The Impact of Early Critical Care delivered by a Specialized Pediatric Transport Team at a Satellite Children’s Hospital

2021 ◽  
Author(s):  
Stephen N. Epps ◽  
Kirsten Johnston ◽  
Michele Moss ◽  
Michael H. Stroud
Keyword(s):  
Critical Care ◽  
Children's Hospital ◽  
Transport Team ◽  
Children’S Hospital ◽  
The Impact

St. Louis Children's Hospital Critical Care Transport Team

2011 ◽  
Vol 30 (5) ◽  
pp. 246-248 ◽  
Author(s):  
Jeff Atwood ◽  
Lance Peeples ◽  
Kathy Donovan
Keyword(s):  
Critical Care ◽  
Children's Hospital ◽  
Transport Team ◽  
Children’S Hospital

Effects of Medical Transport on Outcomes in Children Requiring Intensive Care

2018 ◽  
Vol 35 (9) ◽  
pp. 889-895 ◽  
Author(s):  
Atsushi Kawaguchi ◽  
L. Duncan Saunders ◽  
Yutaka Yasui ◽  
Allan DeCaen
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Intensive Care ◽  
Geographic Area ◽  
Matched Pair ◽  
Initial Contact ◽  
Pediatric Critical Care ◽  
Children's Hospital ◽  
Transport Team ◽  
Children’S Hospital

Background and Objectives: The need to centralize patients for specialty care in the setting of regionalization may delay access to specialist services and compromise outcomes, particularly in a large geographic area. The aim of this study was to explore the effects of interhospital transferring of children requiring intensive care in a Canadian regionalization model. Methods: A retrospective cohort design with a matched pair analysis was adopted to compare the outcomes in children younger than 17 years admitted to a pediatric intensive care unit (PICU) of a Canadian children’s hospital by a specialized transport team (pediatric critical care transported [PCCT] group) and those children admitted directly to PICU from its pediatric emergency department (PED group). The outcomes of interest included mortality 72 hours from initial contact with the critical care team (ie, either PICU transport team or intrahospital PICU team). Results: In total, 680 (27%) transports met our inclusion criteria, whereas 866 (7%) cases of 11 570 total PICU admissions were admitted directly from the emergency department. A total of 493 pairs were formed for the matched analyses. Odds of mortality within 72 hours in the PCCT group were significantly higher than in the PED group (odds ratio [OR]: 2.18, 95% confidence interval [CI]: 1.07-4.45; P = .032). When excluding cases who had at least one episode of cardiac arrest before involvement of the pediatric critical care (PCC) transport team, the OR dropped to 1.66 (95% CI: 0.77-3.46). Conclusions: Children transported from nonpediatric hospitals had a higher 72-hour mortality when compared to those children admitted directly to a children’s hospital PICU from its own PED in a Canadian regionalized health-care model.

scholarly journals Pediatric Surgical Reentry Strategy Following the COVID-19 Pandemic: A Tiered and Balanced Approach

2021 ◽  
pp. 000313482110111
Author(s):  
Ryan C. Pickens ◽  
Angela M. Kao ◽  
Mark A. Williams ◽  
Andrew C. Herman ◽  
Jeffrey S. Kneisl
Keyword(s):  
Pediatric Surgery ◽  
Elective Surgery ◽  
Surgical Care ◽  
Children's Hospital ◽  
Protocol Development ◽  
Balanced Approach ◽  
Projective Curves ◽  
Children’S Hospital ◽  
The Impact ◽  
Emergent Surgery

