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Giordano M, Casavant D, Flores Cano JC, Rempel G, Dorste A, Graham RJ, Quates SK, Belthur MV, Bastianelli LC, Sewell TB, Zamkoff J, Mauskar S, Mariani J, Trost MJ, Simpson B, Stringfellow I, Berry JG. Perioperative Health Interventions in Children With Chronic Neuromuscular Conditions Undergoing Major Musculoskeletal Surgery: A Scoping Review. Hosp Pediatr 2024; 14:e281-e291. [PMID: 38726564 DOI: 10.1542/hpeds.2021-006187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Children with chronic neuromuscular conditions (CCNMC) have many coexisting conditions and often require musculoskeletal surgery for progressive neuromuscular scoliosis or hip dysplasia. Adequate perioperative optimization may decrease adverse perioperative outcomes. The purpose of this scoping review was to allow us to assess associations of perioperative health interventions (POHI) with perioperative outcomes in CCNMC. METHODS Eligible articles included those published from January 1, 2000 through March 1, 2022 in which the authors evaluated the impact of POHI on perioperative outcomes in CCNMC undergoing major musculoskeletal surgery. Multiple databases, including PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, Web of Science, the Cochrane Library, Google Scholar, and ClinicalTrials.gov, were searched by using controlled vocabulary terms and relevant natural language keywords. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines were used to perform the review. A risk of bias assessment for included studies was performed by using the Risk of Bias in Non-randomized Studies of Interventions tool. RESULTS A total of 7013 unique articles were initially identified, of which 6286 (89.6%) were excluded after abstract review. The remaining 727 articles' full texts were then reviewed for eligibility, resulting in the exclusion of 709 (97.5%) articles. Ultimately, 18 articles were retained for final analysis. The authors of these studies reported various impacts of POHI on perioperative outcomes, including postoperative complications, hospital length of stay, and hospitalization costs. Because of the heterogeneity of interventions and outcome measures, meta-analyses with pooled data were not feasible. CONCLUSIONS The findings reveal various impacts of POHI in CCNMC undergoing major musculoskeletal surgery. Multicenter prospective studies are needed to better address the overall impact of specific interventions on perioperative outcomes in CCNMC.
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Affiliation(s)
- Mirna Giordano
- Department of Pediatrics, Division of Critical Care and Hospital Medicine, Columbia University, New York, New York
| | | | - Juan Carlos Flores Cano
- Division of Pediatrics, Pontificia Universidad Catolica de Chile, Hospital Dr. Sotero del Rio, Santiago, Chile
| | - Gina Rempel
- Nutrition Support and Complex Care, Department of Pediatrics and Children Health, University of Manitoba, Winnipeg, Canada
| | - Anna Dorste
- Boston Children's Hospital Medical Library, Boston, Massachusetts
| | | | - Sara K Quates
- Medical College of Wisconsin, Children's Wisconsin Hospital, Milwaukee, Wisconsin
| | - Mohan V Belthur
- Division of Pediatrics, University of Arizona College of Medicine Phoenix, Phoenix, Arizona
| | - Lucia C Bastianelli
- Cerebral Palsy and Spasticity Center, Boston Children's Hospital, Boston, Massachusetts
| | - Taylor B Sewell
- Department of Pediatrics, Division of Critical Care and Hospital Medicine, Columbia University, New York, New York
| | - Jason Zamkoff
- Department of Pediatrics, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Juliana Mariani
- Medical Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Margaret J Trost
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Blair Simpson
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Isabel Stringfellow
- General Pediatrics
- Cerebral Palsy and Spasticity Center, Boston Children's Hospital, Boston, Massachusetts
| | - Jay G Berry
- General Pediatrics
- Cerebral Palsy and Spasticity Center, Boston Children's Hospital, Boston, Massachusetts
