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The Pediatric Hospital Medicine Core Competencies Supplement
| Introduction | v |
| Authors, Reviewers, and Editors | vii |
| Section 1:Common Clinical Diagnoses and Conditions | |
| Acute abdominal pain and the acute abdomen | 1 |
| Apparent life‐threatening event | 2 |
| Asthma | 3 |
| Bone and joint infections | 5 |
| Bronchiolitis | 6 |
| Central nervous system infections | 8 |
| Diabetes mellitus | 9 |
| Failure to thrive | 11 |
| Fever of unknown origin | 13 |
| Gastroenteritis | 14 |
| Kawasaki disease | 16 |
| Neonatal fever | 17 |
| Neonatal jaundice | 18 |
| Pneumonia | 19 |
| Respiratory failure | 21 |
| Seizures | 22 |
| Shock | 24 |
| Sickle cell disease | 25 |
| Skin and soft tissue infection | 26 |
| Toxic ingestion | 28 |
| Upper airway infections | 29 |
| Urinary tract infections | 31 |
| Section 2:Core Skills | |
| Bladder catheterization/suprapubic bladder tap | 34 |
| Electrocardiogram interpretation | 35 |
| Feeding tubes | 36 |
| Fluids and electrolyte management | 37 |
| Intravenous access and phlebotomy | 39 |
| Lumbar puncture | 40 |
| Non‐invasive monitoring | 42 |
| Nutrition | 43 |
| Oxygen delivery and airway management | 44 |
| Pain management | 46 |
| Pediatric advanced life support | 47 |
| Procedural sedation | 49 |
| Radiographic interpretation | 50 |
| Section 3:Specialized Clinical Services | |
| Child abuse and neglect | 53 |
| Hospice and palliative care | 54 |
| Leading a healthcare team | 55 |
| Newborn care and delivery room management | 57 |
| Technology dependent children | 59 |
| Transport of the critically ill child | 60 |
| Section 4:Healthcare Systems: Supporting and Advancing Child Health | |
| Advocacy | 64 |
| Business practices | 65 |
| Communication | 67 |
| Continuous quality improvement | 68 |
| Cost‐effective care | 69 |
| Education | 71 |
| Ethics | 72 |
| Evidence based medicine | 73 |
| Health information systems | 75 |
| Legal issues/risk management | 76 |
| Patient safety | 77 |
| Research | 79 |
| Transitions of care | 80 |
| Appendix Original Research | |
| Pediatric Hospital Medicine Core Competencies: Development and Methodology Erin R. Stucky MD, Mary C. Ottolini MD, MPH and Jennifer Maniscalco MD, MPH | 82 |
| Introduction | v |
| Authors, Reviewers, and Editors | vii |
| Section 1:Common Clinical Diagnoses and Conditions | |
| Acute abdominal pain and the acute abdomen | 1 |
| Apparent life‐threatening event | 2 |
| Asthma | 3 |
| Bone and joint infections | 5 |
| Bronchiolitis | 6 |
| Central nervous system infections | 8 |
| Diabetes mellitus | 9 |
| Failure to thrive | 11 |
| Fever of unknown origin | 13 |
| Gastroenteritis | 14 |
| Kawasaki disease | 16 |
| Neonatal fever | 17 |
| Neonatal jaundice | 18 |
| Pneumonia | 19 |
| Respiratory failure | 21 |
| Seizures | 22 |
| Shock | 24 |
| Sickle cell disease | 25 |
| Skin and soft tissue infection | 26 |
| Toxic ingestion | 28 |
| Upper airway infections | 29 |
| Urinary tract infections | 31 |
| Section 2:Core Skills | |
| Bladder catheterization/suprapubic bladder tap | 34 |
| Electrocardiogram interpretation | 35 |
| Feeding tubes | 36 |
| Fluids and electrolyte management | 37 |
| Intravenous access and phlebotomy | 39 |
| Lumbar puncture | 40 |
| Non‐invasive monitoring | 42 |
| Nutrition | 43 |
| Oxygen delivery and airway management | 44 |
| Pain management | 46 |
| Pediatric advanced life support | 47 |
| Procedural sedation | 49 |
| Radiographic interpretation | 50 |
| Section 3:Specialized Clinical Services | |
| Child abuse and neglect | 53 |
| Hospice and palliative care | 54 |
| Leading a healthcare team | 55 |
| Newborn care and delivery room management | 57 |
| Technology dependent children | 59 |
| Transport of the critically ill child | 60 |
| Section 4:Healthcare Systems: Supporting and Advancing Child Health | |
| Advocacy | 64 |
| Business practices | 65 |
| Communication | 67 |
| Continuous quality improvement | 68 |
| Cost‐effective care | 69 |
| Education | 71 |
| Ethics | 72 |
| Evidence based medicine | 73 |
| Health information systems | 75 |
| Legal issues/risk management | 76 |
| Patient safety | 77 |
| Research | 79 |
| Transitions of care | 80 |
| Appendix Original Research | |
| Pediatric Hospital Medicine Core Competencies: Development and Methodology Erin R. Stucky MD, Mary C. Ottolini MD, MPH and Jennifer Maniscalco MD, MPH | 82 |
| Introduction | v |
| Authors, Reviewers, and Editors | vii |
| Section 1:Common Clinical Diagnoses and Conditions | |
| Acute abdominal pain and the acute abdomen | 1 |
| Apparent life‐threatening event | 2 |
| Asthma | 3 |
| Bone and joint infections | 5 |
| Bronchiolitis | 6 |
| Central nervous system infections | 8 |
| Diabetes mellitus | 9 |
| Failure to thrive | 11 |
| Fever of unknown origin | 13 |
| Gastroenteritis | 14 |
| Kawasaki disease | 16 |
| Neonatal fever | 17 |
| Neonatal jaundice | 18 |
| Pneumonia | 19 |
| Respiratory failure | 21 |
| Seizures | 22 |
| Shock | 24 |
| Sickle cell disease | 25 |
| Skin and soft tissue infection | 26 |
| Toxic ingestion | 28 |
| Upper airway infections | 29 |
| Urinary tract infections | 31 |
| Section 2:Core Skills | |
| Bladder catheterization/suprapubic bladder tap | 34 |
| Electrocardiogram interpretation | 35 |
| Feeding tubes | 36 |
| Fluids and electrolyte management | 37 |
| Intravenous access and phlebotomy | 39 |
| Lumbar puncture | 40 |
| Non‐invasive monitoring | 42 |
| Nutrition | 43 |
| Oxygen delivery and airway management | 44 |
| Pain management | 46 |
| Pediatric advanced life support | 47 |
| Procedural sedation | 49 |
| Radiographic interpretation | 50 |
| Section 3:Specialized Clinical Services | |
| Child abuse and neglect | 53 |
| Hospice and palliative care | 54 |
| Leading a healthcare team | 55 |
| Newborn care and delivery room management | 57 |
| Technology dependent children | 59 |
| Transport of the critically ill child | 60 |
| Section 4:Healthcare Systems: Supporting and Advancing Child Health | |
| Advocacy | 64 |
| Business practices | 65 |
| Communication | 67 |
| Continuous quality improvement | 68 |
| Cost‐effective care | 69 |
| Education | 71 |
| Ethics | 72 |
| Evidence based medicine | 73 |
| Health information systems | 75 |
| Legal issues/risk management | 76 |
| Patient safety | 77 |
| Research | 79 |
| Transitions of care | 80 |
| Appendix Original Research | |
| Pediatric Hospital Medicine Core Competencies: Development and Methodology Erin R. Stucky MD, Mary C. Ottolini MD, MPH and Jennifer Maniscalco MD, MPH | 82 |
Copyright © 2010 Society of Hospital Medicine
New Knowledge Paramount to HM10 Attendees
For an early-career hospitalist like Michele DeKorte, MD, HM10 offers a plethora of opportunities for practical knowledge and bushels of take-home points. “This is my first time, and I’m excited to be here,” Dr. DeKorte said moments after registering for HM10 at the Gaylord National Resort and Convention Center just outside Washington, D.C.
Dr. DeKorte, who has worked as a hospitalist at the University of California at San Diego since 2008, is one of a record 2,500 hospitalists registered for SHM’s annual meeting. She and hundreds of other hospitalists were taking part in Thursday’s lineup of pre-courses.
“I’m doing the procedures pre-course [Essential Procedures for the Hospitalist A Hands-on Experience] in the afternoon. I like procedures, so I think it will be fun,” she said, noting she will focus on the clinical track throughout the four-day event, which features more than 90 educational sessions. “It’s more interesting to me at this stage of the game. I want to have a better idea of how people are practicing HM around the country.”
Catherine Fitzgerald, DO, has worked as a hospitalist since 2005 and is attending her first annual meeting. For two years, she worked in an administrative role with CPMG at St. Joseph’s Memorial Hospital in Denver, and she plans to attend a smattering of practice-management sessions. “I also sit on our heart-failure committee at St. Joseph’s, so I have signed up for the session ‘How to Prevent Heart Failure Readmissions.’” she explained. “The meeting sessions are good reviews of things you already know, and interspersed in the discussions usually are these little pearls of new knowledge for your practice.”
In addition to aiming to improve her HM practice, Dr. Fitzgerald is excited to be in the nation’s capital with loved ones. Dr. Fitzgerald’s mother and 6-year-old son are scheduled to visit the White House.
“I’ll be at the conference all day, but that’s OK,” she said, with a hint of jealousy. “It was snowing in Denver, and we had to de-ice the plane last night. It’s 80 and sunny here, so this is beautiful.”
One of Dr. DeKorte’s colleagues at UCSD, Diana Childers, MD, was filling up the tank of knowledge in the “Documentation and Coding for Hospitalists” pre-course. Dr. Childers is one of the UCSD group’s billing experts, and Dr. DeKorte was looking forward to picking her brain.
“It’s still overwhelming to me,” Dr. DeKorte says. “I’m hoping she’ll pass along the nuggets, the gems of billing and coding.”
For an early-career hospitalist like Michele DeKorte, MD, HM10 offers a plethora of opportunities for practical knowledge and bushels of take-home points. “This is my first time, and I’m excited to be here,” Dr. DeKorte said moments after registering for HM10 at the Gaylord National Resort and Convention Center just outside Washington, D.C.
Dr. DeKorte, who has worked as a hospitalist at the University of California at San Diego since 2008, is one of a record 2,500 hospitalists registered for SHM’s annual meeting. She and hundreds of other hospitalists were taking part in Thursday’s lineup of pre-courses.
“I’m doing the procedures pre-course [Essential Procedures for the Hospitalist A Hands-on Experience] in the afternoon. I like procedures, so I think it will be fun,” she said, noting she will focus on the clinical track throughout the four-day event, which features more than 90 educational sessions. “It’s more interesting to me at this stage of the game. I want to have a better idea of how people are practicing HM around the country.”
Catherine Fitzgerald, DO, has worked as a hospitalist since 2005 and is attending her first annual meeting. For two years, she worked in an administrative role with CPMG at St. Joseph’s Memorial Hospital in Denver, and she plans to attend a smattering of practice-management sessions. “I also sit on our heart-failure committee at St. Joseph’s, so I have signed up for the session ‘How to Prevent Heart Failure Readmissions.’” she explained. “The meeting sessions are good reviews of things you already know, and interspersed in the discussions usually are these little pearls of new knowledge for your practice.”
In addition to aiming to improve her HM practice, Dr. Fitzgerald is excited to be in the nation’s capital with loved ones. Dr. Fitzgerald’s mother and 6-year-old son are scheduled to visit the White House.
“I’ll be at the conference all day, but that’s OK,” she said, with a hint of jealousy. “It was snowing in Denver, and we had to de-ice the plane last night. It’s 80 and sunny here, so this is beautiful.”
One of Dr. DeKorte’s colleagues at UCSD, Diana Childers, MD, was filling up the tank of knowledge in the “Documentation and Coding for Hospitalists” pre-course. Dr. Childers is one of the UCSD group’s billing experts, and Dr. DeKorte was looking forward to picking her brain.
“It’s still overwhelming to me,” Dr. DeKorte says. “I’m hoping she’ll pass along the nuggets, the gems of billing and coding.”
For an early-career hospitalist like Michele DeKorte, MD, HM10 offers a plethora of opportunities for practical knowledge and bushels of take-home points. “This is my first time, and I’m excited to be here,” Dr. DeKorte said moments after registering for HM10 at the Gaylord National Resort and Convention Center just outside Washington, D.C.
Dr. DeKorte, who has worked as a hospitalist at the University of California at San Diego since 2008, is one of a record 2,500 hospitalists registered for SHM’s annual meeting. She and hundreds of other hospitalists were taking part in Thursday’s lineup of pre-courses.
“I’m doing the procedures pre-course [Essential Procedures for the Hospitalist A Hands-on Experience] in the afternoon. I like procedures, so I think it will be fun,” she said, noting she will focus on the clinical track throughout the four-day event, which features more than 90 educational sessions. “It’s more interesting to me at this stage of the game. I want to have a better idea of how people are practicing HM around the country.”
Catherine Fitzgerald, DO, has worked as a hospitalist since 2005 and is attending her first annual meeting. For two years, she worked in an administrative role with CPMG at St. Joseph’s Memorial Hospital in Denver, and she plans to attend a smattering of practice-management sessions. “I also sit on our heart-failure committee at St. Joseph’s, so I have signed up for the session ‘How to Prevent Heart Failure Readmissions.’” she explained. “The meeting sessions are good reviews of things you already know, and interspersed in the discussions usually are these little pearls of new knowledge for your practice.”
In addition to aiming to improve her HM practice, Dr. Fitzgerald is excited to be in the nation’s capital with loved ones. Dr. Fitzgerald’s mother and 6-year-old son are scheduled to visit the White House.
“I’ll be at the conference all day, but that’s OK,” she said, with a hint of jealousy. “It was snowing in Denver, and we had to de-ice the plane last night. It’s 80 and sunny here, so this is beautiful.”
One of Dr. DeKorte’s colleagues at UCSD, Diana Childers, MD, was filling up the tank of knowledge in the “Documentation and Coding for Hospitalists” pre-course. Dr. Childers is one of the UCSD group’s billing experts, and Dr. DeKorte was looking forward to picking her brain.
“It’s still overwhelming to me,” Dr. DeKorte says. “I’m hoping she’ll pass along the nuggets, the gems of billing and coding.”
Evidence‐based medicine
Introduction
Evidence‐based medicine (EBM) is the judicious use of systematically evaluated clinical research applied to care of a patient or population. Evidence‐based medicine principles support use of results from rigorously validated randomized controlled trials where available, in combination with other sources of information such as other published literature, expert opinion and consensus statements. Grading research based on a hierarchy of strength of evidence is a hallmark of EBM. Clinical decisions are then made considering a combination of a patient's value system, specific clinical circumstances, and a thorough assessment of the literature regarding the clinical condition. Used correctly, application of EBM results in use of current best scientific knowledge to create best plans of care while acknowledging the specific circumstance of patients.
Knowledge
Pediatric hospitalists should be able to:
Define EBM and state how its use is integrated into clinical decision‐making for a patient or a population.
Review how EBM support quality improvement and patient safety efforts.
List databases and other resources commonly used to search for medical evidence.
Discuss the risk and benefits of accessing medical resources through publicly available search engines.
Discuss the benefits and limitations of commonly used scientific medical resources, considering issues such as publication bias, consensus statement methodology used, national versus international web indexed articles, and others.
Explain the classification systems used to grade the strength of evidence in a given published work and discuss how this can help guide clinical decision making.
Explain how each of the components (PICO, or patient‐intervention‐control‐outcomes) of a well composed, searchable clinical question aid in obtaining a more accurate and comprehensive list of references.
Distinguish between different study designs, such as retrospective, prospective, case control, and others and list the benefits and limitations of each.
Compare and contrast the major study types such as cost‐effectiveness, therapy, diagnosis, prognosis, harm, and systematic review.
Define commonly used terms such as relative and absolute risk reduction, number needed to treat (NNT), sensitivity, specificity, positive and negative predictive values (PPV, NPV), likelihood ratios (LR).
Skills
Pediatric hospitalists should be able to:
Demonstrate facility with internet search engines to access all potentially relevant sources of information.
Access on line evidence‐based medicine toolkits to assist with the assessment of healthcare literature.
Translate a clinical question into a searchable PICO question or search string.
Identify the type of clinical question being asked: therapy, diagnosis, prognosis or harm/causality.
Identify the most appropriate study design for a given specific question.
Demonstrate proficiency in performance of an EBM literature search using electronic resources such as Pub Med.
Critically appraise the quality of studies, using a consistent method.
Critically interpret study results.
Apply relevant results of validated studies that are of the highest quality available to care for individual patients and populations.
Develop a personal strategy to consistently incorporate evidence, balance of harm and benefits, and patients' values into clinical decision making to deliver the highest quality care.
Attitudes
Pediatric hospitalists should be able to:
Seek the best available evidence to support clinical decision making.
Acquire and maintain EBM skills through integration into daily practice and pursuit of ongoing continuing education.
Recognize how personal practice patterns are influenced by the integration of EBM.
Role model use of EBM at the beside.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in the development and implementation cost‐effective, evidence‐based care pathways to standardize the evaluation and management of hospitalized children in the local system.
Engage with hospital staff, subspecialists, and others in a multidisciplinary team approach toward integrating EBM into clinical decision making processes.
Work with hospital administrators to acquire and maintain effective, efficient electronic resources for the performance of EBM.
Introduction
Evidence‐based medicine (EBM) is the judicious use of systematically evaluated clinical research applied to care of a patient or population. Evidence‐based medicine principles support use of results from rigorously validated randomized controlled trials where available, in combination with other sources of information such as other published literature, expert opinion and consensus statements. Grading research based on a hierarchy of strength of evidence is a hallmark of EBM. Clinical decisions are then made considering a combination of a patient's value system, specific clinical circumstances, and a thorough assessment of the literature regarding the clinical condition. Used correctly, application of EBM results in use of current best scientific knowledge to create best plans of care while acknowledging the specific circumstance of patients.
Knowledge
Pediatric hospitalists should be able to:
Define EBM and state how its use is integrated into clinical decision‐making for a patient or a population.
Review how EBM support quality improvement and patient safety efforts.
List databases and other resources commonly used to search for medical evidence.
Discuss the risk and benefits of accessing medical resources through publicly available search engines.
Discuss the benefits and limitations of commonly used scientific medical resources, considering issues such as publication bias, consensus statement methodology used, national versus international web indexed articles, and others.
Explain the classification systems used to grade the strength of evidence in a given published work and discuss how this can help guide clinical decision making.
Explain how each of the components (PICO, or patient‐intervention‐control‐outcomes) of a well composed, searchable clinical question aid in obtaining a more accurate and comprehensive list of references.
Distinguish between different study designs, such as retrospective, prospective, case control, and others and list the benefits and limitations of each.
Compare and contrast the major study types such as cost‐effectiveness, therapy, diagnosis, prognosis, harm, and systematic review.
Define commonly used terms such as relative and absolute risk reduction, number needed to treat (NNT), sensitivity, specificity, positive and negative predictive values (PPV, NPV), likelihood ratios (LR).
Skills
Pediatric hospitalists should be able to:
Demonstrate facility with internet search engines to access all potentially relevant sources of information.
