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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
Kawasaki disease
Introduction
Kawasaki Disease (KD), also known as mucocutaneous lymph node syndrome, is a multisystem inflammatory disease of childhood. It most commonly presents in children under the age of two, however has been seen up to 12 years of age. Diagnosis can be difficult, as the classic signs and symptoms may not all manifest and the presentation may mimic other causes of fever and rash. Although many organs may be affected, those related to the cardiac system are the most concerning and persistent. Coronary aneurysms have been reported to occur in up to 20% of untreated children with KD. If diagnosed and treated promptly, the cardiac complications can be reduced. Therefore, it is important that pediatric hospitalists have a complete understanding of the diagnostic criteria and treatment of KD.
Knowledge
Pediatric hospitalists should be able to:
Discuss current established criteria and guidelines for diagnosis and treatment.
Define incomplete KD and note age groups in which this is more common.
List the broad categories of alternate diagnoses, and give examples from each.
Discuss the appropriate laboratory and imaging studies that aid in diagnosis.
Explain the pathophysiology of the disease, including the current understanding of development and manifestation of cardiac complications.
Define refractory KD and the list factors that indicate the need for further treatment.
Describe current best practice treatments, including approach toward persistent fever.
Compare and contrast the risks, benefits, and side effects of available treatments such as immunoglobulin, steroids, anti‐platelet medications and immunomodulators.
Cite risk factors associated with increased cardiac complications.
Discuss the immediate and long term follow‐up needed including impact, if any, on physical activity and sports participation.
List appropriate discharge criteria for KD.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose KD by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Promptly consult appropriate subspecialists to assist in evaluation and treatment.
Correctly interpret laboratory and imaging results.
Recognize features of alternate diagnoses and order relevant diagnostic studies as indicated.
Perform careful reassessments daily and as needed, note changes in clinical status and respond with appropriate actions.
Initiate prompt treatment once the diagnosis is established.
Anticipate and treat complications and side effects of instituted therapies.
Identify treatment failure and institute appropriate repeat or alternate therapy.
Demonstrate basic proficiency in reading electrocardiograms.
Coordinate care with subspecialists and the primary care provider, and arrange an appropriate transition and follow‐up plans for after hospital discharge.
Attitudes
Pediatric hospitalists should be able to:
Communicate effectively with patients, the family/caregiver, and other healthcare providers regarding findings and care plans.
Educate patients and the family/caregiver on the natural course of disease.
Collaborate with subspecialists and the primary care provider to ensure coordinated longitudinal care for children with KD.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in early multidisciplinary care to promote efficient diagnosis, treatment and discharge of patients with KD.
Work with hospital staff and subspecialists to educate other healthcare providers regarding the diagnosis and treatment of KD.
Lead, coordinate or participate in community education efforts regarding KD.
Introduction
Kawasaki Disease (KD), also known as mucocutaneous lymph node syndrome, is a multisystem inflammatory disease of childhood. It most commonly presents in children under the age of two, however has been seen up to 12 years of age. Diagnosis can be difficult, as the classic signs and symptoms may not all manifest and the presentation may mimic other causes of fever and rash. Although many organs may be affected, those related to the cardiac system are the most concerning and persistent. Coronary aneurysms have been reported to occur in up to 20% of untreated children with KD. If diagnosed and treated promptly, the cardiac complications can be reduced. Therefore, it is important that pediatric hospitalists have a complete understanding of the diagnostic criteria and treatment of KD.
Knowledge
Pediatric hospitalists should be able to:
Discuss current established criteria and guidelines for diagnosis and treatment.
Define incomplete KD and note age groups in which this is more common.
List the broad categories of alternate diagnoses, and give examples from each.
Discuss the appropriate laboratory and imaging studies that aid in diagnosis.
Explain the pathophysiology of the disease, including the current understanding of development and manifestation of cardiac complications.
Define refractory KD and the list factors that indicate the need for further treatment.
Describe current best practice treatments, including approach toward persistent fever.
Compare and contrast the risks, benefits, and side effects of available treatments such as immunoglobulin, steroids, anti‐platelet medications and immunomodulators.
Cite risk factors associated with increased cardiac complications.
Discuss the immediate and long term follow‐up needed including impact, if any, on physical activity and sports participation.
List appropriate discharge criteria for KD.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose KD by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Promptly consult appropriate subspecialists to assist in evaluation and treatment.
Correctly interpret laboratory and imaging results.
Recognize features of alternate diagnoses and order relevant diagnostic studies as indicated.
Perform careful reassessments daily and as needed, note changes in clinical status and respond with appropriate actions.
Initiate prompt treatment once the diagnosis is established.
Anticipate and treat complications and side effects of instituted therapies.
Identify treatment failure and institute appropriate repeat or alternate therapy.
Demonstrate basic proficiency in reading electrocardiograms.
Coordinate care with subspecialists and the primary care provider, and arrange an appropriate transition and follow‐up plans for after hospital discharge.