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Choong K, Fraser DD, Al-Farsi A, Awlad Thani S, Cameron S, Clark H, Cuello C, Debigaré S, Ewusie J, Kennedy K, Kho ME, Krasevich K, Martin CM, Thabane L, Nanji J, Watts C, Simpson A, Todt A, Wong J, Xie F, Vu M, Cupido C. Early Rehabilitation in Critically ill Children: A Two Center Implementation Study. Pediatr Crit Care Med 2024; 25:92-105. [PMID: 38240534 DOI: 10.1097/pcc.0000000000003343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVES To implement an early rehabilitation bundle in two Canadian PICUs. DESIGN AND SETTING Implementation study in the PICUs at McMaster Children's Hospital (site 1) and London Health Sciences (site 2). PATIENTS All children under 18 years old admitted to the PICU were eligible for the intervention. INTERVENTIONS A bundle consisting of: 1) analgesia-first sedation; 2) delirium monitoring and prevention; and 3) early mobilization. MEASUREMENTS AND MAIN RESULTS Primary outcomes were the duration of implementation, bundle compliance, process of care, safety, and the factors influencing implementation. Secondary endpoints were the impact of the bundle on clinical outcomes such as pain, delirium, iatrogenic withdrawal, ventilator-free days, length of stay, and mortality. Implementation occurred over 26 months (August 2018 to October 2020). Data were collected on 1,036 patients representing 4,065 patient days. Bundle compliance was optimized within 6 months of roll-out. Goal setting for mobilization and level of arousal improved significantly (p < 0.01). Benzodiazepine, opioid, and dexmedetomidine use decreased in site 1 by 23.2% (95% CI, 30.8-15.5%), 26.1% (95% CI, 34.8-17.4%), and 9.2% (95% CI, 18.2-0.2%) patient exposure days, respectively, while at site 2, only dexmedetomidine exposure decreased significantly by 10.5% patient days (95% CI, 19.8-1.1%). Patient comfort, safety, and nursing workload were not adversely affected. There was no significant impact of the bundle on the rate of delirium, ventilator-free days, length of PICU stay, or mortality. Key facilitators to implementation included institutional support, unit-wide practice guidelines, dedicated PICU educators, easily accessible resources, and family engagement. CONCLUSIONS A rehabilitation bundle can improve processes of care and reduce patient sedative exposure without increasing patient discomfort, nursing workload, or harm. We did not observe an impact on short-term clinical outcomes. The efficacy of a PICU-rehabilitation bundle requires ongoing study. Lessons learned in this study provide evidence to inform rehabilitation implementation in the PICU setting.
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Affiliation(s)
- Karen Choong
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Douglas D Fraser
- Department of Medicine, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ahmed Al-Farsi
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Saif Awlad Thani
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Saoirse Cameron
- Lawson Health Research Institute, Children's Hospital at London Health Sciences Center, London, ON, Canada
| | | | - Carlos Cuello
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Joycelyne Ewusie
- The Research Institute, Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Kevin Kennedy
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Claudio M Martin
- Department of Pediatrics, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lehana Thabane
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute, Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Jasmine Nanji
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael Vu
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Cynthia Cupido
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Takashima M, Hyun A, Gibson V, Borello E, Ullman A. Invasive device-associated skin complications and mechanical dysfunctions in paediatric healthcare: A systematic review and meta-analysis. J Adv Nurs 2024. [PMID: 38263365 DOI: 10.1111/jan.16073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/01/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
AIM This study aimed to estimate the proportion and rate of skin complications and mechanical dysfunction associated with indwelling invasive devices in paediatric healthcare. DESIGN This systematic review is reported in accordance with Cochrane standards for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies. DATA SOURCES MEDLINE, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. REVIEW METHODS Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) paediatric participants admitted to a hospital, (3) reporting post-insertion device-associated skin complication and/or mechanical dysfunction, and (4) published in English, were included. Device-associated skin complication and mechanical dysfunction (infiltration, leakage, occlusion/blockage, dislodgement/malposition, breakage and others). Pooled proportion and incidence rate per 1000 device days are reported. RESULTS This review synthesized 114 studies (30,782 devices; 1,635,649 device-days). Skin complications were reported in 40 studies, but none exclusively reported individual device-related pressure injuries. Mechanical dysfunctions were well-reported for central venous access devices, peripheral intravenous catheters, nasogastric/gastric tubes and peritoneal dialysis catheters but less for arterial catheters, extracorporeal membrane oxygenation and ventricular assist devices. CONCLUSIONS This systematic review highlights the need for standardized definitions and reporting methods to better surveil and benchmark device-related complications, particularly for understudied device types. Device-related pressure injuries were not reported in any of the included studies, and all devices except for vascular access devices require standardized reporting of complications. IMPACT Despite the widespread use of invasive devices, comprehensive data on their prevalence, utility, and associated paediatric complications is limited. This review identified prevalent skin complications, occlusions and dislodgments in children with devices, underscoring the need for standardized reporting to enhance surveillance and understanding of paediatric device-related complications. REPORTING METHOD MOOSE (Meta-analyses Of Observational Studies in Epidemiology) Checklist. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Mari Takashima
- The University of Queensland, Brisbane, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Areum Hyun
- The University of Queensland, Brisbane, Queensland, Australia
| | - Victoria Gibson
- The University of Queensland, Brisbane, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Eloise Borello
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Amanda Ullman
- The University of Queensland, Brisbane, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Brisbane, Queensland, Australia
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Lyren A, Haines E, Fanta M, Gutzeit M, Staubach K, Chundi P, Ward V, Srinivasan L, Mackey M, Vonderhaar M, Sisson P, Sheffield-Bradshaw U, Fryzlewicz B, Coffey M, Cowden JD. Racial and ethnic disparities in common inpatient safety outcomes in a children's hospital cohort. BMJ Qual Saf 2024; 33:86-97. [PMID: 37460119 DOI: 10.1136/bmjqs-2022-015786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 06/11/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Emerging evidence has shown racial and ethnic disparities in rates of harm for hospitalised children. Previous work has also demonstrated how highly heterogeneous approaches to collection of race and ethnicity data pose challenges to population-level analyses. This work aims to both create an approach to aggregating safety data from multiple hospitals by race and ethnicity and apply the approach to the examination of potential disparities in high-frequency harm conditions. METHODS In this cross-sectional, multicentre study, a cohort of hospitals from the Solutions for Patient Safety network with varying race and ethnicity data collection systems submitted validated central line-associated bloodstream infection (CLABSI) and unplanned extubation (UE) data stratified by patient race and ethnicity categories. Data were submitted using a crosswalk created by the study team that reconciled varying approaches to race and ethnicity data collection by participating hospitals. Harm rates for race and ethnicity categories were compared with reference values reflective of the cohort and broader children's hospital population. RESULTS Racial and ethnic disparities were identified in both harm types. Multiracial Hispanic, Combined Hispanic and Native Hawaiian or other Pacific Islander patients had CLABSI rates of 2.6-3.6 SD above reference values. For Black or African American patients, UE rates were 3.2-4.4 SD higher. Rates of both events in White patients were significantly lower than reference values. CONCLUSIONS The combination of harm data across hospitals with varying race and ethnicity collection systems was accomplished through iterative development of a race and ethnicity category framework. We identified racial and ethnic disparities in CLABSI and UE that can be addressed in future improvement work by identifying and modifying care delivery factors that contribute to safety disparities.