Access on line evidence‐based medicine toolkits to assist with the assessment of healthcare literature.
Translate a clinical question into a searchable PICO question or search string.
Identify the type of clinical question being asked: therapy, diagnosis, prognosis or harm/causality.
Identify the most appropriate study design for a given specific question.
Demonstrate proficiency in performance of an EBM literature search using electronic resources such as Pub Med.
Critically appraise the quality of studies, using a consistent method.
Critically interpret study results.
Apply relevant results of validated studies that are of the highest quality available to care for individual patients and populations.
Develop a personal strategy to consistently incorporate evidence, balance of harm and benefits, and patients' values into clinical decision making to deliver the highest quality care.
Attitudes
Pediatric hospitalists should be able to:
Seek the best available evidence to support clinical decision making.
Acquire and maintain EBM skills through integration into daily practice and pursuit of ongoing continuing education.
Recognize how personal practice patterns are influenced by the integration of EBM.
Role model use of EBM at the beside.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in the development and implementation cost‐effective, evidence‐based care pathways to standardize the evaluation and management of hospitalized children in the local system.
Engage with hospital staff, subspecialists, and others in a multidisciplinary team approach toward integrating EBM into clinical decision making processes.
Work with hospital administrators to acquire and maintain effective, efficient electronic resources for the performance of EBM.
Introduction
Evidence‐based medicine (EBM) is the judicious use of systematically evaluated clinical research applied to care of a patient or population. Evidence‐based medicine principles support use of results from rigorously validated randomized controlled trials where available, in combination with other sources of information such as other published literature, expert opinion and consensus statements. Grading research based on a hierarchy of strength of evidence is a hallmark of EBM. Clinical decisions are then made considering a combination of a patient's value system, specific clinical circumstances, and a thorough assessment of the literature regarding the clinical condition. Used correctly, application of EBM results in use of current best scientific knowledge to create best plans of care while acknowledging the specific circumstance of patients.
Knowledge
Pediatric hospitalists should be able to:
Define EBM and state how its use is integrated into clinical decision‐making for a patient or a population.
Review how EBM support quality improvement and patient safety efforts.
List databases and other resources commonly used to search for medical evidence.
Discuss the risk and benefits of accessing medical resources through publicly available search engines.
Discuss the benefits and limitations of commonly used scientific medical resources, considering issues such as publication bias, consensus statement methodology used, national versus international web indexed articles, and others.
Explain the classification systems used to grade the strength of evidence in a given published work and discuss how this can help guide clinical decision making.
Explain how each of the components (PICO, or patient‐intervention‐control‐outcomes) of a well composed, searchable clinical question aid in obtaining a more accurate and comprehensive list of references.
Distinguish between different study designs, such as retrospective, prospective, case control, and others and list the benefits and limitations of each.
Compare and contrast the major study types such as cost‐effectiveness, therapy, diagnosis, prognosis, harm, and systematic review.
Define commonly used terms such as relative and absolute risk reduction, number needed to treat (NNT), sensitivity, specificity, positive and negative predictive values (PPV, NPV), likelihood ratios (LR).
Skills
Pediatric hospitalists should be able to:
Demonstrate facility with internet search engines to access all potentially relevant sources of information.
Access on line evidence‐based medicine toolkits to assist with the assessment of healthcare literature.
Translate a clinical question into a searchable PICO question or search string.
Identify the type of clinical question being asked: therapy, diagnosis, prognosis or harm/causality.
Identify the most appropriate study design for a given specific question.
Demonstrate proficiency in performance of an EBM literature search using electronic resources such as Pub Med.
Critically appraise the quality of studies, using a consistent method.
Critically interpret study results.
Apply relevant results of validated studies that are of the highest quality available to care for individual patients and populations.
Develop a personal strategy to consistently incorporate evidence, balance of harm and benefits, and patients' values into clinical decision making to deliver the highest quality care.
Attitudes
Pediatric hospitalists should be able to:
Seek the best available evidence to support clinical decision making.
Acquire and maintain EBM skills through integration into daily practice and pursuit of ongoing continuing education.
Recognize how personal practice patterns are influenced by the integration of EBM.
Role model use of EBM at the beside.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in the development and implementation cost‐effective, evidence‐based care pathways to standardize the evaluation and management of hospitalized children in the local system.
Engage with hospital staff, subspecialists, and others in a multidisciplinary team approach toward integrating EBM into clinical decision making processes.
Work with hospital administrators to acquire and maintain effective, efficient electronic resources for the performance of EBM.
Copyright © 2010 Society of Hospital Medicine
Authors
Rishi Agrawal, MD, MPH
Pediatric Hospitalist, Children's Memorial Hospital and LaRabida Children's Hospital
Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine
Chicago, IL
Feeding Tubes
Brian Alverson, MD
Head, Pediatric Hospitalist Section, Hasbro Children's Hospital
Assistant Professor of Pediatrics, Warren Alpert School of Medicine at Brown University
Providence, RI
Neonatal Fever
Pneumonia
Allison Ballantine, MD
Medical Director of the Integrated Care Service, Children's Hospital of Philadelphia
Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine
Philadelphia, PA
Technology Dependent Children
Julia Beauchamp‐Walters, MD
Pediatric Emergency Transport Coordinator, CSSD, RCHHC Pediatric Emergency Transports, Rady Childrens Hospital
Clinical Instructor of Pediatrics, University of California, San Diego
San Diego, CA
Transport of the Critically Ill Child
Glenn F. Billman, MD
Medical Safety and Regulatory Officer, Rady Children's Hospital
San Diego, CA
Patient Safety
April O. Buchanan, MD, FAAP
Vice Chair of Quality, Department of Pediatrics, Children's Hospital at Greenville Hospital System University Medical Center
Assistant Professor of Clinical Pediatrics, University of South Carolina School of Medicine
Greenville, SC
Shock
Douglas W. Carlson, MD
Chief, Pediatric Hospital Medicine, St. Louis Children's Hospital
Associate Professor of Pediatrics, Washington University
St. Louis, MO
Procedural Sedation
Technology Dependent Children
Vincent W. Chiang, MD
Chief, Inpatient Services, Department of Medicine, Children's Hospital Boston
Associate Professor of Pediatrics, Harvard Medical School
Boston, MA
Seizures
Michael R. Clemmens, MD
Director Pediatric Hospitalist Program, Anne Arundel Medical Center
Assistant Clinical Professor of Pediatrics, The George Washington University School of Medicine
Annapolis, MD
Acute Abdominal Pain and The Acute Abdomen
Jamie L. Clute, MD, FAAP, FHM
Medical Director, Inpatient Services, Joe Dimaggio Children's Hospital
Clinical Assistant Professor, NOVA Southeastern University, College of Osteopathic Medicine and Assistant Affiliate Professor, Barry University
Hollywood, FL
Kawasaki Disease
Shannon Connor Phillips, MD, MPH
Patient Safety Officer, Quality and Patient Safety Institute, Cleveland Clinic
Assistant Professor of Pediatrics, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
Cleveland, OH
Evidence Based Medicine
Tanya Dansky, MD
Medical Director, Children's Physicians Medical GroupMedical Director, San Diego Hospice and The Institute For Palliative Medicine, Rady Children's Hospital
Assistant Clinical Professor of Pediatrics, University of California, San Diego
San Diego, CA
Hospice and Palliative Care, Ethics
Jennifer Daru, MD, FAAP, FHM
Chief, Pediatric Hospitalist Division; Interim Chief, Pediatric and Neonatal Transport, California Pacific Medical Center
Clinical Assistant Professor (pending), University of California San Francisco
San Francisco, CA
Leading a Healthcare Team
Newborn Care and Delivery Room Management
Yasmeen N. Daud, MD
Director of Pediatric Hospitalist Sedation in the Pediatric Acute Wound Service and Director of the Pediatric Hospitalist After Hours Sedation Program, St. Louis Children's Hospital
Assistant Professor of Pediatrics, Washington University School of Medicine
St. Louis, MO
Oxygen Delivery and Airway Management
Craig DeWolfe, MD, MEd
Pediatric Hospitalist, Children's National Medical Center
Assistant Professor of Pediatrics, George Washington School of Medicine and Health Sciences
Washington DC
Apparent Life‐Threatening Event
Joseph M. Geskey, DO
Division Chief, Pediatric Hospital Medicine, Medical Director of Hospital Care Management, Penn State Hershey Children's Hospital
Associate Professor of Pediatrics, Penn State M. S. Hershey Medical Center
Hershey, PA
Pneumonia
Upper Airway Infections
Bronchiolitis
Paul D. Hain, MD
Associate Chief of Staff, Monroe Carell Jr. Children's Hospital at Vanderbilt
Assistant Professor of Pediatrics, Vanderbilt University
Nashville, TN
Health Information Systems
Keith Herzog, MD
Pediatric Hospitalist, St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Philadelphia, PA
Central Nervous System Infections
Margaret Hood, MD, FAAP
Pediatric Hospitalist, Seattle Children's Hospital
Clinical Associate Professor of Pediatrics, University of Washington
Seattle, WA
Diabetes Mellitus
Hospice and Palliative Care
Kevin B. Johnson, MD, MS
Vice Chair of Biomedical Informatics, Vanderbilt University Medical Center
Associate Professor of Medical Informatics and Pediatrics, Vanderbilt University Medical Center
Nashville, TN
Health Information Systems
Rick Johnson, MD, FAAP
Division Head, Regional Pediatrics, CCMC, and American Heart Association Regional and National PALS Faculty, Connecticut Children's Medical Center
Assistant Professor of Pediatrics, University of Connecticut School of Medicine
Hartford, CT
Pediatric Advanced Life Support
Brian Kelly, MD, MRCP (UK), FAAP
Pediatric Hospitalist, Ranken Jordan Pediatric Rehabilitative Hospital, St. Louis Children's Hospital
Assistant Professor of Pediatrics, Washington University School of Medicine
St. Louis, MO
Bladder Catheterization/Suprapubic Bladder Tap
Herbert C Kimmons, MD, MMM
President Children's Specialists of San Diego (Medical Quality Officer of Rady Children's Hospital of San Diego, 20062008), Children's Specialists of San Diego in California
Professor of Pediatrics, University of California San Diego
San Diego, CA
Continuous Quality Improvement
Patient Safety
Su‐Ting T. Li, MD, MPH
Associate Pediatric Residency Program Director, University of California, Davis
Assistant Professor of Pediatrics, University of California, Davis
Sacramento, CA
Skin and Soft Tissue Infections
Patricia S. Lye, MD
Medical Director, Hospitalists, Children's Hospital of Wisconsin
Associate Professor of Pediatrics, Medical College of Wisconsin
Milwaukee, WI
Transitions of Care
Jennifer Maniscalco, MD, MPH, FAAP
Director of Education, Division of Pediatric Hospital Medicine, Children's Hospital Los Angeles
Clinical Assistant Professor of Pediatrics, University of Southern California Keck School of Medicine
Los Angeles, CA
Failure to Thrive
Transitions of Care
Nutrition
David E. Marcello III, MD, FAAP
Pediatric Hospitalist, Connecticut Children's Medical Center
Assistant Professor in Pediatrics, University of Connecticut Medical School
Hartford, CT
Lumbar Puncture
Intravenous Access and Phlebotomy
Sanford M. Melzer, MD, MBA
Senior Vice President, Strategic Planning and Business Development, Seattle Children's Hospital
Professor of Pediatrics, University of Washington School of Medicine
Seattle, WA
Cost Effective Care
Margaret I. Mikula, MD
Pediatric Hospitalist, Penn State Hershey Children's Hospital
Assistant Professor of Pediatrics, Penn State M. S. Hershey Medical Center
Hershey, PA
Pneumonia
Bronchiolitis
Laura J Mirkinson, MD, FAAP
Director of Pediatrics, Blythedale Children's Hospital
Valhalla, NY
Neonatal Jaundice
Christopher D. Miller, MD, FAAP
Pediatric Hospitalist and Allergist, Children's Mercy Hospitals and Clinics
Assistant Professor of Pediatrics, University of Missouri‐Kansas City School of Medicine
Kansas City, MO
Asthma
Christopher O'Hara, MD, FACP
St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Philadelphia PA
Pain Management
Mary C. Ottolini MD, MPH, FAAP, FHM
Chair, Academic Pediatric Association Education Committee Immediate Past Hospitalist Division Chief; Vice Chair for Medical Education, Children's National Medical Center
Professor of Pediatrics, The George Washington University School of Medicine
Washington DC
Fluid and Electrolyte Management
Gastroenteritis
Education
Brian M. Pate, MD, FAAP, FHM
Section Chief, Pediatric Hospital Medicine, Vice Chairman, Inpatient Services, Children's Mercy Hospital and Clinics
Assistant Professor of Pediatrics, University of Missouri‐Kansas City School of Medicine
Business Practices
Asthma
Dana Patrick, RN, BSN
Transport Program Manager NICU\PICU, Rady Children's Hospital
San Diego, CA
Transport of the Critically Ill Child
Jack M. Percelay, MD, MPH, FAAP, FHM
Society of Hospital Medicine, Pediatric Board Member; Immediate Past‐Chair, AAP Section on Hospital Medicine, E.L.M.O. Pediatrics
Associate Professor, Pace University Physician Assistant Program
New York, New York
Advocacy
David Pressel, MD, PhD, FHM, FAAP
Director, General Pediatrics Inpatient Services, A.I. duPont Hospital for Children
Assistant Professor of Pediatrics, Jefferson Medical College, Thomas Jefferson University
Wilmington, DE
Child Abuse and Neglect
Kris P Rehm, MD
Director, Division of Hospital Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt
Assistant Professor of Pediatrics, Vanderbilt University
Nashville, TN
Respiratory Failure
Kyung E. Rhee, MD, MSc
Pediatric Hospitalist, Hasbro Children's Hospital and The Weight Control and Diabetes Research Center
Assistant Professor of Pediatrics, Warren Alpert Medical School of Brown University
Providence, RI
Fever of Unknown Origin
Mark F Riederer, MD
Pediatric Hospitalist, Monroe Carell Jr Children's Hospital at Vanderbilt
Assistant Professor of Pediatrics,
Nashville, TN
Respiratory Failure
Michael Ruhlen, MD, MHCM, FAAP, FHM, FACHE
Vice President and Chief Medical Officer, Carolinas Medical Center Mercy
Carolinas Medical Center Pineville
Charlotte, NC
Legal Issues/Risk Management
Henry M. Seidel, MD
Professor Emeritus, Johns Hopkins Berman Institute of Bioethics
Professor Emeritus of Pediatrics, The Johns Hopkins University School of Medicine
Baltimore, MD
Communication
Anand Sekaran, MD
Medical Director, Inpatient Services, Connecticut Children's Medical Center
Assistant Professor of Pediatrics, University of Connecticut School of Medicine
Hartford, CT
Radiographic Interpretation
Kristin A. Shadman, MD, FAAP
Pediatric Hospitalist
Oxygen Delivery and Airway Management
Vipul Singla, MD, FAAP
Site Leader, Lake Forest Hospital (Children's Memorial Medical Group)
Instructor in Pediatrics, Northwestern University Feinberg School of Medicine
Chicago, IL
Electrocardiogram Interpretation
Karen Smith, MD, MEd
Chief Medical Officer, The HSC Pediatric Center
Assistant Professor of Pediatrics, The George Washington University School of Medicine
Washington DC
Apparent Life‐Threatening Event
Jeffrey L. Sperring, MD
Chief Medical Officer, Riley Hospital for Children
Assistant Professor of Pediatrics, Indiana University School of Medicine
Indianapolis, IN
Bone and Joint Infections
Glenn Stryjewski, MD, MPH
Associate Residency Program Director, AI duPont Hospital for Children
Assistant professor of Pediatrics, Jefferson Medical College, Thomas Jefferson University
Wilmington, DE
Toxic Ingestion
Erin R. Stucky, MD, FAAP, FHM
Director of Graduate Medical Education, Rady Children's Hospital San Diego; Medical Director of Quality Improvement, Rady Children's Hospital San Diego; Associate Program Director, UCSD Pediatric Residency Program; Vice Chair for Clinical Affairs, UCSD Department of Pediatrics; Director, Pediatric Hospital Medicine Fellowship, Rady Children's Hospital
Clinical Professor of Pediatrics, University of California San Diego
San Diego, CA
Evidence Based Medicine
Continuous Quality Improvement
Technology Dependent Children
E. Douglas Thompson, Jr., MD
Director, Pediatric Generalist Service, St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Philadelphia, PA
Sickle Cell Disease
Michael Turmelle, MD
Pediatric Hospitalist, St. Louis Children's Hospital
Assistant Professor of Pediatrics, Washington University School of Medicine
St. Louis, MO
Non‐Invasive Monitoring
Macdara G. Tynan, MD, MBA, FAAP
Associate Director of Inpatient Pediatrics, Levine Children's Hospital
Charlotte, NC
Diabetes Mellitus
Toxic Ingestion
Ronald J. Williams, MD
Pediatric Hospitalist, Penn State Hershey Children's Hospital
Associate Professor of Pediatrics and Medicine, Penn State M. S. Hershey Medical Center
Hershey, PA
Upper Airway Infections
Heidi Wolf MD, FAAP
Director Pediatric Hospitalist Program, Johns Hopkins
Assistant Clinical Professor, John Hopkins University
Baltimore, MD
Fever of Unknown Origin
Neonatal Fever
Susan Wu, MD
Pediatric Hospitalist, Children's Hospital Los Angeles
Clinical Assistant Professor of Pediatrics, University of Southern California Keck School of Medicine
Los Angeles, CA
Bronchiolitis
Lisa B. Zaoutis, MD
Section Chief of Inpatient Services, Division of General Pediatrics, The Children's Hospital of Philadelphia
Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine
Philadelphia, PA
Urinary Tract Infections
William T. Zempsky, MD
Associate Director; Division of Pain Medicine; Department of Pediatrics, Associate Director, Pain Relief Program, Connecticut Children's Medical Center
Professor of Pediatrics, University of Connecticut School of Medicine
Hartford, CT
Pain Management
Reviewers
Allison Ballantine, MD
Medical Director of the Integrated Care Service, Children's Hospital of Philadelphia
Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine
Philadelphia, PA
Technology Dependent Children
Margaret Hood, MD, FAAP
Pediatric Hospitalist, Seattle Children's Hospital
Clinical Associate Professor of Pediatrics, University of Washington
Seattle, WA
Hospice and Palliative Care
Ethics
Brian Kit, MD, MPH
Anne Arundel Medical Center
Assistant Professor of Pediatrics, The George Washington University School of Medicine
Annapolis, MD
Advocacy
Evelina M. Krieger, MD
Children's National Medical Center
Assistant Professor of Pediatrics, The George Washington University School of Medicine
Washington, DC
Advocacy
Cynthia L. Kuelbs, MD
Medical Director, Chadwick Center for Child Abuse; Division Director Pediatric Hospital Medicine, Rady Children's Hospital
Associate Clinical Professor of Pediatrics, University of California San Diego
San Diego, CA
Child Abuse and Neglect
Christopher P. Landrigan, MD, MPH
Division Director, Pediatrics and Hospital Medicine; Research and Fellowship Director, Children's Hospital Boston Inpatient Pediatrics Service; Director, Sleep and Patient Safety Program at the Brigham and Women's Hospital, Children's Hospital Boston
Assistant Professor of Pediatrics and Medicine, Harvard Medical School
Boston, MA
Research
Michael Ruhlen, MD, MHCM, FAAP, FHM, FACHE
Vice President and Chief Medical Officer, Carolinas Medical Center Mercy
Carolinas Medical Center Pineville
Charlotte, NC
Legal Issues/Risk Management
Samir S. Shah, MD, MSCE
Senior Scholar, Center for Clinical Epidemiology and Biostatistics, The Children's Hospital of Philadelphia
Assistant Professor, Departments of Pediatrics and Biostatistics and Epidemiology, University of Pennsylvania School of Medicine
Philadelphia, PA
Research
Rajendu Srivastava, MD, FRCP(C), MPH
Director of Pediatric Research in the Inpatient Setting (PRIS) Network, Primary Children's Medical Center, Intermountain Healthcare Inc.