Attitudes
Pediatric hospitalists should be able to:
Communicate effectively with patients, the family/caregiver, and other healthcare providers regarding findings and care plans.
Educate patients and the family/caregiver on the natural course of disease.
Collaborate with subspecialists and the primary care provider to ensure coordinated longitudinal care for children with KD.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in early multidisciplinary care to promote efficient diagnosis, treatment and discharge of patients with KD.
Work with hospital staff and subspecialists to educate other healthcare providers regarding the diagnosis and treatment of KD.
Lead, coordinate or participate in community education efforts regarding KD.
Introduction
Kawasaki Disease (KD), also known as mucocutaneous lymph node syndrome, is a multisystem inflammatory disease of childhood. It most commonly presents in children under the age of two, however has been seen up to 12 years of age. Diagnosis can be difficult, as the classic signs and symptoms may not all manifest and the presentation may mimic other causes of fever and rash. Although many organs may be affected, those related to the cardiac system are the most concerning and persistent. Coronary aneurysms have been reported to occur in up to 20% of untreated children with KD. If diagnosed and treated promptly, the cardiac complications can be reduced. Therefore, it is important that pediatric hospitalists have a complete understanding of the diagnostic criteria and treatment of KD.
Knowledge
Pediatric hospitalists should be able to:
Discuss current established criteria and guidelines for diagnosis and treatment.
Define incomplete KD and note age groups in which this is more common.
List the broad categories of alternate diagnoses, and give examples from each.
Discuss the appropriate laboratory and imaging studies that aid in diagnosis.
Explain the pathophysiology of the disease, including the current understanding of development and manifestation of cardiac complications.
Define refractory KD and the list factors that indicate the need for further treatment.
Describe current best practice treatments, including approach toward persistent fever.
Compare and contrast the risks, benefits, and side effects of available treatments such as immunoglobulin, steroids, anti‐platelet medications and immunomodulators.
Cite risk factors associated with increased cardiac complications.
Discuss the immediate and long term follow‐up needed including impact, if any, on physical activity and sports participation.
List appropriate discharge criteria for KD.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose KD by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Promptly consult appropriate subspecialists to assist in evaluation and treatment.
Correctly interpret laboratory and imaging results.
Recognize features of alternate diagnoses and order relevant diagnostic studies as indicated.
Perform careful reassessments daily and as needed, note changes in clinical status and respond with appropriate actions.
Initiate prompt treatment once the diagnosis is established.
Anticipate and treat complications and side effects of instituted therapies.
Identify treatment failure and institute appropriate repeat or alternate therapy.
Demonstrate basic proficiency in reading electrocardiograms.
Coordinate care with subspecialists and the primary care provider, and arrange an appropriate transition and follow‐up plans for after hospital discharge.
Attitudes
Pediatric hospitalists should be able to:
Communicate effectively with patients, the family/caregiver, and other healthcare providers regarding findings and care plans.
Educate patients and the family/caregiver on the natural course of disease.
Collaborate with subspecialists and the primary care provider to ensure coordinated longitudinal care for children with KD.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in early multidisciplinary care to promote efficient diagnosis, treatment and discharge of patients with KD.
Work with hospital staff and subspecialists to educate other healthcare providers regarding the diagnosis and treatment of KD.
Lead, coordinate or participate in community education efforts regarding KD.
Copyright © 2010 Society of Hospital Medicine
Urinary tract infections
Introduction
Infections of the urinary tract can involve any structure from the kidney to the urethra. Pyelonephritis exists when the infection involves the kidney. Urinary tract infections (UTI) occur in up to 2.8% of all children and 5% of febrile children. They result in 1.1 million office visits (0.7% of total visits) and 13,000 hospitalizations annually. Costs related to only the acute inpatient care of UTI are estimated at $180 million per year alone. The financial impact of subsequent follow‐up imaging, treatment, long‐term sequelae, and family/caregiver work loss is not well quantitated but is substantial. UTIs may be associated with urologic abnormalities in a significant percentage of young children with pyelonephritis. Pediatric hospitalists frequently encounter children with UTI and must remain current on strategies for diagnosis, treatment and follow‐up care for patients with UTIs.
Knowledge
Pediatric hospitalists should be able to:
Describe the abnormal anatomic and physiologic aspects of the urogenital system that may predispose children to UTIs at varying ages, such as posterior urethral valves, duplicated system, voiding dysfunction, chronic constipation, and others.
Describe the range of clinical presentations attending to differences by age.
Compare and contrast the short and long terms risks of lower versus upper urinary tract infection.
Define a positive urine culture and discuss how the method for obtaining and efficiency of processing urine influences results of cultures.
Identify pathogens that cause UTI in both the previously healthy host and those with underlying disease.
Describe appropriate antibiotic coverage for pathogens of concern with awareness of antibiotic resistance patterns within the local community.
