COVID-19 Impact on Intern Exposure to Common Inpatient Diagnoses

OBJECTIVE We sought to understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on the clinical exposure of pediatric interns to common pediatric inpatient diagnoses. METHODS We analyzed electronic medical record data to compare intern clinical exposure during the COVID-19 pandemic from June 2020 through February 2021 with the same academic blocks from 2017 to 2020. We attributed patients to each pediatric intern on the basis of notes written during their pediatric hospital medicine rotation to compare intern exposures with common inpatient diagnoses before and during the pandemic. We compared the median number of notes written per intern per block overall, as well as for each common inpatient diagnosis. RESULTS Median counts of notes written per intern per block were significantly reduced in the COVID-19 group compared with the pre–COVID-19 group (96 [interquartile range (IQR): 81–119)] vs 129 [IQR: 110–160]; P < .001). Median intern notes per block was lower in the COVID-19 group for all months except February 2021. Although the median number of notes for many common inpatient diagnoses was significantly reduced, they were higher for mental health (4 [IQR: 2–9] vs 2 [IQR: 1–6]; P < .001) and suicidality (4.5 [IQR: 2–8] vs 0 [IQR: 0–2]; P < .001). Median shifts worked per intern per block was also reduced in the COVID-19 group (22 [IQR: 21–23] vs 23 [IQR: 22–24]; P < .001). CONCLUSIONS Our findings reveal a significant reduction in resident exposure to many common inpatient pediatric diagnoses during the COVID-19 pandemic. Residency programs and pediatric hospitalist educators should consider curricular interventions to ensure adequate clinical exposure for residents affected by the pandemic.

1131. You’re Never Too Old for a Time-Out: Implementing Antibiotic Time-Outs on Pediatric Inpatient Teams

Background Antibiotic overuse leads to antimicrobial resistance, adverse events, and excess costs. Antibiotic time-outs (ABTOs) offer a structured approach to reevaluate antimicrobial regimens, but implementing and maintaining ABTOs can be challenging. In this project, we built on previous ABTO implementation in adult inpatient units to incorporate ABTOs in pediatrics using quality improvement (QI) methods. Methods We identified champions, including attending physicians, residents, nurses, team coordinators, and pharmacists. Following pilot testing, ABTOs began in November 2019 and January 2020 for two general pediatric teams, and in June 2020 in the pediatric ICU (PICU). Patients were eligible for an ABTO if they had been on antibiotics for 36-72 hours. ABTOs were documented in the electronic medical record (EMR) with a structured note template. These notes along with patient antimicrobial regimens were extracted and analyzed using an automated EMR query. Metrics included: (1) Proportion of ABTO-eligible patients with an ABTO; (2) Proportion of ABTOs conducted within goal time frame; (3) Documented plan changes in ABTO (e.g. change IV antibiotics to PO); and (4) Proportion of documented changes completed within 24 hours Results To date, there have been 342 pediatric ABTOs over 145 team weeks on the general pediatrics teams and 50 weeks in the PICU, representing 96.9% of eligible patients. 77.8% of ABTOs were completed within the recommended time frame. A majority of ABTOs (67%) resulted in no change to antibiotic regimen, and 18% of patients had already had de-escalation. In 10.5% of patients, the ABTO led to a de-escalation (antibiotics discontinued in 2%, converted from IV to PO in 8.5%). 86.8% of planned changes occurred within 24 hours of ABTO. Figure 1. Compliance with antibiotic time-outs over time, by week. The green line represents the goal of 80%, and the orange line represents median performance. Figure 2. Planned changes to antimicrobial regimen documented in antibiotic time-out. Table 1. Antibiotic time-out performance on participating pediatric services. Conclusion This project demonstrates that ABTOs can be implemented across a variety of teams and showed successful spread of an adult-based QI project to pediatrics. ABTOs led to clear de-escalation in 10.5% of cases, with other changes made in 5% of cases. Future directions include continued spread to inpatient teams, development of EMR-based ABTO alerts, comparison of overall antibiotic use and adverse events before and after ABTO implementation, and characterization of antimicrobial optimization prior to ABTO. Disclosures All Authors: No reported disclosures

Pharmacists’ interventions on 2 years of drug monitoring in an oncology pediatric inpatient ward

Background In oncology, pharmacists contribute to safety and effectiveness of drug treatment, identifying, preventing and forwarding solutions to drug-related problems (DRPs). However, it is still necessary to elucidate the profile of drug-related problems in pediatric cancer treatment to contribute to guide clinical pharmacy activities. Methods A retrospective cross-sectional study was conducted. Records on Excel® spreadsheets of 2 years of pharmaceutical assistance were analyzed regarding the prescriptions of chemotherapy for hospitalized patients aged 0–19 years. Data on age, sex, cancer diagnosis, protocol and drugs prescribed were collected. Causes and types of DRPs and pharmacists’ interventions as their rate of acceptance were measured according to PCNE V 9.0. Results Drug-related problems were identified for 84 patients, in 5.3% of analyzed prescriptions. Leukemias, patients aged 0–4 years and male sex were associated with higher rates of drug-related problems. The BFM 2009 protocol for acute lymphocytic leukemia treatment had the highest frequency of prescriptions with drug-related problems. Main drug-related problems were related to effectiveness (49.2%) and safety (33.2%), with most of them due to drug selection and dose. Rate of acceptance of interventions was 92.2% and 90.6% of drug-related problems were fully resolved. Mercaptopurine and filgrastim were the drugs most associated with drug-related problems. Oral antineoplastic agents represented 36% of the prescriptions with drug-related problems. Conclusion The high rate of acceptance of pharmacist interventions demonstrates the relevance of the pharmacist participation in the care of hospitalized pediatric patients undergoing chemotherapy. Pharmacists need to take attention to cases of necessity of drug prescription, intervening with other health professionals. Special attention to oral chemotherapy is required.

SARS-CoV-2 in Pediatric Inpatient Care: Management, Clinical Presentation and Utilization of Healthcare Capacity

This study scrutinizes management and clinical presentation of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in pediatric inpatient care and evaluates the utilization of pediatric healthcare capacity during the pandemic. Within this retrospective cohort study, we systematically reviewed data of all 16,785 pediatric patients (<18 years admitted to our clinical center between January 2018 and June 2021). Data on SARS-CoV-2 test numbers, hospital admissions and clinical characteristics of infected patients were collected. Since January 2020, a total of 2513 SARS-CoV-2 tests were performed. In total, 36 patients had a positive test result. In total, 25 out of 36 SARS-CoV-2 positive children showed at least mild clinical symptoms while 11 were asymptomatic. Most common clinical symptoms were fever (60%), cough (60%) and rhinitis (20%). In parallel with the rising slope of SARS-CoV-2 in spring and fall 2020, we observed a slight decrease in the number of patients admitted to the pediatric department while the median duration of hospital treatment and intensive care occupancy remained unchanged. This study underlines that SARS-CoV-2 infected children most frequently exhibit an asymptomatic or mild clinical course. Noteworthy, the number of hospital admissions went down during the pandemic. The health and economic consequences need to be discussed within health care society and politics.