Associate Professor, Division of Inpatient Medicine, Department of Pediatrics, University of Utah Health Sciences Center
Salt Lake City, UT
Research
Ben Bauer, MD, FAAP
Pediatric Hospital Medicine; Fellowship Director, Riley Children's Hospital, Indiana University School of Medicine
Indianapolis, IN
John Combes, MD
President/COO, Center for Healthcare Governance, American Hospital Association (AHA)
Washington, DC
Jennifer Daru, MD, FAAP, FHM
Chair‐elect AAP; Section on Hospital Medicine, American Academy of Pediatrics
San Francisco, CA
Jerrold Eichner, MD, FAAP
Chair, AAP National Committee on Hospital Care, American Academy of Pediatrics
Great Falls, MT
Rosemarie Faber, MSN/ED, RN, CCRN
Clinical Practice Specialist, American Association of Critical Care Nurses
Aliso Viejo, CA
Rani S Gereige, MD, MPH, FAAP
Director of Medical Education, Miami Children's Hospital
Miami, FL
David Jaimovich, MD, FAAP
President, QRI (Former Chief Medical Officer and Vice President for International Accreditation Services for Joint Commission Resources (JCR) and Joint Commission International (JCI)), Quality Resources International
Andrea Kline RN, MS, CPNP‐AC, CCRN, FCCM
Executive Board; Professional Issues; Pediatric Critical Care NP, National Association of Pediatric Nurse Practitioners (NAPNAP)
Cherry Hill, NJ
David D. Lloyd, MD, FRCP(C), FAAP
Section Chief of General Pediatrics Children's Healthcare of Atlanta, Director of Undergraduate Pediatric Education, Director of the Pediatric Hospitalist Fellowship, Children's Healthcare of Atlanta, Emory University School of Medicine
Atlanta, GA
Patricia S. Lye, MD, FAAP
AAP Section on Hospital Medicine, American Academy of Pediatrics
Milwaukee, WI
Sanjay Mahant, MD, FRCPC
Pediatric Hospital Medicine Fellowship Director, Hospital for Sick Children, University of Toronto School of Medicine
Toronto, Canada
Jennifer Maniscalco, MD, MPH, FAAP
Pediatric Hospital Medicine Fellowship Director, Children's Hospital Los Angeles
University of Southern California School of Medicine
Marlene Miller, MD, MSc, FAAP
Vice President for Quality, National Association of Children's Hospitals and Related Institutions (NACHRI)
Alexandria, VA
Paul E. Manicone, MD, FAAP
Associate Division Chief; Division of Hospitalist Medicine; Immediate past Fellowship Director, Children's National Medical Center, George Washington University School of Medicine
Washington DC
Warren Newton, MD
American Board of Family Medicine Board of Directors: Research and Development, IT, and Communications/publications Committees; Executive Associate Dean for Medical Education and William B. Aycock Distinguished Professor and Chair, Department of Family Medicine at the University of North Carolina at Chapel Hill, American Board of Family Medicine
Lexington, KY
Daniel Rauch, MD, FAAP, FHM
Chair, AAP Section on Hospital Medicine; Immediate Past Chair, Academic Pediatric Association Hospital Medicine Special Interest Group
AAP and APA
Ellen Schwalenstocker, PhD, MBA
Quality, Advocacy and Measurement, NACHRI
Alexandria, VA
Mary Jean Schuman, MSN, MBA, RN, CPNP
Chief Programs Officer, American Nursing Association
Silver Spring, MD
Neha H. Shah, MD, FAAP
Fellowship Director, Pediatric Hospital Medicine, Children's National Medical Center
George Washington University School of Medicine
Washington, DC
Geeta Singhal, MD, FAAP
Director, Pediatric Hospital Medicine Fellowship; Director, Faculty Inpatient Service; Co‐Director, PEM Faculty Development Program, Texas Children's Hospital, Baylor College of Medicine
Houston, TX
Jeffrey L. Sperring, MD, FAAP
Chair, Academic Pediatric Association Hospital Medicine Special Interest Group
Chief Medical Officer, Academic Pediatric Association
Indianapolis, IN
Erin R. Stucky, MD, FAAP, FHM
Pediatric Hospital Medicine, Fellowship Director, Rady Children's Hospital San Diego
University of California San Diego School of Medicine
San Diego, CA
Editors
Michael G. Burke, MD, MBA
Chairman of Pediatrics, Saint Agnes Hospital
Assistant Professor of Pediatrics, The Johns Hopkins University School of Medicine
Baltimore, MD
Douglas W. Carlson, MD
Chief, Pediatric Hospital Medicine, St. Louis Children's Hospital
Associate Professor of Pediatrics, Washington University
St. Louis, MO
Timothy T. Cornell, MD
C. S. Mott Women and Children's Hospital
Assistant Professor in the Department of Pediatrics and Communicable Diseases, University of Michigan
Ann Arbor, MI
Jack M. Percelay, MD, MPH, FAAP, FHM
Society of Hospital Medicine, Pediatric Board Member; Immediate Past‐Chair, AAP Section on Hospital Medicine, E.L.M.O. Pediatrics
Associate Professor, Pace University Physician Assistant Program
New York, New York
Daniel Rauch, MD, FAAP, FHM
Associate Director of Pediatrics, Elmhurst Hospital
New York
Anand Sekaran, MD
Medical Director, Inpatient Services, Connecticut Children's Medical Center
Assistant Professor of Pediatrics, University of Connecticut School of Medicine
Hartford, CT
E. Douglas Thompson, Jr., MD
Director, Pediatric Generalist Service, St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Philadelphia, PA
Heidi Wolf MD, FAAP
Director Pediatric Hospitalist Program, Johns Hopkins
Assistant Clinical Professor, John Hopkins University
Baltimore, MD
David Zipes, MD FAAP, FHM
Director, St. Vincent Pediatric Hospitalists, Peyton Manning Children's Hospital at St. Vincent
Indianapolis, IN
Senior Editors
Jennifer Maniscalco, MD, MPH, FAAP
Director of Education, Division of Pediatric Hospital Medicine, Children's Hospital Los Angeles
Clinical Assistant Professor of Pediatrics, University of Southern California Keck School of Medicine
Los Angeles, CA
Mary C. Ottolini MD, MPH, FAAP, FHM
Chair, Academic Pediatric Association Education Committee Immediate Past Hospitalist Division Chief; Vice Chair for Medical Education, Children's National Medical Center
Professor of Pediatrics, The George Washington University School of Medicine
Washington DC
Erin R. Stucky, MD, FAAP, FHM
Director of Graduate Medical Education, Rady Children's Hospital San Diego; Medical Director of Quality Improvement, Rady Children's Hospital San Diego; Associate Program Director, UCSD Pediatric Residency Program; Vice Chair for Clinical Affairs, UCSD Department of Pediatrics; Director, Pediatric Hospital Medicine Fellowship, Rady Children's Hospital
Clinical Professor of Pediatrics, University of California San Diego
San Diego, CA
Rishi Agrawal, MD, MPH
Pediatric Hospitalist, Children's Memorial Hospital and LaRabida Children's Hospital
Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine
Chicago, IL
Feeding Tubes
Brian Alverson, MD
Head, Pediatric Hospitalist Section, Hasbro Children's Hospital
Assistant Professor of Pediatrics, Warren Alpert School of Medicine at Brown University
Providence, RI
Neonatal Fever
Pneumonia
Allison Ballantine, MD
Medical Director of the Integrated Care Service, Children's Hospital of Philadelphia
Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine
Philadelphia, PA
Technology Dependent Children
Julia Beauchamp‐Walters, MD
Pediatric Emergency Transport Coordinator, CSSD, RCHHC Pediatric Emergency Transports, Rady Childrens Hospital
Clinical Instructor of Pediatrics, University of California, San Diego
San Diego, CA
Transport of the Critically Ill Child
Glenn F. Billman, MD
Medical Safety and Regulatory Officer, Rady Children's Hospital
San Diego, CA
Patient Safety
April O. Buchanan, MD, FAAP
Vice Chair of Quality, Department of Pediatrics, Children's Hospital at Greenville Hospital System University Medical Center
Assistant Professor of Clinical Pediatrics, University of South Carolina School of Medicine
Greenville, SC
Shock
Douglas W. Carlson, MD
Chief, Pediatric Hospital Medicine, St. Louis Children's Hospital
Associate Professor of Pediatrics, Washington University
St. Louis, MO
Procedural Sedation
Technology Dependent Children
Vincent W. Chiang, MD
Chief, Inpatient Services, Department of Medicine, Children's Hospital Boston
Associate Professor of Pediatrics, Harvard Medical School
Boston, MA
Seizures
Michael R. Clemmens, MD
Director Pediatric Hospitalist Program, Anne Arundel Medical Center
Assistant Clinical Professor of Pediatrics, The George Washington University School of Medicine
Annapolis, MD
Acute Abdominal Pain and The Acute Abdomen
Jamie L. Clute, MD, FAAP, FHM
Medical Director, Inpatient Services, Joe Dimaggio Children's Hospital
Clinical Assistant Professor, NOVA Southeastern University, College of Osteopathic Medicine and Assistant Affiliate Professor, Barry University
Hollywood, FL
Kawasaki Disease
Shannon Connor Phillips, MD, MPH
Patient Safety Officer, Quality and Patient Safety Institute, Cleveland Clinic
Assistant Professor of Pediatrics, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
Cleveland, OH
Evidence Based Medicine
Tanya Dansky, MD
Medical Director, Children's Physicians Medical GroupMedical Director, San Diego Hospice and The Institute For Palliative Medicine, Rady Children's Hospital
Assistant Clinical Professor of Pediatrics, University of California, San Diego
San Diego, CA
Hospice and Palliative Care, Ethics
Jennifer Daru, MD, FAAP, FHM
Chief, Pediatric Hospitalist Division; Interim Chief, Pediatric and Neonatal Transport, California Pacific Medical Center
Clinical Assistant Professor (pending), University of California San Francisco
San Francisco, CA
Leading a Healthcare Team
Newborn Care and Delivery Room Management
Yasmeen N. Daud, MD
Director of Pediatric Hospitalist Sedation in the Pediatric Acute Wound Service and Director of the Pediatric Hospitalist After Hours Sedation Program, St. Louis Children's Hospital
Assistant Professor of Pediatrics, Washington University School of Medicine
St. Louis, MO
Oxygen Delivery and Airway Management
Craig DeWolfe, MD, MEd
Pediatric Hospitalist, Children's National Medical Center
Assistant Professor of Pediatrics, George Washington School of Medicine and Health Sciences
Washington DC
Apparent Life‐Threatening Event
Joseph M. Geskey, DO
Division Chief, Pediatric Hospital Medicine, Medical Director of Hospital Care Management, Penn State Hershey Children's Hospital
Associate Professor of Pediatrics, Penn State M. S. Hershey Medical Center
Hershey, PA
Pneumonia
Upper Airway Infections
Bronchiolitis
Paul D. Hain, MD
Associate Chief of Staff, Monroe Carell Jr. Children's Hospital at Vanderbilt
Assistant Professor of Pediatrics, Vanderbilt University
Nashville, TN
Health Information Systems
Keith Herzog, MD
Pediatric Hospitalist, St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Philadelphia, PA
Central Nervous System Infections
Margaret Hood, MD, FAAP
Pediatric Hospitalist, Seattle Children's Hospital
Clinical Associate Professor of Pediatrics, University of Washington
Seattle, WA
Diabetes Mellitus
Hospice and Palliative Care
Kevin B. Johnson, MD, MS
Vice Chair of Biomedical Informatics, Vanderbilt University Medical Center
Associate Professor of Medical Informatics and Pediatrics, Vanderbilt University Medical Center
Nashville, TN
Health Information Systems
Rick Johnson, MD, FAAP
Division Head, Regional Pediatrics, CCMC, and American Heart Association Regional and National PALS Faculty, Connecticut Children's Medical Center
Assistant Professor of Pediatrics, University of Connecticut School of Medicine
Hartford, CT
Pediatric Advanced Life Support
Brian Kelly, MD, MRCP (UK), FAAP
Pediatric Hospitalist, Ranken Jordan Pediatric Rehabilitative Hospital, St. Louis Children's Hospital
Assistant Professor of Pediatrics, Washington University School of Medicine
St. Louis, MO
Bladder Catheterization/Suprapubic Bladder Tap
Herbert C Kimmons, MD, MMM
President Children's Specialists of San Diego (Medical Quality Officer of Rady Children's Hospital of San Diego, 20062008), Children's Specialists of San Diego in California
Professor of Pediatrics, University of California San Diego
San Diego, CA
Continuous Quality Improvement
Patient Safety
Su‐Ting T. Li, MD, MPH
Associate Pediatric Residency Program Director, University of California, Davis
Assistant Professor of Pediatrics, University of California, Davis
Sacramento, CA
Skin and Soft Tissue Infections
Patricia S. Lye, MD
Medical Director, Hospitalists, Children's Hospital of Wisconsin
Associate Professor of Pediatrics, Medical College of Wisconsin
Milwaukee, WI
Transitions of Care
Jennifer Maniscalco, MD, MPH, FAAP
Director of Education, Division of Pediatric Hospital Medicine, Children's Hospital Los Angeles
Clinical Assistant Professor of Pediatrics, University of Southern California Keck School of Medicine
Los Angeles, CA
Failure to Thrive
Transitions of Care
Nutrition
David E. Marcello III, MD, FAAP
Pediatric Hospitalist, Connecticut Children's Medical Center
Assistant Professor in Pediatrics, University of Connecticut Medical School
Hartford, CT
Lumbar Puncture
Intravenous Access and Phlebotomy
Sanford M. Melzer, MD, MBA
Senior Vice President, Strategic Planning and Business Development, Seattle Children's Hospital
Professor of Pediatrics, University of Washington School of Medicine
Seattle, WA
Cost Effective Care
Margaret I. Mikula, MD
Pediatric Hospitalist, Penn State Hershey Children's Hospital
Assistant Professor of Pediatrics, Penn State M. S. Hershey Medical Center
Hershey, PA
Pneumonia
Bronchiolitis
Laura J Mirkinson, MD, FAAP
Director of Pediatrics, Blythedale Children's Hospital
Valhalla, NY
Neonatal Jaundice
Christopher D. Miller, MD, FAAP
Pediatric Hospitalist and Allergist, Children's Mercy Hospitals and Clinics
Assistant Professor of Pediatrics, University of Missouri‐Kansas City School of Medicine
Kansas City, MO
Asthma
Christopher O'Hara, MD, FACP
St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Philadelphia PA
Pain Management
Mary C. Ottolini MD, MPH, FAAP, FHM
Chair, Academic Pediatric Association Education Committee Immediate Past Hospitalist Division Chief; Vice Chair for Medical Education, Children's National Medical Center
Professor of Pediatrics, The George Washington University School of Medicine
Washington DC
Fluid and Electrolyte Management
Gastroenteritis
Education
Brian M. Pate, MD, FAAP, FHM
Section Chief, Pediatric Hospital Medicine, Vice Chairman, Inpatient Services, Children's Mercy Hospital and Clinics
Assistant Professor of Pediatrics, University of Missouri‐Kansas City School of Medicine
Business Practices
Asthma
Dana Patrick, RN, BSN
Transport Program Manager NICU\PICU, Rady Children's Hospital
San Diego, CA
Transport of the Critically Ill Child
Jack M. Percelay, MD, MPH, FAAP, FHM
Society of Hospital Medicine, Pediatric Board Member; Immediate Past‐Chair, AAP Section on Hospital Medicine, E.L.M.O. Pediatrics
Associate Professor, Pace University Physician Assistant Program
New York, New York
Advocacy
David Pressel, MD, PhD, FHM, FAAP
Director, General Pediatrics Inpatient Services, A.I. duPont Hospital for Children
Assistant Professor of Pediatrics, Jefferson Medical College, Thomas Jefferson University
Wilmington, DE
Child Abuse and Neglect
Kris P Rehm, MD
Director, Division of Hospital Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt
Assistant Professor of Pediatrics, Vanderbilt University
Nashville, TN
Respiratory Failure
Kyung E. Rhee, MD, MSc
Pediatric Hospitalist, Hasbro Children's Hospital and The Weight Control and Diabetes Research Center
Assistant Professor of Pediatrics, Warren Alpert Medical School of Brown University
Providence, RI
Fever of Unknown Origin
Mark F Riederer, MD
Pediatric Hospitalist, Monroe Carell Jr Children's Hospital at Vanderbilt
Assistant Professor of Pediatrics,
Nashville, TN
Respiratory Failure
Michael Ruhlen, MD, MHCM, FAAP, FHM, FACHE
Vice President and Chief Medical Officer, Carolinas Medical Center Mercy
Carolinas Medical Center Pineville
Charlotte, NC
Legal Issues/Risk Management
Henry M. Seidel, MD
Professor Emeritus, Johns Hopkins Berman Institute of Bioethics
Professor Emeritus of Pediatrics, The Johns Hopkins University School of Medicine
Baltimore, MD
Communication
Anand Sekaran, MD
Medical Director, Inpatient Services, Connecticut Children's Medical Center
Assistant Professor of Pediatrics, University of Connecticut School of Medicine
Hartford, CT
Radiographic Interpretation
Kristin A. Shadman, MD, FAAP
Pediatric Hospitalist
Oxygen Delivery and Airway Management
Vipul Singla, MD, FAAP
Site Leader, Lake Forest Hospital (Children's Memorial Medical Group)
Instructor in Pediatrics, Northwestern University Feinberg School of Medicine
Chicago, IL
Electrocardiogram Interpretation
Karen Smith, MD, MEd
Chief Medical Officer, The HSC Pediatric Center
Assistant Professor of Pediatrics, The George Washington University School of Medicine
Washington DC
Apparent Life‐Threatening Event
Jeffrey L. Sperring, MD
Chief Medical Officer, Riley Hospital for Children
Assistant Professor of Pediatrics, Indiana University School of Medicine
Indianapolis, IN
Bone and Joint Infections
Glenn Stryjewski, MD, MPH
Associate Residency Program Director, AI duPont Hospital for Children
Assistant professor of Pediatrics, Jefferson Medical College, Thomas Jefferson University
Wilmington, DE
Toxic Ingestion
Erin R. Stucky, MD, FAAP, FHM
Director of Graduate Medical Education, Rady Children's Hospital San Diego; Medical Director of Quality Improvement, Rady Children's Hospital San Diego; Associate Program Director, UCSD Pediatric Residency Program; Vice Chair for Clinical Affairs, UCSD Department of Pediatrics; Director, Pediatric Hospital Medicine Fellowship, Rady Children's Hospital
Clinical Professor of Pediatrics, University of California San Diego
San Diego, CA
Evidence Based Medicine
Continuous Quality Improvement
Technology Dependent Children
E. Douglas Thompson, Jr., MD
Director, Pediatric Generalist Service, St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Philadelphia, PA
Sickle Cell Disease
Michael Turmelle, MD
Pediatric Hospitalist, St. Louis Children's Hospital
Assistant Professor of Pediatrics, Washington University School of Medicine
St. Louis, MO
Non‐Invasive Monitoring
Macdara G. Tynan, MD, MBA, FAAP
Associate Director of Inpatient Pediatrics, Levine Children's Hospital
Charlotte, NC
Diabetes Mellitus
Toxic Ingestion
Ronald J. Williams, MD
Pediatric Hospitalist, Penn State Hershey Children's Hospital
Associate Professor of Pediatrics and Medicine, Penn State M. S. Hershey Medical Center
Hershey, PA
Upper Airway Infections
Heidi Wolf MD, FAAP
Director Pediatric Hospitalist Program, Johns Hopkins
Assistant Clinical Professor, John Hopkins University
Baltimore, MD
Fever of Unknown Origin
Neonatal Fever
Susan Wu, MD
Pediatric Hospitalist, Children's Hospital Los Angeles
Clinical Assistant Professor of Pediatrics, University of Southern California Keck School of Medicine
Los Angeles, CA
Bronchiolitis
Lisa B. Zaoutis, MD
Section Chief of Inpatient Services, Division of General Pediatrics, The Children's Hospital of Philadelphia
Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine
Philadelphia, PA
Urinary Tract Infections
William T. Zempsky, MD
Associate Director; Division of Pain Medicine; Department of Pediatrics, Associate Director, Pain Relief Program, Connecticut Children's Medical Center
Professor of Pediatrics, University of Connecticut School of Medicine
Hartford, CT
Pain Management
Reviewers
Allison Ballantine, MD
Medical Director of the Integrated Care Service, Children's Hospital of Philadelphia
Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine
Philadelphia, PA
Technology Dependent Children
Margaret Hood, MD, FAAP
Pediatric Hospitalist, Seattle Children's Hospital
Clinical Associate Professor of Pediatrics, University of Washington
Seattle, WA
Hospice and Palliative Care
Ethics
Brian Kit, MD, MPH
Anne Arundel Medical Center
Assistant Professor of Pediatrics, The George Washington University School of Medicine
Annapolis, MD
Advocacy
Evelina M. Krieger, MD
Children's National Medical Center
Assistant Professor of Pediatrics, The George Washington University School of Medicine
Washington, DC
Advocacy
Cynthia L. Kuelbs, MD
Medical Director, Chadwick Center for Child Abuse; Division Director Pediatric Hospital Medicine, Rady Children's Hospital
Associate Clinical Professor of Pediatrics, University of California San Diego
San Diego, CA
Child Abuse and Neglect
Christopher P. Landrigan, MD, MPH
Division Director, Pediatrics and Hospital Medicine; Research and Fellowship Director, Children's Hospital Boston Inpatient Pediatrics Service; Director, Sleep and Patient Safety Program at the Brigham and Women's Hospital, Children's Hospital Boston
Assistant Professor of Pediatrics and Medicine, Harvard Medical School
Boston, MA
Research
Michael Ruhlen, MD, MHCM, FAAP, FHM, FACHE
Vice President and Chief Medical Officer, Carolinas Medical Center Mercy
Carolinas Medical Center Pineville
Charlotte, NC
Legal Issues/Risk Management
Samir S. Shah, MD, MSCE
Senior Scholar, Center for Clinical Epidemiology and Biostatistics, The Children's Hospital of Philadelphia
Assistant Professor, Departments of Pediatrics and Biostatistics and Epidemiology, University of Pennsylvania School of Medicine
Philadelphia, PA
Research
Rajendu Srivastava, MD, FRCP(C), MPH
Director of Pediatric Research in the Inpatient Setting (PRIS) Network, Primary Children's Medical Center, Intermountain Healthcare Inc.