Background In response to the COVID-19 pandemic, children’s hospitals across the country postponed elective surgery beginning in March 2020. As projective curves flattened, administrators and surgeons sought to develop strategies to safely resume non-emergent surgery. This article reviews challenges and solutions specific to a children’s hospital related to the resumption of elective pediatric surgeries. We present our tiered reentry approach for pediatric surgery as well as report early data for surgical volume and tracking COVID-19 cases during reentry. Methods The experience of shutdown, protocol development, and early reentry of elective pediatric surgery are reported from Levine’s Children’s Hospital (LCH), a free-leaning children’s hospital in Charlotte, North Carolina. Data reported were obtained from de-identified hospital databases. Results Pediatric surgery experienced a dramatic decrease in case volumes at LCH during the shutdown, variable by specialty. A tiered and balanced reentry strategy was implemented with steady resumption of elective surgery following strict pre-procedural screening and testing. Early outcomes showed a steady thorough fluctuating increase in elective case volumes without evidence of a surgery-associated positive spread through periprocedural tracking. Conclusion Reentry of non-emergent pediatric surgical care requires unique considerations including the impact of COVID-19 on children, each children hospital structure and resources, and preventing undue delay in intervention for age- and disease-specific pediatric conditions. A carefully balanced strategy has been critical for safe reentry following the anticipated surge. Ongoing tracking of resource utilization, operative volumes, and testing results will remain vital as community spread continues to fluctuate across the country.

Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Justin B. Searns ◽  
Manon C. Williams ◽  
Christine E. MacBrayne ◽  
Ann L. Wirtz ◽  
Jan E. Leonard ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Interrater Reliability ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Primary Treatment ◽  
Treatment Team ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The Impact ◽  
Made In

AbstractObjectivesFew studies describe the impact of antimicrobial stewardship programs (ASPs) on recognizing and preventing diagnostic errors. Handshake stewardship (HS-ASP) is a novel ASP model that prospectively reviews hospital-wide antimicrobial usage with recommendations made in person to treatment teams. The purpose of this study was to determine if HS-ASP could identify and intervene on potential diagnostic errors for children hospitalized at a quaternary care children’s hospital.MethodsPreviously self-identified “Great Catch” (GC) interventions by the Children’s Hospital Colorado HS-ASP team from 10/2014 through 5/2018 were retrospectively reviewed. Each GC was categorized based on the types of recommendations from HS-ASP, including if any diagnostic recommendations were made to the treatment team. Each GC was independently scored using the “Safer Dx Instrument” to determine presence of diagnostic error based on a previously determined cut-off score of ≤1.50. Interrater reliability for the instrument was measured using a randomized subset of one third of GCs.ResultsDuring the study period, there were 162 GC interventions. Of these, 65 (40%) included diagnostic recommendations by HS-ASP and 19 (12%) had a Safer Dx Score of ≤1.50, (Κ=0.44; moderate agreement). Of those GCs associated with diagnostic errors, the HS-ASP team made a diagnostic recommendation to the primary treatment team 95% of the time.ConclusionsHandshake stewardship has the potential to identify and intervene on diagnostic errors for hospitalized children.

The impact of a complex care clinic in a children's hospital

2010 ◽  
Vol 36 (4) ◽  
pp. 574-582 ◽  
Author(s):  
E. Cohen ◽  
J. N. Friedman ◽  
S. Mahant ◽  
S. Adams ◽  
V. Jovcevska ◽  
...  
Keyword(s):  
Complex Care ◽  
Care Clinic ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The Impact

The impact of extended radiology attending coverage in a children's hospital

1998 ◽  
Vol 28 (3) ◽  
pp. 167-170 ◽  
Author(s):  
R. I. Markowitz ◽  
James S. Meyer ◽  
Julie A. Hegman ◽  
Kenneth E. Fellows
Keyword(s):  
Children's Hospital ◽  
Children’S Hospital ◽  
The Impact

AUDIT OF OXYGEN PRESCRIBING IN A CHILDREN'S HOSPITAL

2016 ◽  
Vol 101 (9) ◽  
pp. e2.30-e2 ◽  
Author(s):  
Lucy Wheeler ◽  
Janet James ◽  
Sarah Byrne ◽  
Julian Forton
Keyword(s):  
Critical Care ◽  
British Thoracic Society ◽  
Medical Patients ◽  
Children's Hospital ◽  
National Guidance ◽  
National Patient ◽  
Children’S Hospital ◽  
Medical Wards ◽  
Future Work ◽  
Medication Chart

