clinical outcomes are limited in pediatrics. Our objective was to compare antimicrobial use, and clinical and economic outcomes between hospitalized children with and without BLA. Methods This was a retrospective cohort of pediatric patients hospitalized at an Intermountain Healthcare (IH) hospital from 2007 to 2017. IH has 22 hospitals including one children’s hospital. Patients aged 30 days-17 years who received ≥1 dose of an antimicrobial during hospitalization were included. The exposure variable was the presence of BLA (penicillins or cephalosporins) in the allergy field of the medical record. Patients with BLA were matched to nonallergic controls on age, sex, race, clinical service line, admission date, children’s hospital or other hospital, and co-morbid conditions. We used multivariable log-transformed-linear and logistic regression models to compare patients with BLA to controls in terms of antibiotic selection and total antimicrobial days, antimicrobial cost, length-of-stay (LOS) and 30-day readmission. For antibiotic selection we examined the odds of receiving the following broader-spectrum agents individually and in composite: vancomycin, fluoroquinolones, clindamycin, carbapenems, and macrolides. Results 39,785 patients were identified including 2897 (7%) with BLA. The prevalence of BLA increased with age (Figure 1). 2459 (85%) patients with BLA were matched to a control. Patients with BLA had higher odds of receiving broader-spectrum antibiotics (OR 2.35, 95% CI: 2.07–2.67) and had greater antimicrobial costs (1.21-fold increase, 95% CI: 1.08–1.35) than nonallergic patients (Figure 2). There were no differences in LOS, total antimicrobial days, or 30-day readmission (Figure 2). Conclusion Pediatric patients with BLA are more likely to receive broader-spectrum antibiotics and incur higher antimicrobial costs than matched controls. De-labeling interventions could reduce unnecessary exposure to these agents and lower costs. Disclosures All Authors: No reported Disclosures.

An Association for Child Care in Hospitals

PEDIATRICS ◽  
1967 ◽  
Vol 40 (3) ◽  
pp. 471-472
Author(s):  
T. BERRY BRAZELTON
Keyword(s):  
Child Care ◽  
Patient Care ◽  
American Association ◽  
Medical Center ◽  
Total Patient ◽  
National Organization ◽  
Children's Hospital ◽  
The Past ◽  
Children’S Hospital ◽  
Initial Meeting

In the past 2 years a new national organization, called the American Association for Child Care in Hospitals, has evolved. This organization was initiated by the six "play ladies" who are in charge of the children's hospital programs in Baltimore, Boston, Cleveland, Montreal, Philadelphia, and Pittsburgh. Two years ago, the Children's Hospital Medical Center (CHMC) in Boston was host to 50 participants from these institutions to found the organization. This initial meeting was abetted by the CHMC's concern for total patient care and was made possible by the backing of the administration and the pediatric and psychiatric departments.

scholarly journals A Retrospective Review of Hospital-Acquired Venous Thromboembolism at a Large Pediatric Tertiary Care Center

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3471-3471
Author(s):  
Marissa A. Just ◽  
Joanna Robles ◽  
Karan R. Kumar ◽  
Andrew Yazman ◽  
Jennifer A. Rothman ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Research Funding ◽  
Pediatric Patients ◽  
Central Venous ◽  
Vte Prophylaxis ◽  
Children's Hospital ◽  
Congenital Cardiac Disease ◽  
Children’S Hospital ◽  
Icd 10 ◽  
Hospital Acquired

Introduction: The incidence of venous thromboembolism (VTE) in hospitalized pediatric patients is increasing secondary to the growing medical complexity of pediatric patients and the increasing use of central venous catheters. Pediatric patients diagnosed with VTE have up to 2% mortality associated directly with their thromboses. While incidence, risk factor identification and preventive strategies are well established in hospitalized adults, this information is limited in the pediatric population. There are currently no standardized VTE risk screening tools or thromboprophylaxis guidelines for children at Duke Children's Hospital. The incidence of hospital acquired VTE (HA-VTE), as well as their associated risk factors were investigated in a retrospective review. Methods: Medical records of pediatric patients hospitalized at Duke Children's Hospital during June 2018 through November 2018 were reviewed. The EPIC SlicerDicer tool was used to identify patients with ICD-10 diagnoses codes related to thrombosis or treated with anticoagulants. Included patients were diagnosed with HA-VTE during their hospitalization or within 14 days of discharge. Data collected included demographics, thrombosis characteristics, family history, mobility, and acute or chronic co-morbid conditions. The characteristics of the study population were described by median (with 25th and 75th percentiles) for continuous variables and frequencies (with percentages) for binary or categorical variables. Results: Out of 4,176 total pediatric admissions to all units of Duke Children's Hospital (ages 0-18.99 years) during the inclusion timeframe, 33 VTE events were identified. The incidence of VTE events per 1000 patient days was 0.98. The complete patient and VTE event characteristics are listed in Tables 1 and 2. The median age of patients with VTE events was 0.4 years. Of the identified cohort, 73% had an associated central venous line (CVL). Neonates with congenital cardiac disease comprised the majority of the cohort. Other common patient characteristics observed in this cohort included impaired mobility, recent major surgery, and recent mechanical ventilation. Of the 33 VTE diagnoses, 70% received therapeutic anticoagulation with enoxaparin or unfractionated heparin. Only 2 patients (8%) received prophylactic anticoagulation prior to their diagnosis of VTE. Conclusions: The retrospective review of HA-VTE events at Duke Children's Hospital identified that the majority of the events occurred in neonates with congenital cardiac disease and the presence of CVLs. It was also noted that there was no standardization among the use of anticoagulation agents that were initiated for treatment of VTE. Furthermore, few patients received VTE prophylaxis during the hospitalization. A limitation of this review was that it was retrospective and the documentation of family history of thrombosis was inconsistent. It is also possible that several VTE events were missed due to inadequate ICD-10 coding. Based on the results of this review, there is a need to implement a risk stratification tool and develop standardized recommendations of VTE prophylaxis and treatments for pediatric patients admitted to Duke Children's Hospital. There is an additional quality improvement phase of this project and the goal is to implement a risk calculator that is based on information learned from the retrospective review. Ultimately, this risk calculator will help to decrease the incidence of VTE events at Duke Children's Hospital. Disclosures Rothman: Agios: Honoraria, Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Novartis: Honoraria, Research Funding.