Associate Professor, Division of Inpatient Medicine, Department of Pediatrics, University of Utah Health Sciences Center
Salt Lake City, UT
Research
Ben Bauer, MD, FAAP
Pediatric Hospital Medicine; Fellowship Director, Riley Children's Hospital, Indiana University School of Medicine
Indianapolis, IN
John Combes, MD
President/COO, Center for Healthcare Governance, American Hospital Association (AHA)
Washington, DC
Jennifer Daru, MD, FAAP, FHM
Chair‐elect AAP; Section on Hospital Medicine, American Academy of Pediatrics
San Francisco, CA
Jerrold Eichner, MD, FAAP
Chair, AAP National Committee on Hospital Care, American Academy of Pediatrics
Great Falls, MT
Rosemarie Faber, MSN/ED, RN, CCRN
Clinical Practice Specialist, American Association of Critical Care Nurses
Aliso Viejo, CA
Rani S Gereige, MD, MPH, FAAP
Director of Medical Education, Miami Children's Hospital
Miami, FL
David Jaimovich, MD, FAAP
President, QRI (Former Chief Medical Officer and Vice President for International Accreditation Services for Joint Commission Resources (JCR) and Joint Commission International (JCI)), Quality Resources International
Andrea Kline RN, MS, CPNP‐AC, CCRN, FCCM
Executive Board; Professional Issues; Pediatric Critical Care NP, National Association of Pediatric Nurse Practitioners (NAPNAP)
Cherry Hill, NJ
David D. Lloyd, MD, FRCP(C), FAAP
Section Chief of General Pediatrics Children's Healthcare of Atlanta, Director of Undergraduate Pediatric Education, Director of the Pediatric Hospitalist Fellowship, Children's Healthcare of Atlanta, Emory University School of Medicine
Atlanta, GA
Patricia S. Lye, MD, FAAP
AAP Section on Hospital Medicine, American Academy of Pediatrics
Milwaukee, WI
Sanjay Mahant, MD, FRCPC
Pediatric Hospital Medicine Fellowship Director, Hospital for Sick Children, University of Toronto School of Medicine
Toronto, Canada
Jennifer Maniscalco, MD, MPH, FAAP
Pediatric Hospital Medicine Fellowship Director, Children's Hospital Los Angeles
University of Southern California School of Medicine
Marlene Miller, MD, MSc, FAAP
Vice President for Quality, National Association of Children's Hospitals and Related Institutions (NACHRI)
Alexandria, VA
Paul E. Manicone, MD, FAAP
Associate Division Chief; Division of Hospitalist Medicine; Immediate past Fellowship Director, Children's National Medical Center, George Washington University School of Medicine
Washington DC
Warren Newton, MD
American Board of Family Medicine Board of Directors: Research and Development, IT, and Communications/publications Committees; Executive Associate Dean for Medical Education and William B. Aycock Distinguished Professor and Chair, Department of Family Medicine at the University of North Carolina at Chapel Hill, American Board of Family Medicine
Lexington, KY
Daniel Rauch, MD, FAAP, FHM
Chair, AAP Section on Hospital Medicine; Immediate Past Chair, Academic Pediatric Association Hospital Medicine Special Interest Group
AAP and APA
Ellen Schwalenstocker, PhD, MBA
Quality, Advocacy and Measurement, NACHRI
Alexandria, VA
Mary Jean Schuman, MSN, MBA, RN, CPNP
Chief Programs Officer, American Nursing Association
Silver Spring, MD
Neha H. Shah, MD, FAAP
Fellowship Director, Pediatric Hospital Medicine, Children's National Medical Center
George Washington University School of Medicine
Washington, DC
Geeta Singhal, MD, FAAP
Director, Pediatric Hospital Medicine Fellowship; Director, Faculty Inpatient Service; Co‐Director, PEM Faculty Development Program, Texas Children's Hospital, Baylor College of Medicine
Houston, TX
Jeffrey L. Sperring, MD, FAAP
Chair, Academic Pediatric Association Hospital Medicine Special Interest Group
Chief Medical Officer, Academic Pediatric Association
Indianapolis, IN
Erin R. Stucky, MD, FAAP, FHM
Pediatric Hospital Medicine, Fellowship Director, Rady Children's Hospital San Diego
University of California San Diego School of Medicine
San Diego, CA
Editors
Michael G. Burke, MD, MBA
Chairman of Pediatrics, Saint Agnes Hospital
Assistant Professor of Pediatrics, The Johns Hopkins University School of Medicine
Baltimore, MD
Douglas W. Carlson, MD
Chief, Pediatric Hospital Medicine, St. Louis Children's Hospital
Associate Professor of Pediatrics, Washington University
St. Louis, MO
Timothy T. Cornell, MD
C. S. Mott Women and Children's Hospital
Assistant Professor in the Department of Pediatrics and Communicable Diseases, University of Michigan
Ann Arbor, MI
Jack M. Percelay, MD, MPH, FAAP, FHM
Society of Hospital Medicine, Pediatric Board Member; Immediate Past‐Chair, AAP Section on Hospital Medicine, E.L.M.O. Pediatrics
Associate Professor, Pace University Physician Assistant Program
New York, New York
Daniel Rauch, MD, FAAP, FHM
Associate Director of Pediatrics, Elmhurst Hospital
New York
Anand Sekaran, MD
Medical Director, Inpatient Services, Connecticut Children's Medical Center
Assistant Professor of Pediatrics, University of Connecticut School of Medicine
Hartford, CT
E. Douglas Thompson, Jr., MD
Director, Pediatric Generalist Service, St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Philadelphia, PA
Heidi Wolf MD, FAAP
Director Pediatric Hospitalist Program, Johns Hopkins
Assistant Clinical Professor, John Hopkins University
Baltimore, MD
David Zipes, MD FAAP, FHM
Director, St. Vincent Pediatric Hospitalists, Peyton Manning Children's Hospital at St. Vincent
Indianapolis, IN
Senior Editors
Jennifer Maniscalco, MD, MPH, FAAP
Director of Education, Division of Pediatric Hospital Medicine, Children's Hospital Los Angeles
Clinical Assistant Professor of Pediatrics, University of Southern California Keck School of Medicine
Los Angeles, CA
Mary C. Ottolini MD, MPH, FAAP, FHM
Chair, Academic Pediatric Association Education Committee Immediate Past Hospitalist Division Chief; Vice Chair for Medical Education, Children's National Medical Center
Professor of Pediatrics, The George Washington University School of Medicine
Washington DC
Erin R. Stucky, MD, FAAP, FHM
Director of Graduate Medical Education, Rady Children's Hospital San Diego; Medical Director of Quality Improvement, Rady Children's Hospital San Diego; Associate Program Director, UCSD Pediatric Residency Program; Vice Chair for Clinical Affairs, UCSD Department of Pediatrics; Director, Pediatric Hospital Medicine Fellowship, Rady Children's Hospital
Clinical Professor of Pediatrics, University of California San Diego
San Diego, CA
Rishi Agrawal, MD, MPH
Pediatric Hospitalist, Children's Memorial Hospital and LaRabida Children's Hospital
Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine
Chicago, IL
Feeding Tubes
Brian Alverson, MD
Head, Pediatric Hospitalist Section, Hasbro Children's Hospital
Assistant Professor of Pediatrics, Warren Alpert School of Medicine at Brown University
Providence, RI
Neonatal Fever
Pneumonia
Allison Ballantine, MD
Medical Director of the Integrated Care Service, Children's Hospital of Philadelphia
Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine
Philadelphia, PA
Technology Dependent Children
Julia Beauchamp‐Walters, MD
Pediatric Emergency Transport Coordinator, CSSD, RCHHC Pediatric Emergency Transports, Rady Childrens Hospital
Clinical Instructor of Pediatrics, University of California, San Diego
San Diego, CA
Transport of the Critically Ill Child
Glenn F. Billman, MD
Medical Safety and Regulatory Officer, Rady Children's Hospital
San Diego, CA
Patient Safety
April O. Buchanan, MD, FAAP
Vice Chair of Quality, Department of Pediatrics, Children's Hospital at Greenville Hospital System University Medical Center
Assistant Professor of Clinical Pediatrics, University of South Carolina School of Medicine
Greenville, SC
Shock
Douglas W. Carlson, MD
Chief, Pediatric Hospital Medicine, St. Louis Children's Hospital
Associate Professor of Pediatrics, Washington University
St. Louis, MO
Procedural Sedation
Technology Dependent Children
Vincent W. Chiang, MD
Chief, Inpatient Services, Department of Medicine, Children's Hospital Boston
Associate Professor of Pediatrics, Harvard Medical School
Boston, MA
Seizures
Michael R. Clemmens, MD
Director Pediatric Hospitalist Program, Anne Arundel Medical Center
Assistant Clinical Professor of Pediatrics, The George Washington University School of Medicine
Annapolis, MD
Acute Abdominal Pain and The Acute Abdomen
Jamie L. Clute, MD, FAAP, FHM
Medical Director, Inpatient Services, Joe Dimaggio Children's Hospital
Clinical Assistant Professor, NOVA Southeastern University, College of Osteopathic Medicine and Assistant Affiliate Professor, Barry University
Hollywood, FL
Kawasaki Disease
Shannon Connor Phillips, MD, MPH
Patient Safety Officer, Quality and Patient Safety Institute, Cleveland Clinic
Assistant Professor of Pediatrics, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
Cleveland, OH
Evidence Based Medicine
Tanya Dansky, MD
Medical Director, Children's Physicians Medical GroupMedical Director, San Diego Hospice and The Institute For Palliative Medicine, Rady Children's Hospital
Assistant Clinical Professor of Pediatrics, University of California, San Diego
San Diego, CA
Hospice and Palliative Care, Ethics
Jennifer Daru, MD, FAAP, FHM
Chief, Pediatric Hospitalist Division; Interim Chief, Pediatric and Neonatal Transport, California Pacific Medical Center
Clinical Assistant Professor (pending), University of California San Francisco
San Francisco, CA
Leading a Healthcare Team
Newborn Care and Delivery Room Management
Yasmeen N. Daud, MD
Director of Pediatric Hospitalist Sedation in the Pediatric Acute Wound Service and Director of the Pediatric Hospitalist After Hours Sedation Program, St. Louis Children's Hospital
Assistant Professor of Pediatrics, Washington University School of Medicine
St. Louis, MO
Oxygen Delivery and Airway Management
Craig DeWolfe, MD, MEd
Pediatric Hospitalist, Children's National Medical Center
Assistant Professor of Pediatrics, George Washington School of Medicine and Health Sciences
Washington DC
Apparent Life‐Threatening Event
Joseph M. Geskey, DO
Division Chief, Pediatric Hospital Medicine, Medical Director of Hospital Care Management, Penn State Hershey Children's Hospital
Associate Professor of Pediatrics, Penn State M. S. Hershey Medical Center
Hershey, PA
Pneumonia
Upper Airway Infections
Bronchiolitis
Paul D. Hain, MD
Associate Chief of Staff, Monroe Carell Jr. Children's Hospital at Vanderbilt
Assistant Professor of Pediatrics, Vanderbilt University
Nashville, TN
Health Information Systems
Keith Herzog, MD
Pediatric Hospitalist, St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Philadelphia, PA
Central Nervous System Infections
Margaret Hood, MD, FAAP
Pediatric Hospitalist, Seattle Children's Hospital
Clinical Associate Professor of Pediatrics, University of Washington
Seattle, WA
Diabetes Mellitus
Hospice and Palliative Care
Kevin B. Johnson, MD, MS
Vice Chair of Biomedical Informatics, Vanderbilt University Medical Center
Associate Professor of Medical Informatics and Pediatrics, Vanderbilt University Medical Center
Nashville, TN
Health Information Systems
Rick Johnson, MD, FAAP
Division Head, Regional Pediatrics, CCMC, and American Heart Association Regional and National PALS Faculty, Connecticut Children's Medical Center
Assistant Professor of Pediatrics, University of Connecticut School of Medicine
Hartford, CT
Pediatric Advanced Life Support
Brian Kelly, MD, MRCP (UK), FAAP
Pediatric Hospitalist, Ranken Jordan Pediatric Rehabilitative Hospital, St. Louis Children's Hospital
Assistant Professor of Pediatrics, Washington University School of Medicine
St. Louis, MO
Bladder Catheterization/Suprapubic Bladder Tap
Herbert C Kimmons, MD, MMM
President Children's Specialists of San Diego (Medical Quality Officer of Rady Children's Hospital of San Diego, 20062008), Children's Specialists of San Diego in California
Professor of Pediatrics, University of California San Diego
San Diego, CA
Continuous Quality Improvement
Patient Safety
Su‐Ting T. Li, MD, MPH
Associate Pediatric Residency Program Director, University of California, Davis
Assistant Professor of Pediatrics, University of California, Davis
Sacramento, CA
Skin and Soft Tissue Infections
Patricia S. Lye, MD
Medical Director, Hospitalists, Children's Hospital of Wisconsin
Associate Professor of Pediatrics, Medical College of Wisconsin
Milwaukee, WI
Transitions of Care
Jennifer Maniscalco, MD, MPH, FAAP
Director of Education, Division of Pediatric Hospital Medicine, Children's Hospital Los Angeles
Clinical Assistant Professor of Pediatrics, University of Southern California Keck School of Medicine
Los Angeles, CA
Failure to Thrive
Transitions of Care
Nutrition
David E. Marcello III, MD, FAAP
Pediatric Hospitalist, Connecticut Children's Medical Center
Assistant Professor in Pediatrics, University of Connecticut Medical School
Hartford, CT
Lumbar Puncture
Intravenous Access and Phlebotomy
Sanford M. Melzer, MD, MBA
Senior Vice President, Strategic Planning and Business Development, Seattle Children's Hospital
Professor of Pediatrics, University of Washington School of Medicine
Seattle, WA
Cost Effective Care
Margaret I. Mikula, MD
Pediatric Hospitalist, Penn State Hershey Children's Hospital
Assistant Professor of Pediatrics, Penn State M. S. Hershey Medical Center
Hershey, PA
Pneumonia
Bronchiolitis
Laura J Mirkinson, MD, FAAP
Director of Pediatrics, Blythedale Children's Hospital
Valhalla, NY
Neonatal Jaundice
Christopher D. Miller, MD, FAAP
Pediatric Hospitalist and Allergist, Children's Mercy Hospitals and Clinics
Assistant Professor of Pediatrics, University of Missouri‐Kansas City School of Medicine
Kansas City, MO
Asthma
Christopher O'Hara, MD, FACP
St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Philadelphia PA
Pain Management
Mary C. Ottolini MD, MPH, FAAP, FHM
Chair, Academic Pediatric Association Education Committee Immediate Past Hospitalist Division Chief; Vice Chair for Medical Education, Children's National Medical Center
Professor of Pediatrics, The George Washington University School of Medicine
Washington DC
Fluid and Electrolyte Management
Gastroenteritis
Education
Brian M. Pate, MD, FAAP, FHM
Section Chief, Pediatric Hospital Medicine, Vice Chairman, Inpatient Services, Children's Mercy Hospital and Clinics
Assistant Professor of Pediatrics, University of Missouri‐Kansas City School of Medicine
Business Practices
Asthma
Dana Patrick, RN, BSN
Transport Program Manager NICU\PICU, Rady Children's Hospital
San Diego, CA
Transport of the Critically Ill Child
Jack M. Percelay, MD, MPH, FAAP, FHM
Society of Hospital Medicine, Pediatric Board Member; Immediate Past‐Chair, AAP Section on Hospital Medicine, E.L.M.O. Pediatrics
Associate Professor, Pace University Physician Assistant Program
New York, New York
Advocacy
David Pressel, MD, PhD, FHM, FAAP
Director, General Pediatrics Inpatient Services, A.I. duPont Hospital for Children
Assistant Professor of Pediatrics, Jefferson Medical College, Thomas Jefferson University
Wilmington, DE
Child Abuse and Neglect
Kris P Rehm, MD
Director, Division of Hospital Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt
Assistant Professor of Pediatrics, Vanderbilt University
Nashville, TN
Respiratory Failure
Kyung E. Rhee, MD, MSc
Pediatric Hospitalist, Hasbro Children's Hospital and The Weight Control and Diabetes Research Center
Assistant Professor of Pediatrics, Warren Alpert Medical School of Brown University
Providence, RI
Fever of Unknown Origin
Mark F Riederer, MD
Pediatric Hospitalist, Monroe Carell Jr Children's Hospital at Vanderbilt
Assistant Professor of Pediatrics,
Nashville, TN
Respiratory Failure
Michael Ruhlen, MD, MHCM, FAAP, FHM, FACHE
Vice President and Chief Medical Officer, Carolinas Medical Center Mercy
Carolinas Medical Center Pineville
Charlotte, NC
Legal Issues/Risk Management
Henry M. Seidel, MD
Professor Emeritus, Johns Hopkins Berman Institute of Bioethics
Professor Emeritus of Pediatrics, The Johns Hopkins University School of Medicine
Baltimore, MD
Communication
Anand Sekaran, MD
Medical Director, Inpatient Services, Connecticut Children's Medical Center
Assistant Professor of Pediatrics, University of Connecticut School of Medicine
Hartford, CT
Radiographic Interpretation
Kristin A. Shadman, MD, FAAP
Pediatric Hospitalist
Oxygen Delivery and Airway Management
Vipul Singla, MD, FAAP
Site Leader, Lake Forest Hospital (Children's Memorial Medical Group)
Instructor in Pediatrics, Northwestern University Feinberg School of Medicine
Chicago, IL
Electrocardiogram Interpretation
Karen Smith, MD, MEd
Chief Medical Officer, The HSC Pediatric Center
Assistant Professor of Pediatrics, The George Washington University School of Medicine
Washington DC
Apparent Life‐Threatening Event
Jeffrey L. Sperring, MD
Chief Medical Officer, Riley Hospital for Children
Assistant Professor of Pediatrics, Indiana University School of Medicine
Indianapolis, IN
Bone and Joint Infections
Glenn Stryjewski, MD, MPH
Associate Residency Program Director, AI duPont Hospital for Children
Assistant professor of Pediatrics, Jefferson Medical College, Thomas Jefferson University
Wilmington, DE
Toxic Ingestion
Erin R. Stucky, MD, FAAP, FHM