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Affiliation(s)
- Anne Lyren
- Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- UH Rainbow Babies & Children's, Cleveland, Ohio, USA
| | - Elizabeth Haines
- Pediatrics and Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Hassenfeld Children's Hospital at NYU Langone, New York, New York, USA
| | - Meghan Fanta
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Katherine Staubach
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Pavan Chundi
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Valerie Ward
- Boston Children's Hospital, Boston, Massachusetts, USA
- Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lakshmi Srinivasan
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Megan Mackey
- Special Education and Interventions, Central Connecticut State University, New Britain, Connecticut, USA
| | - Michelle Vonderhaar
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Patricia Sisson
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ursula Sheffield-Bradshaw
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Maitreya Coffey
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - John D Cowden
- Department of Pediatrics, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
- University of Missouri-Kansas City School of Medicine, Kansas, Missouri, USA
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Takashima M, Hyun A, Xu G, Lions A, Gibson V, Cruickshank M, Ullman A. Infection Associated With Invasive Devices in Pediatric Health Care: A Meta-analysis. Hosp Pediatr 2024; 14:e42-e56. [PMID: 38161188 DOI: 10.1542/hpeds.2023-007194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
CONTEXT Indwelling invasive devices inserted into the body for extended are associated with infections. OBJECTIVE This study aimed to estimate infection proportion and rates associated with invasive devices in pediatric healthcare. DATA SOURCES Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. STUDY SELECTION Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) postinsertion infection complications, and (4) published in English, were included. DATA EXTRACTION Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. MAIN OUTCOMES AND MEASURES Device local, organ, and bloodstream infection (BSIs) pooled proportion and incidence rate (IR) per-1000-device-days per device type were reported. RESULTS A total of 116 studies (61 554 devices and 3 632 364 device-days) were included. The highest number of studies were central venous access devices associated BSI (CVAD-BSI), which had a pooled proportion of 8% (95% confidence interval [CI], 6-11; 50 studies) and IR of 0.96 per-1000-device-days (95% CI, 0.78-1.14). This was followed by ventilator-associated pneumonia in respiratory devices, which was 19% (95% CI, 14-24) and IR of 14.08 per-1000-device-days (95%CI, 10.57-17.58). CONCLUSIONS Although CVAD-BSI and ventilator associated pneumonia are well-documented, there is a scarcity of reporting on tissue and local organ infections. Standard guidelines and compliance initiatives similar to those dedicated to CVADs should be implemented in other devices in the future.
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Affiliation(s)
- Mari Takashima
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Areum Hyun
- The University of Queensland, Queensland, Australia
| | - Grace Xu
- The University of Queensland, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| | | | - Victoria Gibson
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Marilyn Cruickshank
- Sydney Children's Hospitals Network, New South Wales, Australia
- The University of Technology Sydney, New South Wales, Australia
| | - Amanda Ullman
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
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Naureckas Li C, Bonebrake A, Schroeder S, Lam SK, Raskin JS. Challenges in defining surgical-site infections following hydrocephalus surgeries. Infect Control Hosp Epidemiol 2023; 44:2065-2067. [PMID: 37332192 PMCID: PMC10755150 DOI: 10.1017/ice.2023.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/17/2023] [Accepted: 04/29/2023] [Indexed: 06/20/2023]
Abstract
Multiple organizations track neurosurgical surgical-site infection (SSI) rates, but significant variation exists among reporting criteria. We report our center's experience with the variation in cases captured by 2 major definitions. Standardization could support improvement activities and SSI reduction.
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Affiliation(s)
- Caitlin Naureckas Li
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Quality and Safety, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - Amanda Bonebrake
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - Sangeeta Schroeder
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Quality and Safety, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Division of Hospital-Based Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - Sandi K. Lam
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - Jeffrey S. Raskin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
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Milliren CE, Denhoff ER, Hahn PD, Ozonoff A. Incidence of Hospital-Acquired Conditions During Pediatric Clinical Research Inpatient Hospitalizations: A Matched Cohort Study. J Patient Saf 2023; 19:469-477. [PMID: 37678187 DOI: 10.1097/pts.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVES In this matched cohort study using data from pediatric hospitals, we compared the incidence of hospital-acquired conditions (HACs) during clinical research hospitalizations to nonresearch hospitalizations. METHODS Using Pediatric Health Information System data for inpatient discharges January 2017-June 2022, we matched research hospitalizations (identified by International Classification of Diseases, Tenth Revision, diagnosis code) to nonresearch hospitalizations within hospital on age (±3 y), sex, discharge year (±2), and All Patients Refined Diagnosis Related Groups classification, severity of illness (±1), and risk of mortality (±1). We calculated the incidence (per 1000 discharges) and incidence rate (per 10,000 patient days) of HAC identified by International Classification of Diseases, Tenth Revision, codes and compare research versus nonresearch using logistic and Poisson regression, accounting for matching using generalized estimating equations and adjusting for sociodemographic factors and hospital utilization. RESULTS We matched 7000 research hospitalizations to 26,447 nonresearch from 28 hospitals. Median age was 6.0 years (interquartile range, 10.6 y). Median length of stay was 4.0 days (interquartile range, 11.0 days) with longer stays among research hospitalizations ( P < 0.001). Incidence of HAC among research hospitalizations was 13.1 versus 7.2 per 1000 for nonresearch ( P < 0.001) and incidence rate 6.7 versus 4.5 per 10,000 patient days. Adjusting for sociodemographic and clinical factors, research stays had 1.65 times the odds of any HAC (95% confidence interval, 1.27-2.16; P < 0.001) and 1.38 times the incidence rate (95% confidence interval, 1.09-1.75; P = 0.009). CONCLUSIONS Our findings indicate that pediatric research hospitalizations are more likely to experience HACs compared with nonresearch hospitalizations. These findings have important safety implications for pediatric inpatient clinical research that warrant further study.