Discuss the utility of commonly obtained laboratory tests such as urinalysis, urine gram stain, urine culture, blood culture, serum chemistries, and others.
Review the typical response to therapy, and list common complications of ineffective treatment.
Summarize current literature regarding treatment and evaluation for underlying abnormalities, including radiography.
List factors warranting subspecialty consultation or referral.
Discuss the potential acute and long‐term sequelae of treated and untreated UTI.
Summarize the discharge plan attending to indications for short and long term parenteral and total antimicrobial therapy, repeat evaluations, and subspecialty referral by age.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose UTI by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Identify patients at risk for UTI.
Order appropriate diagnostic studies for the evaluation of suspected UTI.
Prescribe appropriate initial antimicrobial and supportive therapy based on history and physical examination.
Correctly interpret results of diagnostic testing and use results to guide diagnosis and management.
Correctly identify the need for and efficiently access appropriate consultants and support services needed to provide comprehensive care.
Identify when discharge criteria are met, and initiate efficient discharge orders and plans.
Communicate effectively with patients, the family/caregiver and the primary care provider to ensure appropriate post‐discharge testing and follow‐up.
Attitudes
Pediatric hospitalists should be able to:
Educate the family/caregiver on the expected course of illness, treatment options, and potential sequelae.
Recognize the importance of communicating with the primary care provider to ensure a safe, efficient, and effective discharge and post‐discharge care.
Collaborate with the healthcare team to ensure coordinated hospital care for children with UTI.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Collaborate with referring physicians (primary care, emergency medicine, and referring hospital physicians) to develop and sustain appropriate referral networks for evaluation, admission, or transfer of children with UTI.
Collaborate with subspecialists to ensure consistent, timely, and up‐to‐date evaluation and care in the inpatient setting.
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 children with UTI.
Introduction
Infections of the urinary tract can involve any structure from the kidney to the urethra. Pyelonephritis exists when the infection involves the kidney. Urinary tract infections (UTI) occur in up to 2.8% of all children and 5% of febrile children. They result in 1.1 million office visits (0.7% of total visits) and 13,000 hospitalizations annually. Costs related to only the acute inpatient care of UTI are estimated at $180 million per year alone. The financial impact of subsequent follow‐up imaging, treatment, long‐term sequelae, and family/caregiver work loss is not well quantitated but is substantial. UTIs may be associated with urologic abnormalities in a significant percentage of young children with pyelonephritis. Pediatric hospitalists frequently encounter children with UTI and must remain current on strategies for diagnosis, treatment and follow‐up care for patients with UTIs.
Knowledge
Pediatric hospitalists should be able to:
Describe the abnormal anatomic and physiologic aspects of the urogenital system that may predispose children to UTIs at varying ages, such as posterior urethral valves, duplicated system, voiding dysfunction, chronic constipation, and others.
Describe the range of clinical presentations attending to differences by age.
Compare and contrast the short and long terms risks of lower versus upper urinary tract infection.
Define a positive urine culture and discuss how the method for obtaining and efficiency of processing urine influences results of cultures.
Identify pathogens that cause UTI in both the previously healthy host and those with underlying disease.
Describe appropriate antibiotic coverage for pathogens of concern with awareness of antibiotic resistance patterns within the local community.
Discuss the utility of commonly obtained laboratory tests such as urinalysis, urine gram stain, urine culture, blood culture, serum chemistries, and others.
Review the typical response to therapy, and list common complications of ineffective treatment.
Summarize current literature regarding treatment and evaluation for underlying abnormalities, including radiography.
List factors warranting subspecialty consultation or referral.
Discuss the potential acute and long‐term sequelae of treated and untreated UTI.
Summarize the discharge plan attending to indications for short and long term parenteral and total antimicrobial therapy, repeat evaluations, and subspecialty referral by age.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose UTI by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Identify patients at risk for UTI.
Order appropriate diagnostic studies for the evaluation of suspected UTI.
Prescribe appropriate initial antimicrobial and supportive therapy based on history and physical examination.
Correctly interpret results of diagnostic testing and use results to guide diagnosis and management.
Correctly identify the need for and efficiently access appropriate consultants and support services needed to provide comprehensive care.
Identify when discharge criteria are met, and initiate efficient discharge orders and plans.
Communicate effectively with patients, the family/caregiver and the primary care provider to ensure appropriate post‐discharge testing and follow‐up.
Attitudes
Pediatric hospitalists should be able to:
Educate the family/caregiver on the expected course of illness, treatment options, and potential sequelae.
Recognize the importance of communicating with the primary care provider to ensure a safe, efficient, and effective discharge and post‐discharge care.
Collaborate with the healthcare team to ensure coordinated hospital care for children with UTI.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Collaborate with referring physicians (primary care, emergency medicine, and referring hospital physicians) to develop and sustain appropriate referral networks for evaluation, admission, or transfer of children with UTI.