Director of Graduate Medical Education, Rady Children's Hospital San Diego; Medical Director of Quality Improvement, Rady Children's Hospital San Diego; Associate Program Director, UCSD Pediatric Residency Program; Vice Chair for Clinical Affairs, UCSD Department of Pediatrics; Director, Pediatric Hospital Medicine Fellowship, Rady Children's Hospital
Clinical Professor of Pediatrics, University of California San Diego
San Diego, CA
Evidence Based Medicine
Continuous Quality Improvement
Technology Dependent Children
E. Douglas Thompson, Jr., MD
Director, Pediatric Generalist Service, St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Philadelphia, PA
Sickle Cell Disease
Michael Turmelle, MD
Pediatric Hospitalist, St. Louis Children's Hospital
Assistant Professor of Pediatrics, Washington University School of Medicine
St. Louis, MO
Non‐Invasive Monitoring
Macdara G. Tynan, MD, MBA, FAAP
Associate Director of Inpatient Pediatrics, Levine Children's Hospital
Charlotte, NC
Diabetes Mellitus
Toxic Ingestion
Ronald J. Williams, MD
Pediatric Hospitalist, Penn State Hershey Children's Hospital
Associate Professor of Pediatrics and Medicine, Penn State M. S. Hershey Medical Center
Hershey, PA
Upper Airway Infections
Heidi Wolf MD, FAAP
Director Pediatric Hospitalist Program, Johns Hopkins
Assistant Clinical Professor, John Hopkins University
Baltimore, MD
Fever of Unknown Origin
Neonatal Fever
Susan Wu, MD
Pediatric Hospitalist, Children's Hospital Los Angeles
Clinical Assistant Professor of Pediatrics, University of Southern California Keck School of Medicine
Los Angeles, CA
Bronchiolitis
Lisa B. Zaoutis, MD
Section Chief of Inpatient Services, Division of General Pediatrics, The Children's Hospital of Philadelphia
Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine
Philadelphia, PA
Urinary Tract Infections
William T. Zempsky, MD
Associate Director; Division of Pain Medicine; Department of Pediatrics, Associate Director, Pain Relief Program, Connecticut Children's Medical Center
Professor of Pediatrics, University of Connecticut School of Medicine
Hartford, CT
Pain Management
Reviewers
Allison Ballantine, MD
Medical Director of the Integrated Care Service, Children's Hospital of Philadelphia
Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine
Philadelphia, PA
Technology Dependent Children
Margaret Hood, MD, FAAP
Pediatric Hospitalist, Seattle Children's Hospital
Clinical Associate Professor of Pediatrics, University of Washington
Seattle, WA
Hospice and Palliative Care
Ethics
Brian Kit, MD, MPH
Anne Arundel Medical Center
Assistant Professor of Pediatrics, The George Washington University School of Medicine
Annapolis, MD
Advocacy
Evelina M. Krieger, MD
Children's National Medical Center
Assistant Professor of Pediatrics, The George Washington University School of Medicine
Washington, DC
Advocacy
Cynthia L. Kuelbs, MD
Medical Director, Chadwick Center for Child Abuse; Division Director Pediatric Hospital Medicine, Rady Children's Hospital
Associate Clinical Professor of Pediatrics, University of California San Diego
San Diego, CA
Child Abuse and Neglect
Christopher P. Landrigan, MD, MPH
Division Director, Pediatrics and Hospital Medicine; Research and Fellowship Director, Children's Hospital Boston Inpatient Pediatrics Service; Director, Sleep and Patient Safety Program at the Brigham and Women's Hospital, Children's Hospital Boston
Assistant Professor of Pediatrics and Medicine, Harvard Medical School
Boston, MA
Research
Michael Ruhlen, MD, MHCM, FAAP, FHM, FACHE
Vice President and Chief Medical Officer, Carolinas Medical Center Mercy
Carolinas Medical Center Pineville
Charlotte, NC
Legal Issues/Risk Management
Samir S. Shah, MD, MSCE
Senior Scholar, Center for Clinical Epidemiology and Biostatistics, The Children's Hospital of Philadelphia
Assistant Professor, Departments of Pediatrics and Biostatistics and Epidemiology, University of Pennsylvania School of Medicine
Philadelphia, PA
Research
Rajendu Srivastava, MD, FRCP(C), MPH
Director of Pediatric Research in the Inpatient Setting (PRIS) Network, Primary Children's Medical Center, Intermountain Healthcare Inc.
Associate Professor, Division of Inpatient Medicine, Department of Pediatrics, University of Utah Health Sciences Center
Salt Lake City, UT
Research
Ben Bauer, MD, FAAP
Pediatric Hospital Medicine; Fellowship Director, Riley Children's Hospital, Indiana University School of Medicine
Indianapolis, IN
John Combes, MD
President/COO, Center for Healthcare Governance, American Hospital Association (AHA)
Washington, DC
Jennifer Daru, MD, FAAP, FHM
Chair‐elect AAP; Section on Hospital Medicine, American Academy of Pediatrics
San Francisco, CA
Jerrold Eichner, MD, FAAP
Chair, AAP National Committee on Hospital Care, American Academy of Pediatrics
Great Falls, MT
Rosemarie Faber, MSN/ED, RN, CCRN
Clinical Practice Specialist, American Association of Critical Care Nurses
Aliso Viejo, CA
Rani S Gereige, MD, MPH, FAAP
Director of Medical Education, Miami Children's Hospital
Miami, FL
David Jaimovich, MD, FAAP
President, QRI (Former Chief Medical Officer and Vice President for International Accreditation Services for Joint Commission Resources (JCR) and Joint Commission International (JCI)), Quality Resources International
Andrea Kline RN, MS, CPNP‐AC, CCRN, FCCM
Executive Board; Professional Issues; Pediatric Critical Care NP, National Association of Pediatric Nurse Practitioners (NAPNAP)
Cherry Hill, NJ
David D. Lloyd, MD, FRCP(C), FAAP
Section Chief of General Pediatrics Children's Healthcare of Atlanta, Director of Undergraduate Pediatric Education, Director of the Pediatric Hospitalist Fellowship, Children's Healthcare of Atlanta, Emory University School of Medicine
Atlanta, GA
Patricia S. Lye, MD, FAAP
AAP Section on Hospital Medicine, American Academy of Pediatrics
Milwaukee, WI
Sanjay Mahant, MD, FRCPC
Pediatric Hospital Medicine Fellowship Director, Hospital for Sick Children, University of Toronto School of Medicine
Toronto, Canada
Jennifer Maniscalco, MD, MPH, FAAP
Pediatric Hospital Medicine Fellowship Director, Children's Hospital Los Angeles
University of Southern California School of Medicine
Marlene Miller, MD, MSc, FAAP
Vice President for Quality, National Association of Children's Hospitals and Related Institutions (NACHRI)
Alexandria, VA
Paul E. Manicone, MD, FAAP
Associate Division Chief; Division of Hospitalist Medicine; Immediate past Fellowship Director, Children's National Medical Center, George Washington University School of Medicine
Washington DC
Warren Newton, MD
American Board of Family Medicine Board of Directors: Research and Development, IT, and Communications/publications Committees; Executive Associate Dean for Medical Education and William B. Aycock Distinguished Professor and Chair, Department of Family Medicine at the University of North Carolina at Chapel Hill, American Board of Family Medicine
Lexington, KY
Daniel Rauch, MD, FAAP, FHM
Chair, AAP Section on Hospital Medicine; Immediate Past Chair, Academic Pediatric Association Hospital Medicine Special Interest Group
AAP and APA
Ellen Schwalenstocker, PhD, MBA
Quality, Advocacy and Measurement, NACHRI
Alexandria, VA
Mary Jean Schuman, MSN, MBA, RN, CPNP
Chief Programs Officer, American Nursing Association
Silver Spring, MD
Neha H. Shah, MD, FAAP
Fellowship Director, Pediatric Hospital Medicine, Children's National Medical Center
George Washington University School of Medicine
Washington, DC
Geeta Singhal, MD, FAAP
Director, Pediatric Hospital Medicine Fellowship; Director, Faculty Inpatient Service; Co‐Director, PEM Faculty Development Program, Texas Children's Hospital, Baylor College of Medicine
Houston, TX
Jeffrey L. Sperring, MD, FAAP
Chair, Academic Pediatric Association Hospital Medicine Special Interest Group
Chief Medical Officer, Academic Pediatric Association
Indianapolis, IN
Erin R. Stucky, MD, FAAP, FHM
Pediatric Hospital Medicine, Fellowship Director, Rady Children's Hospital San Diego
University of California San Diego School of Medicine
San Diego, CA
Editors
Michael G. Burke, MD, MBA
Chairman of Pediatrics, Saint Agnes Hospital
Assistant Professor of Pediatrics, The Johns Hopkins University School of Medicine
Baltimore, MD
Douglas W. Carlson, MD
Chief, Pediatric Hospital Medicine, St. Louis Children's Hospital
Associate Professor of Pediatrics, Washington University
St. Louis, MO
Timothy T. Cornell, MD
C. S. Mott Women and Children's Hospital
Assistant Professor in the Department of Pediatrics and Communicable Diseases, University of Michigan
Ann Arbor, MI
Jack M. Percelay, MD, MPH, FAAP, FHM
Society of Hospital Medicine, Pediatric Board Member; Immediate Past‐Chair, AAP Section on Hospital Medicine, E.L.M.O. Pediatrics
Associate Professor, Pace University Physician Assistant Program
New York, New York
Daniel Rauch, MD, FAAP, FHM
Associate Director of Pediatrics, Elmhurst Hospital
New York
Anand Sekaran, MD
Medical Director, Inpatient Services, Connecticut Children's Medical Center
Assistant Professor of Pediatrics, University of Connecticut School of Medicine
Hartford, CT
E. Douglas Thompson, Jr., MD
Director, Pediatric Generalist Service, St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Philadelphia, PA
Heidi Wolf MD, FAAP
Director Pediatric Hospitalist Program, Johns Hopkins
Assistant Clinical Professor, John Hopkins University
Baltimore, MD
David Zipes, MD FAAP, FHM
Director, St. Vincent Pediatric Hospitalists, Peyton Manning Children's Hospital at St. Vincent
Indianapolis, IN
Senior Editors
Jennifer Maniscalco, MD, MPH, FAAP
Director of Education, Division of Pediatric Hospital Medicine, Children's Hospital Los Angeles
Clinical Assistant Professor of Pediatrics, University of Southern California Keck School of Medicine
Los Angeles, CA
Mary C. Ottolini MD, MPH, FAAP, FHM
Chair, Academic Pediatric Association Education Committee Immediate Past Hospitalist Division Chief; Vice Chair for Medical Education, Children's National Medical Center
Professor of Pediatrics, The George Washington University School of Medicine
Washington DC
Erin R. Stucky, MD, FAAP, FHM
Director of Graduate Medical Education, Rady Children's Hospital San Diego; Medical Director of Quality Improvement, Rady Children's Hospital San Diego; Associate Program Director, UCSD Pediatric Residency Program; Vice Chair for Clinical Affairs, UCSD Department of Pediatrics; Director, Pediatric Hospital Medicine Fellowship, Rady Children's Hospital
Clinical Professor of Pediatrics, University of California San Diego
San Diego, CA
Copyright © 2010 Society of Hospital Medicine
Transitions of care
Introduction
Transitions of care occur when a patient moves from one level of care to another or from one institution to another. One component of transitions of care is the patient handoff, which refers to the interaction between providers when responsibility for patient care is transferred from one provider to another. Ineffective transitions of care jeopardize patient safety and may result in adverse events, increased healthcare utilization, and patient or caregiver stress. Thus, every transition of care should involve a set of actions designed to ensure that the transfer is safe, efficient, and effective. Pediatric hospitalists are routinely involved in patient transfers and can lead institutional efforts to promote optimal patient handoffs and transitions of care.
Knowledge
Pediatric hospitalists should be able to:
Compare and contrast patient handoffs with transitions of care.
List the critical elements that should be communicated between providers at the time of a patient handoff, and describe how these elements may vary depending on characteristics of the patient or the provider.
List the relevant information that should be communicated during each transition of care to ensure patient safety and promote the continuum of care.
Explain the pros and cons of different modes of communication in the context of the various types of patient transfers.
Differentiate between the available levels of care and determine the most appropriate option for each patient, taking the need for isolation and level of nursing care into account.
Describe the impact of the Emergency Medical Treatment and Active Labor Act (EMTALA) on patient transfers.
Articulate the National Patient Safety Goals that relate to transitions of care, including effectiveness of communication and medication reconciliation.
Skills
Pediatric hospitalists should be able to:
Prepare concise clinical summaries in preparation for patient handoffs or transitions of care, incorporating key elements as appropriate.
Utilize the most efficient and reliable mode of communication for each transition of care.
Arrange safe and efficient transfers to, from, and within the inpatient setting.
Promptly review the medical information received from referring providers and clarify any discrepancies when accepting a new patient.
Anticipate needs at the time of discharge and begin discharge planning early in the hospitalization.
Provide legible and clear discharge instructions that take into account the primary language and reading level of the patient and caregiver and include information about available resources after discharge should questions arise.
Communicate effectively with the primary care provider and other providers as necessary at the time of admission, discharge, and when there is a significant change in clinical status.
Accurately and completely reconcile medications during transitions of care.
Develop systems to ensure the future comprehensive review of patient data that was pending at the time of discharge.
Attitudes
Pediatric hospitalists should be able to:
Appreciate the impact of ineffective handoffs and transitions of care on patient safety and quality of care.
Demonstrate respect for referring physicians and seek their input when developing protocols for communication during transitions of care.
Appreciate the impact of the transfer on the patient and caregiver and ensure their goals and preferences are incorporated into the care plan at all stages of the transition of care.
Take responsibility for the coordination of a multidisciplinary approach to patient and caregiver education in preparation for the transition of care.
Maintain availability to patients, caregivers, and providers after transitions of care should questions arise.
Systems Organization and Improvement
Pediatric hospitalists should be able to:
Lead, coordinate, or participate in the ongoing evaluation and improvement of the referral, admission, and discharge processes at their institution, taking into account input from stakeholders.
Lead, coordinate, or participate in initiatives to develop and implement systems that promote timely and effective communication between providers during handoffs and transitions of care.
Introduction
Transitions of care occur when a patient moves from one level of care to another or from one institution to another. One component of transitions of care is the patient handoff, which refers to the interaction between providers when responsibility for patient care is transferred from one provider to another. Ineffective transitions of care jeopardize patient safety and may result in adverse events, increased healthcare utilization, and patient or caregiver stress. Thus, every transition of care should involve a set of actions designed to ensure that the transfer is safe, efficient, and effective. Pediatric hospitalists are routinely involved in patient transfers and can lead institutional efforts to promote optimal patient handoffs and transitions of care.
Knowledge
Pediatric hospitalists should be able to:
Compare and contrast patient handoffs with transitions of care.
List the critical elements that should be communicated between providers at the time of a patient handoff, and describe how these elements may vary depending on characteristics of the patient or the provider.
List the relevant information that should be communicated during each transition of care to ensure patient safety and promote the continuum of care.
Explain the pros and cons of different modes of communication in the context of the various types of patient transfers.
Differentiate between the available levels of care and determine the most appropriate option for each patient, taking the need for isolation and level of nursing care into account.
Describe the impact of the Emergency Medical Treatment and Active Labor Act (EMTALA) on patient transfers.
Articulate the National Patient Safety Goals that relate to transitions of care, including effectiveness of communication and medication reconciliation.
Skills
Pediatric hospitalists should be able to:
Prepare concise clinical summaries in preparation for patient handoffs or transitions of care, incorporating key elements as appropriate.
Utilize the most efficient and reliable mode of communication for each transition of care.
Arrange safe and efficient transfers to, from, and within the inpatient setting.
Promptly review the medical information received from referring providers and clarify any discrepancies when accepting a new patient.