scholarly journals Improving Pediatric Adverse Drug Event Reporting through Clinical Pharmacy Services

2011 ◽  
Vol 16 (4) ◽  
pp. 285-290
Author(s):  
David M. Crowther ◽  
Marcia L. Buck ◽  
Michelle W. McCarthy ◽  
Virginia W. Barton
Keyword(s):  
Causative Agent ◽  
Adverse Drug Event ◽  
Pediatric Patients ◽  
Drug Event ◽  
University Of Virginia ◽  
Children's Hospital ◽  
Therapeutic Class ◽  
Children’S Hospital ◽  
The University

OBJECTIVES The purpose of this study was to summarize adverse drug event (ADE) reporting and to characterize the type of healthcare practitioners involved in reporting over a 10-year period at a 120-bed university-affiliated children's hospital. METHODS The University of Virginia Children's Hospital ADE database was analyzed for records involving pediatric patients. Data from patients <18 years of age who were admitted to the University of Virginia Children's Hospital between January 1, 2000, and December 31, 2009, were analyzed. Data collected included drug name and therapeutic class of the suspected causative agent, description of the event, severity, causality, outcome, and the type of healthcare practitioner reporting the event. RESULTS A total of 863 ADEs were reported over the 10-year period. The 5 most common types reported were extravasation injury (10%), rash (8%), hypotension (5%), pruritus (5%), and renal failure (3%). A total of 196 (21%) cases were categorized as mild, 436 (47%) cases as moderate, and 296 (32%) cases as severe. Further characterization of extravasations was performed to identify trends relating to potential causes. In 45 (57%) reports, parenteral nutrition was identified as the causative agent. Full recovery was documented in 21 (47%) extravasations. Of the total events reported, 83% were reported by pharmacists, 16% by nurses, and <1% by other healthcare practitioners. CONCLUSIONS Results of this study are consistent with those of previous studies involving ADE reporting in children's hospitals. This consistency is due in part to system design and use of unit-based pharmacists as the primary reporters.

DIAGNOSTIC INERTIA

PEDIATRICS ◽  
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.

scholarly journals MENISCUS REPAIR VERSUS DEBRIDEMENT FOR MENISCAL TEARS IN PEDIATRIC PATIENTS – PREDICTORS FOR TREATMENT BASED ON DEMOGRAPHICS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0016
Author(s):  
Lauren Agatstein ◽  
Alton W. Skaggs ◽  
Matthew J. Brown ◽  
Nicole Friel ◽  
Brian Haus
Keyword(s):  
Pediatric Patients ◽  
Private Insurance ◽  
Meniscal Repair ◽  
Meniscus Repair ◽  
Meniscus Tear ◽  
Children's Hospitals ◽  
Children's Hospital ◽  
Children’S Hospitals ◽  
Meniscus Tears ◽  
Children’S Hospital

BACKGROUND: Pediatric and adolescent patients with meniscus tears have a relatively high rate of healing after meniscus repair – up to greater than 80% in the literature. Despite this fact, many patients undergo meniscus debridement for treatment of their meniscus tears. In this study, we investigated the demographic factors predictive of whether a pediatric patient would receive a meniscal repair or a meniscal debridement for their meniscal tear. METHODS: The California statewide ambulatory surgery database (OSHPD) was queried for all patients under 18 years old who underwent meniscus debridement or meniscus repair from 2008-2016. The effect of age, hospital setting (adult versus pediatric hospital), injury chronicity, gender, insurance type, race, and year of service was assessed using logistic regression. RESULTS: A total of 13,906 pediatric patients had meniscal surgery during the timeframe. 83% (11,561/13,906) underwent meniscal debridement and 17% (2,345/13,906) underwent meniscal repair. Age, hospital type, nature of injury, gender, private insurance, being Hispanic, and year of service were statistically significant in predicting the odds of having meniscus repair versus meniscus debridement. Surgery at a children’s hospital increases the odds of having meniscus repair (p < 0.001). Of the 82.6% of pediatric patients (11,491/13,906) treated at non-children’s hospitals, 16% (1839) had repair and 84% underwent debridement (9,652). Of the 17.4% (2,415) treated at children’s hospitals, 21% (506) had repair and 79% (1,909) underwent debridement. As patients age, the odds of receiving a meniscus repair decrease (p < 0.001). Acute meniscus injury (p < 0.001) or private insurance (p < 0.05) increase the odds of having meniscus repair. However, females (p < 0.05) and Hispanics (p < 0.01) had decreased odds of having meniscus repair. As time between injury and surgery progressed, the odds of having meniscus repair versus meniscus debridement increased (p < 0.001). CONCLUSIONS: There is increasing evidence that pediatric patients have successful outcomes after meniscal repair surgery. The results of this study demonstrate that the majority of pediatric patients with meniscus tears undergo a meniscal debridement rather than a repair. Treatment at a children’s hospital, private insurance, and a short time frame between injury and surgery were positive predictors of meniscus repair over debridement. The results of the study may help inform patients, families, and referring physicians about what type of treatment a patient may receive for a meniscus tear, based on their demographic profile.

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