Collaborate with subspecialists to ensure consistent, timely, and up‐to‐date evaluation and care in the inpatient setting.
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 children with UTI.
Introduction
Infections of the urinary tract can involve any structure from the kidney to the urethra. Pyelonephritis exists when the infection involves the kidney. Urinary tract infections (UTI) occur in up to 2.8% of all children and 5% of febrile children. They result in 1.1 million office visits (0.7% of total visits) and 13,000 hospitalizations annually. Costs related to only the acute inpatient care of UTI are estimated at $180 million per year alone. The financial impact of subsequent follow‐up imaging, treatment, long‐term sequelae, and family/caregiver work loss is not well quantitated but is substantial. UTIs may be associated with urologic abnormalities in a significant percentage of young children with pyelonephritis. Pediatric hospitalists frequently encounter children with UTI and must remain current on strategies for diagnosis, treatment and follow‐up care for patients with UTIs.
Knowledge
Pediatric hospitalists should be able to:
Describe the abnormal anatomic and physiologic aspects of the urogenital system that may predispose children to UTIs at varying ages, such as posterior urethral valves, duplicated system, voiding dysfunction, chronic constipation, and others.
Describe the range of clinical presentations attending to differences by age.
Compare and contrast the short and long terms risks of lower versus upper urinary tract infection.
Define a positive urine culture and discuss how the method for obtaining and efficiency of processing urine influences results of cultures.
Identify pathogens that cause UTI in both the previously healthy host and those with underlying disease.
Describe appropriate antibiotic coverage for pathogens of concern with awareness of antibiotic resistance patterns within the local community.
Discuss the utility of commonly obtained laboratory tests such as urinalysis, urine gram stain, urine culture, blood culture, serum chemistries, and others.
Review the typical response to therapy, and list common complications of ineffective treatment.
Summarize current literature regarding treatment and evaluation for underlying abnormalities, including radiography.
List factors warranting subspecialty consultation or referral.
Discuss the potential acute and long‐term sequelae of treated and untreated UTI.
Summarize the discharge plan attending to indications for short and long term parenteral and total antimicrobial therapy, repeat evaluations, and subspecialty referral by age.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose UTI by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Identify patients at risk for UTI.
Order appropriate diagnostic studies for the evaluation of suspected UTI.
Prescribe appropriate initial antimicrobial and supportive therapy based on history and physical examination.
Correctly interpret results of diagnostic testing and use results to guide diagnosis and management.
Correctly identify the need for and efficiently access appropriate consultants and support services needed to provide comprehensive care.
Identify when discharge criteria are met, and initiate efficient discharge orders and plans.
Communicate effectively with patients, the family/caregiver and the primary care provider to ensure appropriate post‐discharge testing and follow‐up.
Attitudes
Pediatric hospitalists should be able to:
Educate the family/caregiver on the expected course of illness, treatment options, and potential sequelae.
Recognize the importance of communicating with the primary care provider to ensure a safe, efficient, and effective discharge and post‐discharge care.
Collaborate with the healthcare team to ensure coordinated hospital care for children with UTI.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Collaborate with referring physicians (primary care, emergency medicine, and referring hospital physicians) to develop and sustain appropriate referral networks for evaluation, admission, or transfer of children with UTI.
Collaborate with subspecialists to ensure consistent, timely, and up‐to‐date evaluation and care in the inpatient setting.
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 children with UTI.
Copyright © 2010 Society of Hospital Medicine
Introduction to the Pediatric Hospital Medicine Core Competencies
Background
Pediatric Hospital Medicine continues to evolve as an area of specialization, with the refinement of a distinct knowledgebase and skill set focused on the provision of high quality general pediatric care in the inpatient setting. It is the latest site‐specific specialty to emerge from the field of general pediatrics, following a course similar to that charted by pediatric emergency medicine and pediatric critical care medicine in recent decades. The growth of the field has been spurred by a number of factors, including the converging needs for a dedicated emphasis on patient safety, quality improvement, throughput management, and teaching in the inpatient setting.
The number of practicing pediatric hospitalists is estimated to be approximately 2500 and rapidly increasing. To meet the educational needs of this growing cohort of pediatricians, local, regional, and national continuing medical education offerings occur on a regular basis. Furthermore, at least ten fellowships dedicated to advanced training in pediatric hospital medicine have been developed at academic institutions across North America. Despite this, there has been an absence of an accepted and peer‐reviewed framework for professional and curriculum development.
The Pediatric Hospital Medicine Core Competencies represent the first comprehensive attempt to more formally define the standards for the knowledge, skills, attitudes, and focus on systems improvements that are expected of all pediatric hospitalists, regardless of practice setting or location. It is the culmination of more than five years of planning, research, and development by the Society of Hospital Medicine Pediatric Core Curriculum Task Force, leaders within the Academic Pediatric Association and the American Academy of Pediatrics, and the editorial board. The competencies include contributions from over 80 pediatric hospitalists, content experts, and internal and external reviewers representing university and community hospitals, teaching and non‐teaching programs, and key societies and agencies involved in child health from all geographic regions of the United States and Canada. A companion article to Pediatric Hospital Medicine Core Competencies in this Supplement provides additional details regarding the project methodology.