Anticipate needs at the time of discharge and begin discharge planning early in the hospitalization.
Provide legible and clear discharge instructions that take into account the primary language and reading level of the patient and caregiver and include information about available resources after discharge should questions arise.
Communicate effectively with the primary care provider and other providers as necessary at the time of admission, discharge, and when there is a significant change in clinical status.
Accurately and completely reconcile medications during transitions of care.
Develop systems to ensure the future comprehensive review of patient data that was pending at the time of discharge.
Attitudes
Pediatric hospitalists should be able to:
Appreciate the impact of ineffective handoffs and transitions of care on patient safety and quality of care.
Demonstrate respect for referring physicians and seek their input when developing protocols for communication during transitions of care.
Appreciate the impact of the transfer on the patient and caregiver and ensure their goals and preferences are incorporated into the care plan at all stages of the transition of care.
Take responsibility for the coordination of a multidisciplinary approach to patient and caregiver education in preparation for the transition of care.
Maintain availability to patients, caregivers, and providers after transitions of care should questions arise.
Systems Organization and Improvement
Pediatric hospitalists should be able to:
Lead, coordinate, or participate in the ongoing evaluation and improvement of the referral, admission, and discharge processes at their institution, taking into account input from stakeholders.
Lead, coordinate, or participate in initiatives to develop and implement systems that promote timely and effective communication between providers during handoffs and transitions of care.
Introduction
Transitions of care occur when a patient moves from one level of care to another or from one institution to another. One component of transitions of care is the patient handoff, which refers to the interaction between providers when responsibility for patient care is transferred from one provider to another. Ineffective transitions of care jeopardize patient safety and may result in adverse events, increased healthcare utilization, and patient or caregiver stress. Thus, every transition of care should involve a set of actions designed to ensure that the transfer is safe, efficient, and effective. Pediatric hospitalists are routinely involved in patient transfers and can lead institutional efforts to promote optimal patient handoffs and transitions of care.
Knowledge
Pediatric hospitalists should be able to:
Compare and contrast patient handoffs with transitions of care.
List the critical elements that should be communicated between providers at the time of a patient handoff, and describe how these elements may vary depending on characteristics of the patient or the provider.
List the relevant information that should be communicated during each transition of care to ensure patient safety and promote the continuum of care.
Explain the pros and cons of different modes of communication in the context of the various types of patient transfers.
Differentiate between the available levels of care and determine the most appropriate option for each patient, taking the need for isolation and level of nursing care into account.
Describe the impact of the Emergency Medical Treatment and Active Labor Act (EMTALA) on patient transfers.
Articulate the National Patient Safety Goals that relate to transitions of care, including effectiveness of communication and medication reconciliation.
Skills
Pediatric hospitalists should be able to:
Prepare concise clinical summaries in preparation for patient handoffs or transitions of care, incorporating key elements as appropriate.
Utilize the most efficient and reliable mode of communication for each transition of care.
Arrange safe and efficient transfers to, from, and within the inpatient setting.
Promptly review the medical information received from referring providers and clarify any discrepancies when accepting a new patient.
Anticipate needs at the time of discharge and begin discharge planning early in the hospitalization.
Provide legible and clear discharge instructions that take into account the primary language and reading level of the patient and caregiver and include information about available resources after discharge should questions arise.
Communicate effectively with the primary care provider and other providers as necessary at the time of admission, discharge, and when there is a significant change in clinical status.
Accurately and completely reconcile medications during transitions of care.
Develop systems to ensure the future comprehensive review of patient data that was pending at the time of discharge.
Attitudes
Pediatric hospitalists should be able to:
Appreciate the impact of ineffective handoffs and transitions of care on patient safety and quality of care.
Demonstrate respect for referring physicians and seek their input when developing protocols for communication during transitions of care.
Appreciate the impact of the transfer on the patient and caregiver and ensure their goals and preferences are incorporated into the care plan at all stages of the transition of care.
Take responsibility for the coordination of a multidisciplinary approach to patient and caregiver education in preparation for the transition of care.
Maintain availability to patients, caregivers, and providers after transitions of care should questions arise.
Systems Organization and Improvement
Pediatric hospitalists should be able to:
Lead, coordinate, or participate in the ongoing evaluation and improvement of the referral, admission, and discharge processes at their institution, taking into account input from stakeholders.
Lead, coordinate, or participate in initiatives to develop and implement systems that promote timely and effective communication between providers during handoffs and transitions of care.
Copyright © 2010 Society of Hospital Medicine
Neonatal jaundice
Introduction
Jaundice due to unconjugated hyperbilirubinemia is the most common complication of the normal newborn period and occurs in nearly 50% of normal term newborns. Physiologic jaundice occurs as serum bilirubin rises from 1.5mg/dL in cord blood to 6 mg/dL by day 3 of life, followed by a subsequent decline to normal (less than 1 mg/dL) by day 10‐12 of life. Physiologic jaundice is a normal process and does not cause morbidity but must be distinguished from pathologic jaundice. Pathologic jaundice can be due to a number of underlying etiologies and may present when there is an onset of clinical jaundice at less than 24 hours of life, the rate of rise of bilirubin is greater than 0.5mg/dL per hour, the serum bilirubin concentration is greater than 20 mg/dL, or the direct (conjugated) bilirubin level is either greater than 2mg/dL or more than 10% of the total bilirubin concentration. Failure to recognize severe hyperbilirubinemia and pathologic jaundice may result in severe morbidity, including bilirubin encephalopathy (kernicterus). Pediatric hospitalists are often asked to provide consultation regarding necessity for admission as well as render inpatient care, and must be knowledgeable about diagnosis and treatment of neonatal jaundice
Knowledge
Pediatric hospitalists should be able to:
Describe the physiology of bilirubin production and metabolism including the pathophysiology that leads to jaundice.
Compare and contrast the features that distinguish pathologic jaundice from physiologic jaundice.
List the elements of the birth and family histories and review of systems which may aid in determining the etiology of the jaundice.
Cite the physical examination findings which may support a potential underlying diagnosis attending to skin, abdominal, dysmorphic features and others.
Discuss risk factors for pathologic jaundice such as prematurity and sepsis.
Describe the differential diagnosis of direct and indirect hyperbilirubinemia attending to inborn error of metabolism, sepsis, anatomic defects, hemolytic diseases, and others.
Compare and contrast the pathophysiology and epidemiology breast milk jaundice versus breastfeeding jaundice.
Review the pathophysiology involved in development of kernicterus including associated factors affecting the blood‐brain barrier such as acidosis and prematurity.
Review the approach toward diagnosis including commonly performed laboratory tests.
Describe the use of diagnostic imaging in evaluating direct hyperbilirubinemia.
Explain the current national recommendations for the management of hyperbilirubinemia in the newborn.
Skills
Pediatric hospitalists should be able to:
Recognize jaundice during a newborn physical examination.
Accurately obtain information from the newborn and maternal histories.
Perform a comprehensive exam, eliciting findings to support potential underlying diagnoses.
Correctly order and interpret bilirubin results based on risk factors for developing kernicterus.
Correctly order and interpret other studies to diagnose underlying conditions.
Recognize indications for initiating, continuing and discontinuing phototherapy and/or exchange transfusion.
Efficiently obtain appropriate consultative services for infants with cholestatic jaundice or possible pathologic underlying condition.
Identify neonates requiring a higher level of care and efficiently coordinate transfer.
Perform careful reassessments daily and as needed, note changes in clinical status and respond with appropriate actions.
Efficiently render care by creating a discharge plan that includes an efficient and comprehensive hand‐off communication with specific outpatient follow‐up needs such as weight checks and repeat lab testing as appropriate.
Attitudes
Pediatric hospitalists should be able to:
Educate the family/caregiver and other professional staff regarding the risks, evaluation and therapies available for hyperbilirubinemia.
Coordinate discharge plans with the primary care provider and home care agencies as appropriate.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in the development and implementation of cost‐effective, safe, evidence‐based care pathways to standardize the evaluation and management of hospitalized neonates with jaundice.
Lead, coordinate or participate in education programs for the family/caregiver and the community to increase awareness of evidence‐based guidelines and strategies to reduce admission rates.
Introduction
Jaundice due to unconjugated hyperbilirubinemia is the most common complication of the normal newborn period and occurs in nearly 50% of normal term newborns. Physiologic jaundice occurs as serum bilirubin rises from 1.5mg/dL in cord blood to 6 mg/dL by day 3 of life, followed by a subsequent decline to normal (less than 1 mg/dL) by day 10‐12 of life. Physiologic jaundice is a normal process and does not cause morbidity but must be distinguished from pathologic jaundice. Pathologic jaundice can be due to a number of underlying etiologies and may present when there is an onset of clinical jaundice at less than 24 hours of life, the rate of rise of bilirubin is greater than 0.5mg/dL per hour, the serum bilirubin concentration is greater than 20 mg/dL, or the direct (conjugated) bilirubin level is either greater than 2mg/dL or more than 10% of the total bilirubin concentration. Failure to recognize severe hyperbilirubinemia and pathologic jaundice may result in severe morbidity, including bilirubin encephalopathy (kernicterus). Pediatric hospitalists are often asked to provide consultation regarding necessity for admission as well as render inpatient care, and must be knowledgeable about diagnosis and treatment of neonatal jaundice
Knowledge
Pediatric hospitalists should be able to:
Describe the physiology of bilirubin production and metabolism including the pathophysiology that leads to jaundice.
Compare and contrast the features that distinguish pathologic jaundice from physiologic jaundice.
List the elements of the birth and family histories and review of systems which may aid in determining the etiology of the jaundice.
Cite the physical examination findings which may support a potential underlying diagnosis attending to skin, abdominal, dysmorphic features and others.
Discuss risk factors for pathologic jaundice such as prematurity and sepsis.
Describe the differential diagnosis of direct and indirect hyperbilirubinemia attending to inborn error of metabolism, sepsis, anatomic defects, hemolytic diseases, and others.
Compare and contrast the pathophysiology and epidemiology breast milk jaundice versus breastfeeding jaundice.
Review the pathophysiology involved in development of kernicterus including associated factors affecting the blood‐brain barrier such as acidosis and prematurity.
Review the approach toward diagnosis including commonly performed laboratory tests.
Describe the use of diagnostic imaging in evaluating direct hyperbilirubinemia.
Explain the current national recommendations for the management of hyperbilirubinemia in the newborn.
Skills
Pediatric hospitalists should be able to:
Recognize jaundice during a newborn physical examination.
Accurately obtain information from the newborn and maternal histories.
Perform a comprehensive exam, eliciting findings to support potential underlying diagnoses.
Correctly order and interpret bilirubin results based on risk factors for developing kernicterus.
Correctly order and interpret other studies to diagnose underlying conditions.
Recognize indications for initiating, continuing and discontinuing phototherapy and/or exchange transfusion.
Efficiently obtain appropriate consultative services for infants with cholestatic jaundice or possible pathologic underlying condition.
Identify neonates requiring a higher level of care and efficiently coordinate transfer.
Perform careful reassessments daily and as needed, note changes in clinical status and respond with appropriate actions.
Efficiently render care by creating a discharge plan that includes an efficient and comprehensive hand‐off communication with specific outpatient follow‐up needs such as weight checks and repeat lab testing as appropriate.
Attitudes
Pediatric hospitalists should be able to:
Educate the family/caregiver and other professional staff regarding the risks, evaluation and therapies available for hyperbilirubinemia.
Coordinate discharge plans with the primary care provider and home care agencies as appropriate.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in the development and implementation of cost‐effective, safe, evidence‐based care pathways to standardize the evaluation and management of hospitalized neonates with jaundice.
Lead, coordinate or participate in education programs for the family/caregiver and the community to increase awareness of evidence‐based guidelines and strategies to reduce admission rates.
Introduction
Jaundice due to unconjugated hyperbilirubinemia is the most common complication of the normal newborn period and occurs in nearly 50% of normal term newborns. Physiologic jaundice occurs as serum bilirubin rises from 1.5mg/dL in cord blood to 6 mg/dL by day 3 of life, followed by a subsequent decline to normal (less than 1 mg/dL) by day 10‐12 of life. Physiologic jaundice is a normal process and does not cause morbidity but must be distinguished from pathologic jaundice. Pathologic jaundice can be due to a number of underlying etiologies and may present when there is an onset of clinical jaundice at less than 24 hours of life, the rate of rise of bilirubin is greater than 0.5mg/dL per hour, the serum bilirubin concentration is greater than 20 mg/dL, or the direct (conjugated) bilirubin level is either greater than 2mg/dL or more than 10% of the total bilirubin concentration. Failure to recognize severe hyperbilirubinemia and pathologic jaundice may result in severe morbidity, including bilirubin encephalopathy (kernicterus). Pediatric hospitalists are often asked to provide consultation regarding necessity for admission as well as render inpatient care, and must be knowledgeable about diagnosis and treatment of neonatal jaundice
Knowledge
Pediatric hospitalists should be able to:
Describe the physiology of bilirubin production and metabolism including the pathophysiology that leads to jaundice.
Compare and contrast the features that distinguish pathologic jaundice from physiologic jaundice.
List the elements of the birth and family histories and review of systems which may aid in determining the etiology of the jaundice.
Cite the physical examination findings which may support a potential underlying diagnosis attending to skin, abdominal, dysmorphic features and others.
Discuss risk factors for pathologic jaundice such as prematurity and sepsis.
Describe the differential diagnosis of direct and indirect hyperbilirubinemia attending to inborn error of metabolism, sepsis, anatomic defects, hemolytic diseases, and others.
Compare and contrast the pathophysiology and epidemiology breast milk jaundice versus breastfeeding jaundice.
Review the pathophysiology involved in development of kernicterus including associated factors affecting the blood‐brain barrier such as acidosis and prematurity.
Review the approach toward diagnosis including commonly performed laboratory tests.
Describe the use of diagnostic imaging in evaluating direct hyperbilirubinemia.
Explain the current national recommendations for the management of hyperbilirubinemia in the newborn.
Skills
Pediatric hospitalists should be able to:
Recognize jaundice during a newborn physical examination.
Accurately obtain information from the newborn and maternal histories.
Perform a comprehensive exam, eliciting findings to support potential underlying diagnoses.
Correctly order and interpret bilirubin results based on risk factors for developing kernicterus.
Correctly order and interpret other studies to diagnose underlying conditions.
Recognize indications for initiating, continuing and discontinuing phototherapy and/or exchange transfusion.
Efficiently obtain appropriate consultative services for infants with cholestatic jaundice or possible pathologic underlying condition.
Identify neonates requiring a higher level of care and efficiently coordinate transfer.
Perform careful reassessments daily and as needed, note changes in clinical status and respond with appropriate actions.
Efficiently render care by creating a discharge plan that includes an efficient and comprehensive hand‐off communication with specific outpatient follow‐up needs such as weight checks and repeat lab testing as appropriate.
Attitudes
Pediatric hospitalists should be able to:
Educate the family/caregiver and other professional staff regarding the risks, evaluation and therapies available for hyperbilirubinemia.
Coordinate discharge plans with the primary care provider and home care agencies as appropriate.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in the development and implementation of cost‐effective, safe, evidence‐based care pathways to standardize the evaluation and management of hospitalized neonates with jaundice.
Lead, coordinate or participate in education programs for the family/caregiver and the community to increase awareness of evidence‐based guidelines and strategies to reduce admission rates.
Copyright © 2010 Society of Hospital Medicine
Pediatric advanced life support
Introduction
The American Academy of Pediatrics (AAP) and the American Heart Association (AHA), in conjunction with International Liaison Committee on Resuscitation (ILCOR), developed the Pediatric Advanced Life Support (PALS) curriculum. The course teaches healthcare providers to more effectively recognize potential respiratory failure and shock in infants and children and to respond with early appropriate interventions to prevent cardiopulmonary arrest. The hallmark of the PALS curriculum is the rapid identification of life threatening conditions in infants and children by utilizing a 4‐tiered Pediatric Assessment scheme focused on simplicity and graduated to provoke timely and appropriate early interventions. The scheme uses a recurring cycle of assess‐categorize‐decide‐act management scheme for the management of seriously ill or injured infants and children. This scheme funnels emergency decision making into respiratory (distress or failure) and circulatory (compensated or hypotensive) categories, which can be further defined, based upon additional information gathered in the 4‐tiered assessment process. The PALS curriculum further emphasizes the importance of the Resuscitation Team Concept, which encourages clear, collaborative communication. The Neonatal Resuscitation Program (NRP), also offered by the AAP and AHA, addresses the resuscitation of the newborn in the delivery room or in the neonatal intensive care unit and is discussed elsewhere in this publication. Pediatric hospitalists frequently encounter clinical situations that require immediate intervention based on these guidelines.
Knowledge
Pediatric hospitalists should be able to:
Define the roles, team composition, and responsibilities of rapid response and code blue teams, noting local context.
List the common etiologies and recognize early signs of respiratory failure and all forms of shock, attending to variations in each due to age.
Describe how deterioration can lead to cardiopulmonary arrest when early signs of distress are not recognized or acted upon.
Discuss the utility of early warning systems/pediatric rapid assessment tools designed to anticipate significant clinical instability within the local context.
Describe how basic airway, breathing, circulation, and disability, and exposure (ABCDE) life support maneuvers differ with age from newborns to infants and older children.
Summarize the modalities commonly available to support the airway, breathing and circulation in children with worsening respiratory distress, in increasing intensity/emnvasiveness.
Compare and contrast the advantages, disadvantages, and proper selection of bag‐mask ventilation versus advanced airway management techniques.
Describe the pathophysiology of hypovolemic, septic, and cardiogenic shock.
Review the approach toward stabilization of hypovolemic, septic and cardiogenic shock, attending to varied age groups and including treatments and testing.
Explain how assessment tools and interventions should be customized for special resuscitation situations such as trauma, toxicological emergencies, rapid sequence intubation, procedural sedation, children with special health care needs and others.
List common pediatric cardiac dysrhythmias and describe the most appropriate algorithm to apply for each.
Describe the appropriate context and use of automated external defibrillators in children.
Review the management of post resuscitation care and transport.
Discuss the basic pharmacology of drugs most commonly utilized in PALS.
Skills
Pediatric hospitalists should be able to:
Successfully complete the Pediatric Advanced Life Support course and maintain certification.
Recognize early warning signs of acute respiratory distress and cardiac compromise and institute corrective actions to avert further deterioration.
Identify patients requiring institution of PALS techniques, accurately perform rapid assessment, and apply appropriate interventions.
Perform effective cardiopulmonary resuscitation and basic life support skills.
Perform effective resuscitation and stabilization of newborns in the delivery room as appropriate for local context.
Efficiently stabilize the airway, using effective non‐invasive and invasive airway management techniques in collaboration with other services as appropriate.
Efficiently obtain peripheral or central vascular access by placement if intravenous, intraosseous or central venous catheters in collaboration with other services as appropriate.
Correctly identify and treat common pediatric cardiac dysrhythmias.
Correctly utilize an Automated External Defibrillator under appropriate circumstances.
Effectively use weight/size based resuscitation tools.
Correctly apply PALS principles to special resuscitation situations such as toxicological emergencies, procedural sedation, or trauma.