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Affiliation(s)
- Carly E Milliren
- From the Institutional Centers for Clinical and Translational Research
| | - Erica R Denhoff
- From the Institutional Centers for Clinical and Translational Research
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Tripathi S, McGarvey J, Lee K, Staubach K, Gehring E, Sisson P, McCaskey M, Mack E, Hord J, Pallotto EK, Lyren A, Coffey M. Compliance With Central Line Maintenance Bundle and Infection Rates. Pediatrics 2023; 152:e2022059688. [PMID: 37539480 DOI: 10.1542/peds.2022-059688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Reliable bundle performance is the mainstay of central line-associated bloodstream infections (CLABSI) prevention despite an unclear relationship between bundle reliability and outcomes. Our primary objective was to evaluate the correlation between reported bundle compliance and CLABSI rate in the Solutions for Patient Safety network. The secondary objective was to identify which hospital and process factors impact this correlation. METHODS We examined data on bundle compliance and monthly CLABSI rates from January 11 to December 21 in 159 hospitals. The correlation (adjusting for temporal trend) between CLABSI rates and bundle compliance was done at the network level. Negative binomial regression was done to detect the impact of hospital type, central line audit rate, and adoption of a comprehensive safety culture program on the association between bundle compliance and CLABSI rates. RESULTS During the study, hospitals reported 27 196 CLABSI on 20 274 565 line days (1.34 CLABSI/1000 line days). Out of 2 460 133 observed bundle opportunities, 2 085 700 (84%) were compliant. There was a negative correlation between the monthly bundle reliability and monthly CLABSI rate (-0.35, P <.001). After adjusting for the temporal trend, the partial correlation was -0.25 (P = .004). On negative binomial regression, significant positive interaction was only noted for the hospital type, with Hospital Within Hospital (but not freestanding children's hospitals) revealing a significant association between compliance ≥95% and lower CLABSI rates. CONCLUSIONS Adherence to best practice guidelines is associated with a reduction in CLABSI rate. Hospital-level factors (hospitals within hospitals vs freestanding), but not process-related (central line audit rate and safety culture training), impact this association.
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Affiliation(s)
- Sandeep Tripathi
- Pediatric Intensive Care, OSF HealthCare, Children's Hospital of Illinois/University of Illinois College of Medicine at Peoria, Illinois
| | | | - Kejin Lee
- Pusan National University (Department of Education), Busan, South Korea
| | - Katherine Staubach
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Emily Gehring
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Patricia Sisson
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Elizabeth Mack
- Pediatric Critical Care Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Jeffrey Hord
- Department of Pediatrics, Pediatric Hematology-Oncology, Akron Children's Hospital, Akron, Ohio
| | - Eugenia K Pallotto
- Neonatal-Perinatal Medicine, Department of Pediatrics, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - Anne Lyren
- Case Western Reserve University School of Medicine, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Maitreya Coffey
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
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Pellerito A, Berman S, Ortiz A, Cossais C, Mangum CD. Integrating quality improvement into healthcare operations: A system's approach. Curr Probl Pediatr Adolesc Health Care 2023; 53:101464. [PMID: 37980236 DOI: 10.1016/j.cppeds.2023.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
A palpable pulse on organizational culture is imperative for allowing senior leadership to understand the current state and use this as a starting point to measure the gap between the current state and where the organization should be to meet strategic goals related to quality and safety. Knowledge gleaned from causal analysis and coding of safety events provides the organization with that information. Our organization was unknowingly making decisions on a small quantity of coded and classified events, which led to mistakes on our journey to becoming a high-reliability organization. To remedy this, the Quality and Safety Team improved the user interface of the event reporting system and created standard work for all frontline staff, physicians, area managers and senior leaders. After several interventions, we reduced the time between reported events and documented resolution by 15.28% and increased the quantity of coded and classified safety events tenfold. These changes improved our organization's ability to make better informed decisions and plot a more precise course on the journey to becoming a high-reliability organization.