Purpose
The Pediatric Hospital Medicine Core Competencies provide a framework for professional and curriculum development for all pediatric hospitalists. The framework is intended for use by hospital medicine program directors, directors of medical student clerkships, residency programs, fellowships, and continuing medical education, as well as other educators involved in curriculum development. The competencies do not focus on specific content, but rather general learning objectives within the skills, knowledge, and attitudes related to each topic. Attaining competency in the areas defined in these chapters is expected to require post‐residency training. This training is most likely to be obtained through a combination of work experience, local mentorship, and engagement in specific educational programs or fellowship. Pediatric hospitalists, directors, and educators can create specific instructional activities and methods chosen to reflect the characteristics of the intended learners and context of the practice environment.
Organization Structure
The Pediatric Hospital Medicine Core Competencies consist of 54 chapters, divided into four sections Common Clinical Diagnoses and Conditions, Specialized Clinical Services, Core Skills, and Healthcare Systems: Supporting and Advancing Child Health. Within each section, individual chapters on focused topics provide competencies in three domains of educational outcomes: the Cognitive Domain (Knowledge), the Psychomotor Domain (Skills), and the Affective Domain (Attitudes). To reflect the emphasis of hospital medicine practice on improving healthcare systems, a fourth section entitled Systems Organization and Improvement is also included. An attempt has been made to make the objectives timeless, allowing for creation of curriculum that can be nimble and reactive to new discoveries. Highly specific temporal changes in medicine are purposefully excluded, and instead the focus is on the drivers for these changes or advancements. Phrases and wording were selected to help guide the learning activities most likely to achieve each competency and to reflect the varied roles that pediatric hospitalists have in different practice settings. In this document, the terms child and children include infants, children, adolescents, and young adults up to the age of 21, in accordance of policies of the American Academy of Pediatrics. However, it is also understood that care is rendered in pediatric settings for patients who may surpass this upper age limit based on diagnosis or special healthcare needs. Finally, although the entire document can be a resource for comprehensive program development, each chapter is intended to stand alone and thus support curriculum development specific to the needs of individual programs.
Conclusion and Acknowledgement
The Pediatric Hospital Medicine Core Competencies are intended to provide standards for the knowledge, skills, and attitudes expected of all pediatric hospitalists and to provide a framework for ongoing professional and curriculum development for learners at all levels. We welcome feedback and evaluation from pediatric hospitalists and from all with whom we partner to improve the care for hospitalized children.
We wish to acknowledge the dedication of authors and associate editors, and the thoughtful review by the members of hospital organizations, accrediting bodies, and agencies listed in this supplement. This inaugural edition of the Pediatric Hospital Medicine Core Competenciesshould serve as the foundation from which the field of Pediatric Hospital Medicine will continue to evolve. We look forward with anticipation to future revisions as we reflect on our goals and advance our field.
The Pediatric Hospital Medicine Core Competencies Editorial Board
Erin Stucky, MD
Mary C Ottolini, MD, MPH
Jennifer Maniscalco, MD, MPH
Background
Pediatric Hospital Medicine continues to evolve as an area of specialization, with the refinement of a distinct knowledgebase and skill set focused on the provision of high quality general pediatric care in the inpatient setting. It is the latest site‐specific specialty to emerge from the field of general pediatrics, following a course similar to that charted by pediatric emergency medicine and pediatric critical care medicine in recent decades. The growth of the field has been spurred by a number of factors, including the converging needs for a dedicated emphasis on patient safety, quality improvement, throughput management, and teaching in the inpatient setting.
The number of practicing pediatric hospitalists is estimated to be approximately 2500 and rapidly increasing. To meet the educational needs of this growing cohort of pediatricians, local, regional, and national continuing medical education offerings occur on a regular basis. Furthermore, at least ten fellowships dedicated to advanced training in pediatric hospital medicine have been developed at academic institutions across North America. Despite this, there has been an absence of an accepted and peer‐reviewed framework for professional and curriculum development.
The Pediatric Hospital Medicine Core Competencies represent the first comprehensive attempt to more formally define the standards for the knowledge, skills, attitudes, and focus on systems improvements that are expected of all pediatric hospitalists, regardless of practice setting or location. It is the culmination of more than five years of planning, research, and development by the Society of Hospital Medicine Pediatric Core Curriculum Task Force, leaders within the Academic Pediatric Association and the American Academy of Pediatrics, and the editorial board. The competencies include contributions from over 80 pediatric hospitalists, content experts, and internal and external reviewers representing university and community hospitals, teaching and non‐teaching programs, and key societies and agencies involved in child health from all geographic regions of the United States and Canada. A companion article to Pediatric Hospital Medicine Core Competencies in this Supplement provides additional details regarding the project methodology.