Attitudes
Pediatric hospitalists should be able to:
Effectively lead or participate as a member of a stabilization (rapid response) and/or resuscitation (code blue) team.
Communicate effectively and compassionately with the family/caregiver.
Advocate for family/caregiver presence during resuscitation when appropriate.
Collaborate with the primary care provider to enhance support for the family/caregiver.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in the development of a local Pediatric Advanced Life Support training program.
Work with hospital administration to ensure code carts are pediatric‐specific and contain adequate, appropriate equipment.
Work with hospital administration to create inter‐facility transport and affiliation agreements between community hospitals and pediatric tertiary care centers to foster effective and appropriate triage of sick and injured children.
Advocate for statewide Emergency Medical Systems (EMS) for Children program which places pediatric emergency care in its proper place within the EMS system.
Introduction
The American Academy of Pediatrics (AAP) and the American Heart Association (AHA), in conjunction with International Liaison Committee on Resuscitation (ILCOR), developed the Pediatric Advanced Life Support (PALS) curriculum. The course teaches healthcare providers to more effectively recognize potential respiratory failure and shock in infants and children and to respond with early appropriate interventions to prevent cardiopulmonary arrest. The hallmark of the PALS curriculum is the rapid identification of life threatening conditions in infants and children by utilizing a 4‐tiered Pediatric Assessment scheme focused on simplicity and graduated to provoke timely and appropriate early interventions. The scheme uses a recurring cycle of assess‐categorize‐decide‐act management scheme for the management of seriously ill or injured infants and children. This scheme funnels emergency decision making into respiratory (distress or failure) and circulatory (compensated or hypotensive) categories, which can be further defined, based upon additional information gathered in the 4‐tiered assessment process. The PALS curriculum further emphasizes the importance of the Resuscitation Team Concept, which encourages clear, collaborative communication. The Neonatal Resuscitation Program (NRP), also offered by the AAP and AHA, addresses the resuscitation of the newborn in the delivery room or in the neonatal intensive care unit and is discussed elsewhere in this publication. Pediatric hospitalists frequently encounter clinical situations that require immediate intervention based on these guidelines.
Knowledge
Pediatric hospitalists should be able to:
Define the roles, team composition, and responsibilities of rapid response and code blue teams, noting local context.
List the common etiologies and recognize early signs of respiratory failure and all forms of shock, attending to variations in each due to age.
Describe how deterioration can lead to cardiopulmonary arrest when early signs of distress are not recognized or acted upon.
Discuss the utility of early warning systems/pediatric rapid assessment tools designed to anticipate significant clinical instability within the local context.
Describe how basic airway, breathing, circulation, and disability, and exposure (ABCDE) life support maneuvers differ with age from newborns to infants and older children.
Summarize the modalities commonly available to support the airway, breathing and circulation in children with worsening respiratory distress, in increasing intensity/emnvasiveness.
Compare and contrast the advantages, disadvantages, and proper selection of bag‐mask ventilation versus advanced airway management techniques.
Describe the pathophysiology of hypovolemic, septic, and cardiogenic shock.
Review the approach toward stabilization of hypovolemic, septic and cardiogenic shock, attending to varied age groups and including treatments and testing.
Explain how assessment tools and interventions should be customized for special resuscitation situations such as trauma, toxicological emergencies, rapid sequence intubation, procedural sedation, children with special health care needs and others.
List common pediatric cardiac dysrhythmias and describe the most appropriate algorithm to apply for each.
Describe the appropriate context and use of automated external defibrillators in children.
Review the management of post resuscitation care and transport.
Discuss the basic pharmacology of drugs most commonly utilized in PALS.
Skills
Pediatric hospitalists should be able to:
Successfully complete the Pediatric Advanced Life Support course and maintain certification.
Recognize early warning signs of acute respiratory distress and cardiac compromise and institute corrective actions to avert further deterioration.
Identify patients requiring institution of PALS techniques, accurately perform rapid assessment, and apply appropriate interventions.
Perform effective cardiopulmonary resuscitation and basic life support skills.
Perform effective resuscitation and stabilization of newborns in the delivery room as appropriate for local context.
Efficiently stabilize the airway, using effective non‐invasive and invasive airway management techniques in collaboration with other services as appropriate.
Efficiently obtain peripheral or central vascular access by placement if intravenous, intraosseous or central venous catheters in collaboration with other services as appropriate.
Correctly identify and treat common pediatric cardiac dysrhythmias.
Correctly utilize an Automated External Defibrillator under appropriate circumstances.
Effectively use weight/size based resuscitation tools.
Correctly apply PALS principles to special resuscitation situations such as toxicological emergencies, procedural sedation, or trauma.
Attitudes
Pediatric hospitalists should be able to:
Effectively lead or participate as a member of a stabilization (rapid response) and/or resuscitation (code blue) team.
Communicate effectively and compassionately with the family/caregiver.
Advocate for family/caregiver presence during resuscitation when appropriate.
Collaborate with the primary care provider to enhance support for the family/caregiver.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in the development of a local Pediatric Advanced Life Support training program.
Work with hospital administration to ensure code carts are pediatric‐specific and contain adequate, appropriate equipment.
Work with hospital administration to create inter‐facility transport and affiliation agreements between community hospitals and pediatric tertiary care centers to foster effective and appropriate triage of sick and injured children.
Advocate for statewide Emergency Medical Systems (EMS) for Children program which places pediatric emergency care in its proper place within the EMS system.
Introduction
The American Academy of Pediatrics (AAP) and the American Heart Association (AHA), in conjunction with International Liaison Committee on Resuscitation (ILCOR), developed the Pediatric Advanced Life Support (PALS) curriculum. The course teaches healthcare providers to more effectively recognize potential respiratory failure and shock in infants and children and to respond with early appropriate interventions to prevent cardiopulmonary arrest. The hallmark of the PALS curriculum is the rapid identification of life threatening conditions in infants and children by utilizing a 4‐tiered Pediatric Assessment scheme focused on simplicity and graduated to provoke timely and appropriate early interventions. The scheme uses a recurring cycle of assess‐categorize‐decide‐act management scheme for the management of seriously ill or injured infants and children. This scheme funnels emergency decision making into respiratory (distress or failure) and circulatory (compensated or hypotensive) categories, which can be further defined, based upon additional information gathered in the 4‐tiered assessment process. The PALS curriculum further emphasizes the importance of the Resuscitation Team Concept, which encourages clear, collaborative communication. The Neonatal Resuscitation Program (NRP), also offered by the AAP and AHA, addresses the resuscitation of the newborn in the delivery room or in the neonatal intensive care unit and is discussed elsewhere in this publication. Pediatric hospitalists frequently encounter clinical situations that require immediate intervention based on these guidelines.
Knowledge
Pediatric hospitalists should be able to:
Define the roles, team composition, and responsibilities of rapid response and code blue teams, noting local context.
List the common etiologies and recognize early signs of respiratory failure and all forms of shock, attending to variations in each due to age.
Describe how deterioration can lead to cardiopulmonary arrest when early signs of distress are not recognized or acted upon.
Discuss the utility of early warning systems/pediatric rapid assessment tools designed to anticipate significant clinical instability within the local context.
Describe how basic airway, breathing, circulation, and disability, and exposure (ABCDE) life support maneuvers differ with age from newborns to infants and older children.
Summarize the modalities commonly available to support the airway, breathing and circulation in children with worsening respiratory distress, in increasing intensity/emnvasiveness.
Compare and contrast the advantages, disadvantages, and proper selection of bag‐mask ventilation versus advanced airway management techniques.
Describe the pathophysiology of hypovolemic, septic, and cardiogenic shock.
Review the approach toward stabilization of hypovolemic, septic and cardiogenic shock, attending to varied age groups and including treatments and testing.
Explain how assessment tools and interventions should be customized for special resuscitation situations such as trauma, toxicological emergencies, rapid sequence intubation, procedural sedation, children with special health care needs and others.
List common pediatric cardiac dysrhythmias and describe the most appropriate algorithm to apply for each.
Describe the appropriate context and use of automated external defibrillators in children.
Review the management of post resuscitation care and transport.
Discuss the basic pharmacology of drugs most commonly utilized in PALS.
Skills
Pediatric hospitalists should be able to:
Successfully complete the Pediatric Advanced Life Support course and maintain certification.
Recognize early warning signs of acute respiratory distress and cardiac compromise and institute corrective actions to avert further deterioration.
Identify patients requiring institution of PALS techniques, accurately perform rapid assessment, and apply appropriate interventions.
Perform effective cardiopulmonary resuscitation and basic life support skills.
Perform effective resuscitation and stabilization of newborns in the delivery room as appropriate for local context.
Efficiently stabilize the airway, using effective non‐invasive and invasive airway management techniques in collaboration with other services as appropriate.
Efficiently obtain peripheral or central vascular access by placement if intravenous, intraosseous or central venous catheters in collaboration with other services as appropriate.
Correctly identify and treat common pediatric cardiac dysrhythmias.
Correctly utilize an Automated External Defibrillator under appropriate circumstances.
Effectively use weight/size based resuscitation tools.
Correctly apply PALS principles to special resuscitation situations such as toxicological emergencies, procedural sedation, or trauma.
Attitudes
Pediatric hospitalists should be able to:
Effectively lead or participate as a member of a stabilization (rapid response) and/or resuscitation (code blue) team.
Communicate effectively and compassionately with the family/caregiver.
Advocate for family/caregiver presence during resuscitation when appropriate.
Collaborate with the primary care provider to enhance support for the family/caregiver.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in the development of a local Pediatric Advanced Life Support training program.
Work with hospital administration to ensure code carts are pediatric‐specific and contain adequate, appropriate equipment.
Work with hospital administration to create inter‐facility transport and affiliation agreements between community hospitals and pediatric tertiary care centers to foster effective and appropriate triage of sick and injured children.
Advocate for statewide Emergency Medical Systems (EMS) for Children program which places pediatric emergency care in its proper place within the EMS system.
Copyright © 2010 Society of Hospital Medicine
Patient safety
Introduction
The topic of Patient Safety became a major priority for healthcare providers in 1999 when the Institute of Medicine (IOM) report entitled To Err is Human focused attention on patient safety and medical errors. The Institute of Medicine defined safety as freedom from accidental injury and error as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. The IOM report estimated that between 44,000 to 98,000 Americans die each year as a result of medical errors which exceed the number attributable to the 8th leading cause of death in America. Total national costs of preventable adverse events are estimated to be up to $29 billion. Since the initial publication of the 1999 IOM report, there have been a number of local, state, and national programs focused on reducing error. Efforts over the past few years have attempted to better classify errors by the harm caused, allowing targeted interventions to specifically address these more clinically significant events. Children, as a vulnerable population, are at particular risk for medical errors and specifically medication errors. Pediatric hospitalists have an exceptional opportunity to promote patient safety and help develop systems that will reduce harm in the inpatient arena.
Knowledge
Pediatric hospitalists should be able to:
Identify the basic principles of patient safety as outlined in the original 1999 IOM report.
Describe the culture necessary for successful safety efforts. Define Just culture.
Define commonly used terms and tools of Patient Safety such as reliability, transparency, adverse medical event, harm, preventable errors, failure mode effects analysis (FMEA), root cause analysis (RCA) and trigger tool.
Name common patient safety practices and enhancements including pre‐printed order sets, practice guidelines, electronic health information systems, bar coding, time‐outs, and others. Explain how new errors can be associated with the introduction of these enhancements.
Discuss why errors are more often a result of systems failures rather than individual failures.
Explain how decreasing unwanted variability in care impacts patient safety.
Illustrate that building safety into everyday processes of care is the most effective way to reduce or prevent errors.
Describe how patient safety is threatened by poor information transfer and failed communication.
Discuss strategies for effective, efficient, and safe communications that impact all aspects of patient care such as handoffs between healthcare providers, team rounds, family engagement, and others. List the strengths and limitations of different communication methods.
Describe the effects of sleep quality and quantity on healthcare providers and the impact on patient safety.
Summarize the components of family centered care and discuss the importance of engaging patients and the family/caregiver in safety efforts.
Define the role of the Joint Commission (TJC) in hospital accreditation and describe how pediatric hospitalists can help assure relevant standards are met.
Articulate TJC guidelines on patient safety and the National Patient Safety Goals.
Discuss factors unique to children that lead to increased risk for medication errors, attending to weight‐based dosing, developmental physiology, compounding and drug delivery methods, and others.
Discuss how financial reimbursement from private and government payers can be tied to preventable patient safety events.
List the common national societies and agencies [such as the Institute for Healthcare Improvement (IHI), American Academy of Pediatrics (AAP), TJC, Centers for Medicare and Medicaid Services (CMS)] influencing inpatient pediatric safety measures and describe pediatric hospitalists' role in responding to their statements.
Delineate the role of pediatric hospitalists in assuring proper supervision of trainees and the impact of this on patient safety.
Skills
Pediatric hospitalists should be able to:
Arrange safe and efficient hospital admissions and discharges, addressing issues such as level of nursing care needed and coordination of care, respectively.
Proactively identify sources of potential patient harm, including environmental and personal factors that affect your ability to render safe medical care. Develop a plan to address appropriate negative influences.
Consistently adhere to patient safety principles when providing direct patient care such as when ordering treatment, performing procedures, and communicating care plans.
Set performance standards and expectations for patient safety in the hospital setting.
Educate trainees, nursing staff, ancillary staff and peers on basic safety principles.
Demonstrate proficiency in using the institution's safety reporting system.
Work effectively and collaboratively with safety teams, utilizing safety tools including reduction of process complexity, building in redundancy, improving team functioning and identifying team members' assumptions.
Implement and serve as a physician champion for patient safety initiatives that protect children from harm.
Actively contribute during ad hoc and sentinel event reviews.
Disclose medical errors clearly, concisely and completely to patients and/or caregivers.
Attitudes
Pediatric hospitalists should be able to:
Seek opportunities to be involved in strategies to eliminate harm.
Role model effective infection control practices in daily patient care activities.
Build an awareness of the need for and will for change to make patient safety a high and consistent priority.
Model behavior and take initiative in reporting medical errors.
Work collaboratively to help create an open culture of safety within the institution.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Engage the hospital senior management, the hospital board of directors and the medical staff leadership in making patient safety one of the top strategic priorities for the institution.
Advocate for the necessary information systems and other infrastructure to secure accurate data and assure success with safety initiatives.
Participate on patient safety committees at the group or systems level and seek opportunities to serve as medical safety officers or medical safety consultants locally or nationally.
Introduction
The topic of Patient Safety became a major priority for healthcare providers in 1999 when the Institute of Medicine (IOM) report entitled To Err is Human focused attention on patient safety and medical errors. The Institute of Medicine defined safety as freedom from accidental injury and error as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. The IOM report estimated that between 44,000 to 98,000 Americans die each year as a result of medical errors which exceed the number attributable to the 8th leading cause of death in America. Total national costs of preventable adverse events are estimated to be up to $29 billion. Since the initial publication of the 1999 IOM report, there have been a number of local, state, and national programs focused on reducing error. Efforts over the past few years have attempted to better classify errors by the harm caused, allowing targeted interventions to specifically address these more clinically significant events. Children, as a vulnerable population, are at particular risk for medical errors and specifically medication errors. Pediatric hospitalists have an exceptional opportunity to promote patient safety and help develop systems that will reduce harm in the inpatient arena.
Knowledge
Pediatric hospitalists should be able to:
Identify the basic principles of patient safety as outlined in the original 1999 IOM report.
Describe the culture necessary for successful safety efforts. Define Just culture.
Define commonly used terms and tools of Patient Safety such as reliability, transparency, adverse medical event, harm, preventable errors, failure mode effects analysis (FMEA), root cause analysis (RCA) and trigger tool.
Name common patient safety practices and enhancements including pre‐printed order sets, practice guidelines, electronic health information systems, bar coding, time‐outs, and others. Explain how new errors can be associated with the introduction of these enhancements.
Discuss why errors are more often a result of systems failures rather than individual failures.
Explain how decreasing unwanted variability in care impacts patient safety.
Illustrate that building safety into everyday processes of care is the most effective way to reduce or prevent errors.
Describe how patient safety is threatened by poor information transfer and failed communication.
Discuss strategies for effective, efficient, and safe communications that impact all aspects of patient care such as handoffs between healthcare providers, team rounds, family engagement, and others. List the strengths and limitations of different communication methods.
Describe the effects of sleep quality and quantity on healthcare providers and the impact on patient safety.
Summarize the components of family centered care and discuss the importance of engaging patients and the family/caregiver in safety efforts.
Define the role of the Joint Commission (TJC) in hospital accreditation and describe how pediatric hospitalists can help assure relevant standards are met.
Articulate TJC guidelines on patient safety and the National Patient Safety Goals.
Discuss factors unique to children that lead to increased risk for medication errors, attending to weight‐based dosing, developmental physiology, compounding and drug delivery methods, and others.
Discuss how financial reimbursement from private and government payers can be tied to preventable patient safety events.
List the common national societies and agencies [such as the Institute for Healthcare Improvement (IHI), American Academy of Pediatrics (AAP), TJC, Centers for Medicare and Medicaid Services (CMS)] influencing inpatient pediatric safety measures and describe pediatric hospitalists' role in responding to their statements.
Delineate the role of pediatric hospitalists in assuring proper supervision of trainees and the impact of this on patient safety.
Skills
Pediatric hospitalists should be able to:
Arrange safe and efficient hospital admissions and discharges, addressing issues such as level of nursing care needed and coordination of care, respectively.
Proactively identify sources of potential patient harm, including environmental and personal factors that affect your ability to render safe medical care. Develop a plan to address appropriate negative influences.
Consistently adhere to patient safety principles when providing direct patient care such as when ordering treatment, performing procedures, and communicating care plans.
Set performance standards and expectations for patient safety in the hospital setting.
Educate trainees, nursing staff, ancillary staff and peers on basic safety principles.
Demonstrate proficiency in using the institution's safety reporting system.
Work effectively and collaboratively with safety teams, utilizing safety tools including reduction of process complexity, building in redundancy, improving team functioning and identifying team members' assumptions.
Implement and serve as a physician champion for patient safety initiatives that protect children from harm.
Actively contribute during ad hoc and sentinel event reviews.
Disclose medical errors clearly, concisely and completely to patients and/or caregivers.
Attitudes
Pediatric hospitalists should be able to:
Seek opportunities to be involved in strategies to eliminate harm.
Role model effective infection control practices in daily patient care activities.
Build an awareness of the need for and will for change to make patient safety a high and consistent priority.
Model behavior and take initiative in reporting medical errors.
Work collaboratively to help create an open culture of safety within the institution.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Engage the hospital senior management, the hospital board of directors and the medical staff leadership in making patient safety one of the top strategic priorities for the institution.
Advocate for the necessary information systems and other infrastructure to secure accurate data and assure success with safety initiatives.
Participate on patient safety committees at the group or systems level and seek opportunities to serve as medical safety officers or medical safety consultants locally or nationally.