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Affiliation(s)
- Amanda Pellerito
- Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA; Neuroscience Department, Children's Hospital of The King's Daughters, Norfolk, VA.
| | - Susan Berman
- Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA
| | - Angela Ortiz
- Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA
| | - Christelle Cossais
- Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA
| | - Christopher D Mangum
- Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA
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Harrington JW, Cholis T, Colacchio K. Navigating quality and safety in your health system: understanding the alphabet soup. Curr Probl Pediatr Adolesc Health Care 2023; 53:101460. [PMID: 37993300 DOI: 10.1016/j.cppeds.2023.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Entering any new healthcare system today requires thorough knowledge about its quality and safety structure and culture. Learning that language is generally the first step in gaining a better understanding of how systems function. This overview of common mnemonics in the quality and safety world will provide the reader with better comprehension of their quality systems within their institutions. Healthcare providers should understand how patient safety organizations were established and the importance of our safety event classification system, along with the ability to recognize gaps in care that highlight opportunities for improvement. In addition, this review provides explanations of error prevention tools used every day to help new colleagues communicate better and share situational awareness to keep patients safe. Lastly, utilization of standard quality improvement tools can facilitate quality improvement projects and assist all healthcare systems to become highly reliable organizations.
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Affiliation(s)
- John W Harrington
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA; Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA.
| | - Tom Cholis
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA; Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA
| | - Kathryn Colacchio
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA; Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA
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11
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Mangum CD. Journey to STEEEP healthcare: A focus on systems through a patient's experience. Curr Probl Pediatr Adolesc Health Care 2023; 53:101461. [PMID: 37996313 DOI: 10.1016/j.cppeds.2023.101461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Healthcare systems continue to struggle with providing safe, timely, effective, efficient, equitable and patient-centered (STEEEP) care. Upon audit by clinicians, treatment processes such as those completed following clinical pathways appear to manage care safely. However, when reviewing the treatment process through the patient and/or their family's lens, the experience is quite different. This article will use a vignette detailing care provided in a primary care physician's office along with the patient's outpatient testing experience to reveal opportunities for improvement, a glimpse into the patient's experience and share methods for achieving STEEEP healthcare.
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Affiliation(s)
- Christopher D Mangum
- Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA, USA.
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12
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Wong C, Macias C, Miller M. Imperfection in adverse event detection: is this the opportunity to mature our focus on preventing harm in paediatrics? BMJ Qual Saf 2023:bmjqs-2022-015776. [PMID: 37142413 DOI: 10.1136/bmjqs-2022-015776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Chris Wong
- UH Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | - Charles Macias
- UH Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Marlene Miller
- UH Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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13
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Hunter J, Houchens N, Gupta A. Quality and safety in the literature: January 2023. BMJ Qual Saf 2023; 32:56-60. [PMID: 36549698 DOI: 10.1136/bmjqs-2022-015682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 12/24/2022]
Affiliation(s)
- John Hunter
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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14
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Landrigan CP. Pediatric Patient Safety-First Steps Forward. JAMA Pediatr 2022; 176:850-851. [PMID: 35877110 DOI: 10.1001/jamapediatrics.2022.2500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christopher P Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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