Purpose
The Pediatric Hospital Medicine Core Competencies provide a framework for professional and curriculum development for all pediatric hospitalists. The framework is intended for use by hospital medicine program directors, directors of medical student clerkships, residency programs, fellowships, and continuing medical education, as well as other educators involved in curriculum development. The competencies do not focus on specific content, but rather general learning objectives within the skills, knowledge, and attitudes related to each topic. Attaining competency in the areas defined in these chapters is expected to require post‐residency training. This training is most likely to be obtained through a combination of work experience, local mentorship, and engagement in specific educational programs or fellowship. Pediatric hospitalists, directors, and educators can create specific instructional activities and methods chosen to reflect the characteristics of the intended learners and context of the practice environment.
Organization Structure
The Pediatric Hospital Medicine Core Competencies consist of 54 chapters, divided into four sections Common Clinical Diagnoses and Conditions, Specialized Clinical Services, Core Skills, and Healthcare Systems: Supporting and Advancing Child Health. Within each section, individual chapters on focused topics provide competencies in three domains of educational outcomes: the Cognitive Domain (Knowledge), the Psychomotor Domain (Skills), and the Affective Domain (Attitudes). To reflect the emphasis of hospital medicine practice on improving healthcare systems, a fourth section entitled Systems Organization and Improvement is also included. An attempt has been made to make the objectives timeless, allowing for creation of curriculum that can be nimble and reactive to new discoveries. Highly specific temporal changes in medicine are purposefully excluded, and instead the focus is on the drivers for these changes or advancements. Phrases and wording were selected to help guide the learning activities most likely to achieve each competency and to reflect the varied roles that pediatric hospitalists have in different practice settings. In this document, the terms child and children include infants, children, adolescents, and young adults up to the age of 21, in accordance of policies of the American Academy of Pediatrics. However, it is also understood that care is rendered in pediatric settings for patients who may surpass this upper age limit based on diagnosis or special healthcare needs. Finally, although the entire document can be a resource for comprehensive program development, each chapter is intended to stand alone and thus support curriculum development specific to the needs of individual programs.
Conclusion and Acknowledgement
The Pediatric Hospital Medicine Core Competencies are intended to provide standards for the knowledge, skills, and attitudes expected of all pediatric hospitalists and to provide a framework for ongoing professional and curriculum development for learners at all levels. We welcome feedback and evaluation from pediatric hospitalists and from all with whom we partner to improve the care for hospitalized children.
We wish to acknowledge the dedication of authors and associate editors, and the thoughtful review by the members of hospital organizations, accrediting bodies, and agencies listed in this supplement. This inaugural edition of the Pediatric Hospital Medicine Core Competenciesshould serve as the foundation from which the field of Pediatric Hospital Medicine will continue to evolve. We look forward with anticipation to future revisions as we reflect on our goals and advance our field.
The Pediatric Hospital Medicine Core Competencies Editorial Board
Erin Stucky, MD
Mary C Ottolini, MD, MPH
Jennifer Maniscalco, MD, MPH
Background
Pediatric Hospital Medicine continues to evolve as an area of specialization, with the refinement of a distinct knowledgebase and skill set focused on the provision of high quality general pediatric care in the inpatient setting. It is the latest site‐specific specialty to emerge from the field of general pediatrics, following a course similar to that charted by pediatric emergency medicine and pediatric critical care medicine in recent decades. The growth of the field has been spurred by a number of factors, including the converging needs for a dedicated emphasis on patient safety, quality improvement, throughput management, and teaching in the inpatient setting.
The number of practicing pediatric hospitalists is estimated to be approximately 2500 and rapidly increasing. To meet the educational needs of this growing cohort of pediatricians, local, regional, and national continuing medical education offerings occur on a regular basis. Furthermore, at least ten fellowships dedicated to advanced training in pediatric hospital medicine have been developed at academic institutions across North America. Despite this, there has been an absence of an accepted and peer‐reviewed framework for professional and curriculum development.
The Pediatric Hospital Medicine Core Competencies represent the first comprehensive attempt to more formally define the standards for the knowledge, skills, attitudes, and focus on systems improvements that are expected of all pediatric hospitalists, regardless of practice setting or location. It is the culmination of more than five years of planning, research, and development by the Society of Hospital Medicine Pediatric Core Curriculum Task Force, leaders within the Academic Pediatric Association and the American Academy of Pediatrics, and the editorial board. The competencies include contributions from over 80 pediatric hospitalists, content experts, and internal and external reviewers representing university and community hospitals, teaching and non‐teaching programs, and key societies and agencies involved in child health from all geographic regions of the United States and Canada. A companion article to Pediatric Hospital Medicine Core Competencies in this Supplement provides additional details regarding the project methodology.