AimTo audit oxygen prescribing in a children's hospital following the introduction of a new paediatric medication chart, which incorporates an oxygen prescription section.MethodIn June 2015 a 1-day snapshot audit was carried out across all wards in the children's hospital. All patients receiving oxygen on that day were included:▸ The audit was repeated in July 2015.▸ The standards for the audit were set at 100% in accordance with our local guidelines.1 ▸ All patients receiving oxygen should have a prescription. Of these:▸ All patients should have target saturations identified.▸ All patients should have an administration device identified.▸ All patients should have a nurse signature on the chart within the last 12 hrs.ResultsIn June, 13 patients were receiving oxygen on the audit day. 0/14 had a prescription.In July, 18 patients were receiving oxygen on the audit day. (14 critical care, 4 medicine).4/18 had an oxygen prescription (22%). These were all medical patients. Of these, 4 patients had a target saturation identified (100%), 1 had a device prescribed (25%), and 4 had a nurse signature within the last 12 hrs (100%).ConclusionThe initial audit showed no compliance with either local or national guidance for oxygen prescribing.1 2 The re-audit showed improved prescribing on the medical wards but not within critical care. The new paediatric medication chart was launched early in 2015, along with a training package for doctors, nurses and pharmacists. This was in response to the National Patient Safety Agency (NPSA) rapid response report on oxygen safety in hospitals.3 There was a gap between the training and the new charts being available which may have led to the poor results in the first audit. Increased awareness of the charts and the initial audit results probably helped improve prescribing in the re-audit. For medical patients, prescribing and monitoring was good, although device was infrequently prescribed. Critical care have not engaged with the new chart and oxygen prescription process. Although the British Thoracic Society guidelines indicate that oxygen for adult patients must be prescribed, these do not currently cover critical care or children under 16 years.2 There are guidelines for children in development which are likely to advocate the same. This could be another reason why there is no prescribing in critical care.Patient numbers were small in this snapshot audit which could limit its validity. Future work will include re-audit in our hospital and audit across the whole region where the new charts have been introduced.

scholarly journals Decline in Cases of Rotavirus Gastroenteritis Presenting to The Children's Hospital of Philadelphia after Introduction of a Pentavalent Rotavirus Vaccine

2009 ◽  
Vol 16 (3) ◽  
pp. 382-386 ◽  
Author(s):  
H Fred Clark ◽  
Diane Lawley ◽  
Laura A. Mallette ◽  
Mark J. DiNubile ◽  
Richard L. Hodinka
Keyword(s):  
The United States ◽  
Annual Number ◽  
Enzyme Linked Immunosorbent Assay ◽  
Rotavirus Vaccine ◽  
Epidemic Season ◽  
Vaccination Rates ◽  
Children's Hospital ◽  
Rotavirus Gastroenteritis ◽  
Children’S Hospital ◽  
The Impact

ABSTRACT A pentavalent rotavirus vaccine for infants became available in the United States in February 2006. By 2007, vaccination rates nationwide were estimated to be ∼50%. We studied the effectiveness of the vaccine in a real-world setting outside of a clinical trial. All children presenting to The Children's Hospital of Philadelphia with acute gastroenteritis have been monitored for the presence of rotavirus antigen in the stool by enzyme-linked immunosorbent assay (ELISA [followed by genotyping if ELISA positive]) since the 1994-1995 epidemic season, presenting a unique opportunity to assess the impact of the recently introduced vaccine. The annual number of community-acquired cases over the preceding 13 years had approached or exceeded 100, with 271 cases in 2005 to 2006 and 167 cases in 2006 to 2007. In the 2007-2008 season, only 36 community-acquired cases were identified, representing an 87% reduction from the same period in 2005 to 2006. G3 was the predominant serotype, accounting for 15 community cases (42%). Our study is limited by its observational design using historical comparisons. Nonetheless, the abrupt decline in rotavirus gastroenteritis cases during the 2007-2008 season likely resulted from vaccination. Because protection rates appeared to have exceeded vaccination rates, herd immunity may have contributed to some degree to the effectiveness of the vaccine.

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