ABSTRACT Objective: As more critically ill patients are managed by pediatric hospital medicine (PHM), accurately capturing the services provided and corresponding reimbursement essential for hospitalists. We sought to increase proportion of critical care codes billed in eligible PHM from a baseline mean 21% than 50% over 6 months. Methods: A quality improvement (QI) initiative was conducted at tertiary children’s on service November 2023-April 2024. Eligibility billing determined Centers...

In-hospital arrests are uncommon in pediatrics, making it difficult to identify the risk factors for unrecognized deterioration and determine effectiveness of rapid response systems. An emergency transfer (ET) is a from an acute care floor intensive unit (ICU) where patient received intubation, inotropes, or ≥3 fluid boluses first hour after arrival before transfer. Improvement science work has reduced ETs, but ETs have not been validated against important health outcomes. This case-control...

Abstract Introduction Sepsis is a leading cause of pediatric mortality. While there has been significant effort toward improving adherence to evidence‐based care, gaps remain. Immersive multiuser virtual reality (MUVR) simulation may be an approach enhance provider clinical competency and situation awareness for sepsis. Methods A prospective, observational pilot interprofessional MUVR assessing decompensating patient from sepsis was conducted January June 2021. The study objective establish...

BACKGROUND Health care workers in the United States are facing increasing rates of exposure to aggressive behavior, resulting an increase employee injuries related specifically patient behavioral events. By leveraging interprofessional collaboration and system-level innovation, we aimed reduce rate events at a children’s hospital by 50% over 3-year period. METHODS An interdisciplinary quality improvement team comprising physicians, behavior analysts, nursing, other key stakeholders developed...

Background10 The Joint Commission identified inpatient alarm reduction as an opportunity to improve patient safety; enhance patient, family and nursing satisfaction; optimise workflow. We used quality improvement (QI) methods safely decrease non-actionable notifications bedside providers. Methods In a paediatric tertiary care centre, we convened multidisciplinary team address in our acute cardiology unit. Alarm notification was defined any alert providers for each patient-triggered monitor...

BACKGROUND AND OBJECTIVES Interventions to improve care team situation awareness (SA) are associated with reduced rates of unrecognized clinical deterioration in hospitalized children. By addressing themes from recent safety events and emerging corruptors SA our system, we aimed decrease emergency transfers (ETs) the ICU by 50% over 10 months. METHODS An interdisciplinary physicians, nurses, respiratory therapists, families convened original model for address communication inadequacies...

To use improved situation awareness to decrease cardiopulmonary resuscitation events by 25% over 18 months and demonstrate process outcome sustainability.Structured quality improvement initiative.Single-center, 35-bed quaternary-care PICU.All patients admitted the PICU from February 1, 2017, December 31, 2020.Interventions targeted included bid safety huddles, bedside mitigation signs smaller pod-based an automated clinical decision support tool identify high-risk patients.The primary...

Significant advancements in the care of children with cardiac valve disease over past 15 years have led to increasingly common use percutaneous transcatheter implantation as an alternative surgical replacement selected patient populations. Although approach has several advantages, this and valves used are not without complications. Bacterial endocarditis is a known concerning complication after pulmonary (TPVR). Most reported cases involved organisms that etiologic agents bacterial readily...

Although many quality improvement initiatives in health care see early and laudable success, 1 of the greatest challenges is sustaining gains avoiding natural tendency systems to revert their original state, function, outcomes. Reliability science describes a mathematical systematic framework for understanding level reliability interventions, therefore anticipated success failure rate both steps process cumulative overall. Successful utilization this framework, along with mindful organizing...

Critical deterioration events (CDEs) and emergency transfers (ETs) are two proximal measures to cardiopulmonary arrest, both aim evaluate how systems recognize respond clinical in children. This retrospective observational study sought (1) characterize CDEs ETs by timing, overlap, intervention category, (2) the performance of watcher identification system pediatric early warning score (PEWS) identify patients who experience these events. A total 359 88 occurred during period. Respiratory...

The authors declare no conflict of interest.

Introduction: Gastrostomy tube (G-tube)-related problems, including dislodgements, are a frequent cause for emergency department (ED) visits in pediatric patients. We aimed to reduce G-tube-related ED at our children's hospital. Methods: An interprofessional team was formed family advisor, nurse practitioners, discharge coordinators, surgeon, surgical residents, nurses, and quality improvement coaches. A number of interventions were put into place intended improve caregiver preparation...

Unrecognized clinical deterioration is a common and significant source of preventable harm to hospitalized children. Yet, unlike other sources harm, outside the ICU lacks clear, “gold standard” outcome guide prevention efforts. This gap limits multicenter learning, which crucial for identifying effective generalizable interventions prevention. In fact, date, no coordinated safety/quality initiative currently exists targeting from unrecognized in pediatric patients, startling given morbidity...

Abstract Systems to detect and respond deteriorating hospitalized children are common despite little evidence supporting best practices. Our objective was describe systems detect/respond at Pediatric Resuscitation Quality Collaborative (pediRES‐Q) institutions. We performed a cross‐sectional survey of pediRES‐Q leaders. Questionnaire design utilized expert validation cognitive interviews. Thirty centers (88%) responded. Most (93%) used ≥1 system deterioration: most commonly, early warning...

Introduction: Inpatient coronavirus disease 2019 (COVID-19) vaccination initiatives offer a novel strategy to eliminate barriers care, provide access interprofessional teams, and decrease COVID-19 morbidity mortality. Our inpatient initiative aimed triple the baseline rate of eligible hospitalized children vaccinated against from 0.95% 2.85% December 2021 June 2022. Methods: We implemented program for pediatric inpatients receive dose based on age, current guidelines, prior doses received....

Abstract Consensus guidelines currently exist for the evaluation of pediatric patients with suspected brain death. The include requirement two consistent examinations separated by an observation period and a threshold 60 mm Hg PaCO2 during apnea testing. We present patient who met all prerequisites to perform death examination but had variability in discuss our strategy managing these unexpected findings, including importance open ongoing communication family, implications current...

Improved situation awareness (SA) decreases rates of clinical deterioration in the pediatric inpatient setting. We used a prospective, cross‐sectional, observational study to measure interprofessional care team SA for intensive unit (PICU) patients. The resident, bedside nurse, and respiratory therapist each patient were surveyed regarding high risk status as defined by criteria identified PICU fellow or attending mitigation plan. From March 2018 July 2019, we 400 trios caring 73 high‐risk...

High-risk therapies (HRTs), including medications and medical devices, are an important driver of preventable harm in children's hospitals. To facilitate shared situation awareness (SA) thus targeted prevention, we aimed to increase the percentage electronic health record (EHR) alerts with correct descriptor HRT from 11% 100% on a high-acuity hospital unit over 6-month period.The interdisciplinary team defined as medication or device significant risk for that required heightened awareness....

BACKGROUND Febrile infants aged 0 to 60 days are often hospitalized for a 36‐to‐48 hour observation period rule out invasive bacterial infections (IBI). Evidence suggests that monitoring blood and cerebrospinal fluid (CSF) cultures 24 hours may be appropriate most infants. We aimed decrease the average culture time (COT) from 38 30 among old over 12 months. METHODS This quality improvement initiative occurred at large children's hospital, in conjunction with development of multidisciplinary...