Purpose
The Pediatric Hospital Medicine Core Competencies provide a framework for professional and curriculum development for all pediatric hospitalists. The framework is intended for use by hospital medicine program directors, directors of medical student clerkships, residency programs, fellowships, and continuing medical education, as well as other educators involved in curriculum development. The competencies do not focus on specific content, but rather general learning objectives within the skills, knowledge, and attitudes related to each topic. Attaining competency in the areas defined in these chapters is expected to require post‐residency training. This training is most likely to be obtained through a combination of work experience, local mentorship, and engagement in specific educational programs or fellowship. Pediatric hospitalists, directors, and educators can create specific instructional activities and methods chosen to reflect the characteristics of the intended learners and context of the practice environment.
Organization Structure
The Pediatric Hospital Medicine Core Competencies consist of 54 chapters, divided into four sections Common Clinical Diagnoses and Conditions, Specialized Clinical Services, Core Skills, and Healthcare Systems: Supporting and Advancing Child Health. Within each section, individual chapters on focused topics provide competencies in three domains of educational outcomes: the Cognitive Domain (Knowledge), the Psychomotor Domain (Skills), and the Affective Domain (Attitudes). To reflect the emphasis of hospital medicine practice on improving healthcare systems, a fourth section entitled Systems Organization and Improvement is also included. An attempt has been made to make the objectives timeless, allowing for creation of curriculum that can be nimble and reactive to new discoveries. Highly specific temporal changes in medicine are purposefully excluded, and instead the focus is on the drivers for these changes or advancements. Phrases and wording were selected to help guide the learning activities most likely to achieve each competency and to reflect the varied roles that pediatric hospitalists have in different practice settings. In this document, the terms child and children include infants, children, adolescents, and young adults up to the age of 21, in accordance of policies of the American Academy of Pediatrics. However, it is also understood that care is rendered in pediatric settings for patients who may surpass this upper age limit based on diagnosis or special healthcare needs. Finally, although the entire document can be a resource for comprehensive program development, each chapter is intended to stand alone and thus support curriculum development specific to the needs of individual programs.
Conclusion and Acknowledgement
The Pediatric Hospital Medicine Core Competencies are intended to provide standards for the knowledge, skills, and attitudes expected of all pediatric hospitalists and to provide a framework for ongoing professional and curriculum development for learners at all levels. We welcome feedback and evaluation from pediatric hospitalists and from all with whom we partner to improve the care for hospitalized children.
We wish to acknowledge the dedication of authors and associate editors, and the thoughtful review by the members of hospital organizations, accrediting bodies, and agencies listed in this supplement. This inaugural edition of the Pediatric Hospital Medicine Core Competenciesshould serve as the foundation from which the field of Pediatric Hospital Medicine will continue to evolve. We look forward with anticipation to future revisions as we reflect on our goals and advance our field.
The Pediatric Hospital Medicine Core Competencies Editorial Board
Erin Stucky, MD
Mary C Ottolini, MD, MPH
Jennifer Maniscalco, MD, MPH
Copyright © 2010 Society of Hospital Medicine
Health information systems
Introduction
Health information systems encompass the range of technology in health care used to acquire, store, deliver and analyze medical data. In the hospital environment, this technology is one of the most important components to the delivery of high‐quality and safe care. In particular, healthcare provider order entry, has been shown to reduce medical errors, while systems that display recently completed laboratory testing may decrease redundant testing. Despite these benefits, hospitals have been slow to adopt these technologies. The Institute of Medicine and the Department of Health and Human Services have recognized this fact and have begun serious efforts to improve the adoption of electronic medical information systems in all health care environments. Pediatric hospitalists use these systems for clinical care, education, quality improvement efforts and research and can assist with assessing and implementing systems
Knowledge
Pediatric hospitalists should be able to:
Compare and contrast the varied health information systems used to manage medical information across different hospital settings, especially with regard to the differences between adult and pediatric needs.
Describe the importance of proper storage and retrieval of protected health information.
Discuss the impact of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule on health information systems security.
Explain the value of clinical decision support in rendering patient care.
Compare and contrast the influence of electronic health information on practice management, clinical decision‐making, quality improvement projects and performance of research.
Identify at least one improvement in patient safety that can be realized with institution of an electronic medical record.
Describe how hospital policies and procedures impact information systems operations, and that in turn delivery of health care to children influences these policies, procedures, and systems.
Describe the basic organization of the information technology department.
Describe resources that can be accessed to address questions about information systems such as a hospital HELP desk, vendor support lines, or online access to other healthcare providers who use the system.
Delineate how staff dedicated to information technology support quality and safety efforts and data retrieval.
List information resources and tools available to support life‐long learning.
Discuss the importance of pediatric hospitalists in creating, modifying, and evaluating changes to health information systems.
Describe the unique needs of children in regard to information technology, and the importance of careful design and implementation of health information systems in hospitals and clinics that care for children.