Introduction
The topic of Patient Safety became a major priority for healthcare providers in 1999 when the Institute of Medicine (IOM) report entitled To Err is Human focused attention on patient safety and medical errors. The Institute of Medicine defined safety as freedom from accidental injury and error as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. The IOM report estimated that between 44,000 to 98,000 Americans die each year as a result of medical errors which exceed the number attributable to the 8th leading cause of death in America. Total national costs of preventable adverse events are estimated to be up to $29 billion. Since the initial publication of the 1999 IOM report, there have been a number of local, state, and national programs focused on reducing error. Efforts over the past few years have attempted to better classify errors by the harm caused, allowing targeted interventions to specifically address these more clinically significant events. Children, as a vulnerable population, are at particular risk for medical errors and specifically medication errors. Pediatric hospitalists have an exceptional opportunity to promote patient safety and help develop systems that will reduce harm in the inpatient arena.
Knowledge
Pediatric hospitalists should be able to:
Identify the basic principles of patient safety as outlined in the original 1999 IOM report.
Describe the culture necessary for successful safety efforts. Define Just culture.
Define commonly used terms and tools of Patient Safety such as reliability, transparency, adverse medical event, harm, preventable errors, failure mode effects analysis (FMEA), root cause analysis (RCA) and trigger tool.
Name common patient safety practices and enhancements including pre‐printed order sets, practice guidelines, electronic health information systems, bar coding, time‐outs, and others. Explain how new errors can be associated with the introduction of these enhancements.
Discuss why errors are more often a result of systems failures rather than individual failures.
Explain how decreasing unwanted variability in care impacts patient safety.
Illustrate that building safety into everyday processes of care is the most effective way to reduce or prevent errors.
Describe how patient safety is threatened by poor information transfer and failed communication.
Discuss strategies for effective, efficient, and safe communications that impact all aspects of patient care such as handoffs between healthcare providers, team rounds, family engagement, and others. List the strengths and limitations of different communication methods.
Describe the effects of sleep quality and quantity on healthcare providers and the impact on patient safety.
Summarize the components of family centered care and discuss the importance of engaging patients and the family/caregiver in safety efforts.
Define the role of the Joint Commission (TJC) in hospital accreditation and describe how pediatric hospitalists can help assure relevant standards are met.
Articulate TJC guidelines on patient safety and the National Patient Safety Goals.
Discuss factors unique to children that lead to increased risk for medication errors, attending to weight‐based dosing, developmental physiology, compounding and drug delivery methods, and others.
Discuss how financial reimbursement from private and government payers can be tied to preventable patient safety events.
List the common national societies and agencies [such as the Institute for Healthcare Improvement (IHI), American Academy of Pediatrics (AAP), TJC, Centers for Medicare and Medicaid Services (CMS)] influencing inpatient pediatric safety measures and describe pediatric hospitalists' role in responding to their statements.
Delineate the role of pediatric hospitalists in assuring proper supervision of trainees and the impact of this on patient safety.
Skills
Pediatric hospitalists should be able to:
Arrange safe and efficient hospital admissions and discharges, addressing issues such as level of nursing care needed and coordination of care, respectively.
Proactively identify sources of potential patient harm, including environmental and personal factors that affect your ability to render safe medical care. Develop a plan to address appropriate negative influences.
Consistently adhere to patient safety principles when providing direct patient care such as when ordering treatment, performing procedures, and communicating care plans.
Set performance standards and expectations for patient safety in the hospital setting.
Educate trainees, nursing staff, ancillary staff and peers on basic safety principles.
Demonstrate proficiency in using the institution's safety reporting system.
Work effectively and collaboratively with safety teams, utilizing safety tools including reduction of process complexity, building in redundancy, improving team functioning and identifying team members' assumptions.
Implement and serve as a physician champion for patient safety initiatives that protect children from harm.
Actively contribute during ad hoc and sentinel event reviews.
Disclose medical errors clearly, concisely and completely to patients and/or caregivers.
Attitudes
Pediatric hospitalists should be able to:
Seek opportunities to be involved in strategies to eliminate harm.
Role model effective infection control practices in daily patient care activities.
Build an awareness of the need for and will for change to make patient safety a high and consistent priority.
Model behavior and take initiative in reporting medical errors.
Work collaboratively to help create an open culture of safety within the institution.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Engage the hospital senior management, the hospital board of directors and the medical staff leadership in making patient safety one of the top strategic priorities for the institution.
Advocate for the necessary information systems and other infrastructure to secure accurate data and assure success with safety initiatives.
Participate on patient safety committees at the group or systems level and seek opportunities to serve as medical safety officers or medical safety consultants locally or nationally.
Copyright © 2010 Society of Hospital Medicine
Ethics
Introduction
Morality is the right or wrong of human conduct, where ethics is the disciplined study of the justification for rules of human conduct. Morality concerns obligations of what ought to be and what virtues should be cultivated to sustain a truly moral society. The field of bioethics (or medical ethics) applies theory to address ethical issues in medicine, including those that arise during the care of patients as well as those focused on organizations and policy. Bioethics focuses on what morality should be for patients, healthcare professionals, healthcare institutions, and healthcare policy. The rights and responsibilities of patients and the fiduciary responsibility of healthcare providers to patients are central to this definition. Pediatric hospitalists must have a basic knowledge of ethical principles to provide balanced, ethical care.
Knowledge
Pediatric hospitalists should be able to:
Describe the core principles of ethics: beneficence, justice, respect for autonomy, and non‐maleficence.
Discuss the four virtues of a fiduciary‐ self‐effacement, self‐sacrifice, compassion, and integrity.
Identify the elements of informed consent and describe the concept of informed assent.
Describe special circumstances impacting the informed consent process specific to the pediatric population, such as patients in the juvenile justice system, ward of the court, emancipated minors, child protection cases, and others.
Describe the role and composition of the hospital Ethics Committee.
Compare and contrast the fiduciary responsibilities of the institution, insurer, and healthcare provider and discuss the impact of these on delivery of ethical patient care.
Distinguish between substantive justice (concern that the outcomes of a process is fair) and procedural justice (concern that the decision‐making process itself is fair).
Describe how ethical principles can inform development of healthcare policy.
Give examples of how patients and the family/caregiver meet ethical obligations to healthcare professionals (such as engagement in informed consent), to others in the household (such as discussions on undue burden to other members), and society (such as appropriate allocation of resources).
Explain the concept of medical futility and its shortcomings.
Skills
Pediatric hospitalists should be able to:
Apply ethical principles to daily patient care.
Obtain informed consent and assent, as appropriate.
Access legal support as needed to obtain consent to treat as appropriate in special circumstances.
Communicate effectively, maintaining confidentiality and patient privacy.
Identify situations involving ethical conflict, and take steps to resolve this conflict.
Consult the Ethics Committee/Team appropriately.
Attitudes
Pediatric hospitalists should be able to:
Acknowledge personal biases that impact ethical decision‐making.
Recognize gaps in knowledge and seek opportunities for ethics education.
Role model ethical practices.
Systems Organization and Improvement
In order to improve efficiency and quality in their organizations, pediatric hospitalists should:
Work with hospital administration to identify and modify institutional practices and policies to assure ethical healthcare delivery.
Advocate for healthcare policy that ensures appropriate access to healthcare services for children.
Introduction
Morality is the right or wrong of human conduct, where ethics is the disciplined study of the justification for rules of human conduct. Morality concerns obligations of what ought to be and what virtues should be cultivated to sustain a truly moral society. The field of bioethics (or medical ethics) applies theory to address ethical issues in medicine, including those that arise during the care of patients as well as those focused on organizations and policy. Bioethics focuses on what morality should be for patients, healthcare professionals, healthcare institutions, and healthcare policy. The rights and responsibilities of patients and the fiduciary responsibility of healthcare providers to patients are central to this definition. Pediatric hospitalists must have a basic knowledge of ethical principles to provide balanced, ethical care.
Knowledge
Pediatric hospitalists should be able to:
Describe the core principles of ethics: beneficence, justice, respect for autonomy, and non‐maleficence.
Discuss the four virtues of a fiduciary‐ self‐effacement, self‐sacrifice, compassion, and integrity.
Identify the elements of informed consent and describe the concept of informed assent.
Describe special circumstances impacting the informed consent process specific to the pediatric population, such as patients in the juvenile justice system, ward of the court, emancipated minors, child protection cases, and others.
Describe the role and composition of the hospital Ethics Committee.
Compare and contrast the fiduciary responsibilities of the institution, insurer, and healthcare provider and discuss the impact of these on delivery of ethical patient care.
Distinguish between substantive justice (concern that the outcomes of a process is fair) and procedural justice (concern that the decision‐making process itself is fair).
Describe how ethical principles can inform development of healthcare policy.
Give examples of how patients and the family/caregiver meet ethical obligations to healthcare professionals (such as engagement in informed consent), to others in the household (such as discussions on undue burden to other members), and society (such as appropriate allocation of resources).
Explain the concept of medical futility and its shortcomings.
Skills
Pediatric hospitalists should be able to:
Apply ethical principles to daily patient care.
Obtain informed consent and assent, as appropriate.
Access legal support as needed to obtain consent to treat as appropriate in special circumstances.
Communicate effectively, maintaining confidentiality and patient privacy.
Identify situations involving ethical conflict, and take steps to resolve this conflict.
Consult the Ethics Committee/Team appropriately.
Attitudes
Pediatric hospitalists should be able to:
Acknowledge personal biases that impact ethical decision‐making.
Recognize gaps in knowledge and seek opportunities for ethics education.
Role model ethical practices.
Systems Organization and Improvement
In order to improve efficiency and quality in their organizations, pediatric hospitalists should:
Work with hospital administration to identify and modify institutional practices and policies to assure ethical healthcare delivery.
Advocate for healthcare policy that ensures appropriate access to healthcare services for children.
Introduction
Morality is the right or wrong of human conduct, where ethics is the disciplined study of the justification for rules of human conduct. Morality concerns obligations of what ought to be and what virtues should be cultivated to sustain a truly moral society. The field of bioethics (or medical ethics) applies theory to address ethical issues in medicine, including those that arise during the care of patients as well as those focused on organizations and policy. Bioethics focuses on what morality should be for patients, healthcare professionals, healthcare institutions, and healthcare policy. The rights and responsibilities of patients and the fiduciary responsibility of healthcare providers to patients are central to this definition. Pediatric hospitalists must have a basic knowledge of ethical principles to provide balanced, ethical care.
Knowledge
Pediatric hospitalists should be able to:
Describe the core principles of ethics: beneficence, justice, respect for autonomy, and non‐maleficence.
Discuss the four virtues of a fiduciary‐ self‐effacement, self‐sacrifice, compassion, and integrity.
Identify the elements of informed consent and describe the concept of informed assent.
Describe special circumstances impacting the informed consent process specific to the pediatric population, such as patients in the juvenile justice system, ward of the court, emancipated minors, child protection cases, and others.
Describe the role and composition of the hospital Ethics Committee.
Compare and contrast the fiduciary responsibilities of the institution, insurer, and healthcare provider and discuss the impact of these on delivery of ethical patient care.
Distinguish between substantive justice (concern that the outcomes of a process is fair) and procedural justice (concern that the decision‐making process itself is fair).
Describe how ethical principles can inform development of healthcare policy.
Give examples of how patients and the family/caregiver meet ethical obligations to healthcare professionals (such as engagement in informed consent), to others in the household (such as discussions on undue burden to other members), and society (such as appropriate allocation of resources).
Explain the concept of medical futility and its shortcomings.
Skills
Pediatric hospitalists should be able to:
Apply ethical principles to daily patient care.
Obtain informed consent and assent, as appropriate.
Access legal support as needed to obtain consent to treat as appropriate in special circumstances.
Communicate effectively, maintaining confidentiality and patient privacy.
Identify situations involving ethical conflict, and take steps to resolve this conflict.
Consult the Ethics Committee/Team appropriately.
Attitudes
Pediatric hospitalists should be able to:
Acknowledge personal biases that impact ethical decision‐making.
Recognize gaps in knowledge and seek opportunities for ethics education.
Role model ethical practices.
Systems Organization and Improvement
In order to improve efficiency and quality in their organizations, pediatric hospitalists should:
Work with hospital administration to identify and modify institutional practices and policies to assure ethical healthcare delivery.
Advocate for healthcare policy that ensures appropriate access to healthcare services for children.
Copyright © 2010 Society of Hospital Medicine
Non‐invasive monitoring
Introduction
Collection and monitoring of objective data such as vital signs and pulse oximetry measurements are essential components of care for hospitalized children. Combined with clinical assessments, these data are critical when making therapeutic or diagnostic decisions. A complete understanding of non‐invasive monitoring techniques is necessary to accurately interpret the data generated. Pediatric hospitalists regularly incorporate this data into their clinical practice and, especially when overseeing procedural sedation or emergent clinical situations, may be responsible for implementing or supervising the appropriate type and level of monitoring.
Knowledge
Pediatric hospitalists should be able to:
List the different types of non‐invasive monitoring techniques and devices that are available and describe the indications for each.
Compare and contrast the types and level of monitoring generally available on the inpatient ward compared to the intensive care unit or other care settings.
Describe the proper procedures for common non‐invasive monitoring techniques, including vital sign measurement, cardiopulmonary monitoring, pulse oximetry, and capnography.
List the limitations or complications associated with common non‐invasive monitoring techniques, such as inadequate wave form for pulse oximetry.
Discuss the importance of accurate and timely interpretation of information generated by monitoring devices, as well as the importance of an immediate response when abnormal data is noted.
Skills
Pediatric hospitalists should be able to:
Determine the type and level of monitoring needed based on the clinical situation and medical complexity of the patient.
Identify the need for a higher or lower level of monitoring as changes in the clinical status occur and transfer the patient to the appropriate inpatient setting.
Ensure proper placement of monitoring equipment (e.g., placement of monitor leads) and execution of proper technique (e.g., use of correct size blood pressure cuff) in order to obtain accurate data.
Correctly interpret monitoring data and respond with appropriate actions.
Attitudes
Pediatric hospitalists should be able to:
Assume responsibility for ordering the appropriate monitoring and interpreting monitoring data.
Collaborate with nurses, subspecialists, and other healthcare providers to determine the appropriate level of monitoring and the corresponding care setting, especially when clinical changes occur.
Communicate effectively with patients and the family/caregiver regarding the need for non‐invasive monitoring, the findings, and the care plan.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate, or participate in the development and implementation of cost‐effective, safe, evidence‐based procedures and policies related to non‐invasive monitoring.
Work with hospital administration, biomedical engineering, and others to obtain high quality and reliable monitoring equipment.
Lead, coordinate, or participate in the development of continuing education programs focused on non‐invasive monitoring and the interpretation of related data.
Lead, coordinate or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction into monitoring strategies.
Introduction
Collection and monitoring of objective data such as vital signs and pulse oximetry measurements are essential components of care for hospitalized children. Combined with clinical assessments, these data are critical when making therapeutic or diagnostic decisions. A complete understanding of non‐invasive monitoring techniques is necessary to accurately interpret the data generated. Pediatric hospitalists regularly incorporate this data into their clinical practice and, especially when overseeing procedural sedation or emergent clinical situations, may be responsible for implementing or supervising the appropriate type and level of monitoring.
Knowledge
Pediatric hospitalists should be able to:
List the different types of non‐invasive monitoring techniques and devices that are available and describe the indications for each.
Compare and contrast the types and level of monitoring generally available on the inpatient ward compared to the intensive care unit or other care settings.
Describe the proper procedures for common non‐invasive monitoring techniques, including vital sign measurement, cardiopulmonary monitoring, pulse oximetry, and capnography.
List the limitations or complications associated with common non‐invasive monitoring techniques, such as inadequate wave form for pulse oximetry.
Discuss the importance of accurate and timely interpretation of information generated by monitoring devices, as well as the importance of an immediate response when abnormal data is noted.
Skills
Pediatric hospitalists should be able to:
Determine the type and level of monitoring needed based on the clinical situation and medical complexity of the patient.
Identify the need for a higher or lower level of monitoring as changes in the clinical status occur and transfer the patient to the appropriate inpatient setting.
Ensure proper placement of monitoring equipment (e.g., placement of monitor leads) and execution of proper technique (e.g., use of correct size blood pressure cuff) in order to obtain accurate data.
Correctly interpret monitoring data and respond with appropriate actions.
Attitudes
Pediatric hospitalists should be able to:
Assume responsibility for ordering the appropriate monitoring and interpreting monitoring data.
Collaborate with nurses, subspecialists, and other healthcare providers to determine the appropriate level of monitoring and the corresponding care setting, especially when clinical changes occur.
Communicate effectively with patients and the family/caregiver regarding the need for non‐invasive monitoring, the findings, and the care plan.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate, or participate in the development and implementation of cost‐effective, safe, evidence‐based procedures and policies related to non‐invasive monitoring.
Work with hospital administration, biomedical engineering, and others to obtain high quality and reliable monitoring equipment.
Lead, coordinate, or participate in the development of continuing education programs focused on non‐invasive monitoring and the interpretation of related data.
Lead, coordinate or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction into monitoring strategies.
Introduction
Collection and monitoring of objective data such as vital signs and pulse oximetry measurements are essential components of care for hospitalized children. Combined with clinical assessments, these data are critical when making therapeutic or diagnostic decisions. A complete understanding of non‐invasive monitoring techniques is necessary to accurately interpret the data generated. Pediatric hospitalists regularly incorporate this data into their clinical practice and, especially when overseeing procedural sedation or emergent clinical situations, may be responsible for implementing or supervising the appropriate type and level of monitoring.
Knowledge
Pediatric hospitalists should be able to:
List the different types of non‐invasive monitoring techniques and devices that are available and describe the indications for each.
Compare and contrast the types and level of monitoring generally available on the inpatient ward compared to the intensive care unit or other care settings.
Describe the proper procedures for common non‐invasive monitoring techniques, including vital sign measurement, cardiopulmonary monitoring, pulse oximetry, and capnography.
List the limitations or complications associated with common non‐invasive monitoring techniques, such as inadequate wave form for pulse oximetry.
Discuss the importance of accurate and timely interpretation of information generated by monitoring devices, as well as the importance of an immediate response when abnormal data is noted.
Skills
Pediatric hospitalists should be able to:
Determine the type and level of monitoring needed based on the clinical situation and medical complexity of the patient.
Identify the need for a higher or lower level of monitoring as changes in the clinical status occur and transfer the patient to the appropriate inpatient setting.
Ensure proper placement of monitoring equipment (e.g., placement of monitor leads) and execution of proper technique (e.g., use of correct size blood pressure cuff) in order to obtain accurate data.
Correctly interpret monitoring data and respond with appropriate actions.
Attitudes
Pediatric hospitalists should be able to:
Assume responsibility for ordering the appropriate monitoring and interpreting monitoring data.
Collaborate with nurses, subspecialists, and other healthcare providers to determine the appropriate level of monitoring and the corresponding care setting, especially when clinical changes occur.
Communicate effectively with patients and the family/caregiver regarding the need for non‐invasive monitoring, the findings, and the care plan.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate, or participate in the development and implementation of cost‐effective, safe, evidence‐based procedures and policies related to non‐invasive monitoring.
Work with hospital administration, biomedical engineering, and others to obtain high quality and reliable monitoring equipment.
Lead, coordinate, or participate in the development of continuing education programs focused on non‐invasive monitoring and the interpretation of related data.
Lead, coordinate or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction into monitoring strategies.
Copyright © 2010 Society of Hospital Medicine