Skills
Pediatric hospitalists should be able to:
Demonstrate proficiency with foundational computer skills (email, literature searching, downloading and uploading files.) and common computer applications (word processing, spreadsheet use, and presentation software) as well as the local provider order entry system.
Skillfully access and use web‐based educational resources for continuing education and enrichment of trainee learning experiences.
Effectively and efficiently utilize local health information systems for clinical care, education, and performance of projects as appropriate within the context of the local system.
Assist in creation of order sets and documentation templates.
Assess the value of rules and alerts and assist with editing these as appropriate.
Attitudes
Pediatric hospitalists should be able to:
Be accountable for working to ensure the successful functioning of health information systems.
Advocate for the proper alignment of health information systems choices with clinical needs.
Effectively communicate with information systems managers.
Respect patient confidentiality by using the security‐directed features of information systems.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Participate in appropriate hospital committees and assist with information technology solutions to address causes of unsafe care.
Work with hospital administrators and the Medical Staff to integrate new technologies to the practice of medicine (such as telemedicine, medical decision making, computerized medical records, electronic information networks and others).
Seek opportunities to improve the role of information technology in managing costs, quality improvement efforts, and research, if applicable.
Introduction
Health information systems encompass the range of technology in health care used to acquire, store, deliver and analyze medical data. In the hospital environment, this technology is one of the most important components to the delivery of high‐quality and safe care. In particular, healthcare provider order entry, has been shown to reduce medical errors, while systems that display recently completed laboratory testing may decrease redundant testing. Despite these benefits, hospitals have been slow to adopt these technologies. The Institute of Medicine and the Department of Health and Human Services have recognized this fact and have begun serious efforts to improve the adoption of electronic medical information systems in all health care environments. Pediatric hospitalists use these systems for clinical care, education, quality improvement efforts and research and can assist with assessing and implementing systems
Knowledge
Pediatric hospitalists should be able to:
Compare and contrast the varied health information systems used to manage medical information across different hospital settings, especially with regard to the differences between adult and pediatric needs.
Describe the importance of proper storage and retrieval of protected health information.
Discuss the impact of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule on health information systems security.
Explain the value of clinical decision support in rendering patient care.
Compare and contrast the influence of electronic health information on practice management, clinical decision‐making, quality improvement projects and performance of research.
Identify at least one improvement in patient safety that can be realized with institution of an electronic medical record.
Describe how hospital policies and procedures impact information systems operations, and that in turn delivery of health care to children influences these policies, procedures, and systems.
Describe the basic organization of the information technology department.
Describe resources that can be accessed to address questions about information systems such as a hospital HELP desk, vendor support lines, or online access to other healthcare providers who use the system.
Delineate how staff dedicated to information technology support quality and safety efforts and data retrieval.
List information resources and tools available to support life‐long learning.
Discuss the importance of pediatric hospitalists in creating, modifying, and evaluating changes to health information systems.
Describe the unique needs of children in regard to information technology, and the importance of careful design and implementation of health information systems in hospitals and clinics that care for children.
Skills
Pediatric hospitalists should be able to:
Demonstrate proficiency with foundational computer skills (email, literature searching, downloading and uploading files.) and common computer applications (word processing, spreadsheet use, and presentation software) as well as the local provider order entry system.
Skillfully access and use web‐based educational resources for continuing education and enrichment of trainee learning experiences.
Effectively and efficiently utilize local health information systems for clinical care, education, and performance of projects as appropriate within the context of the local system.
Assist in creation of order sets and documentation templates.
Assess the value of rules and alerts and assist with editing these as appropriate.
Attitudes
Pediatric hospitalists should be able to:
Be accountable for working to ensure the successful functioning of health information systems.
Advocate for the proper alignment of health information systems choices with clinical needs.
Effectively communicate with information systems managers.
Respect patient confidentiality by using the security‐directed features of information systems.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Participate in appropriate hospital committees and assist with information technology solutions to address causes of unsafe care.
Work with hospital administrators and the Medical Staff to integrate new technologies to the practice of medicine (such as telemedicine, medical decision making, computerized medical records, electronic information networks and others).
Seek opportunities to improve the role of information technology in managing costs, quality improvement efforts, and research, if applicable.
Introduction
Health information systems encompass the range of technology in health care used to acquire, store, deliver and analyze medical data. In the hospital environment, this technology is one of the most important components to the delivery of high‐quality and safe care. In particular, healthcare provider order entry, has been shown to reduce medical errors, while systems that display recently completed laboratory testing may decrease redundant testing. Despite these benefits, hospitals have been slow to adopt these technologies. The Institute of Medicine and the Department of Health and Human Services have recognized this fact and have begun serious efforts to improve the adoption of electronic medical information systems in all health care environments. Pediatric hospitalists use these systems for clinical care, education, quality improvement efforts and research and can assist with assessing and implementing systems
Knowledge
Pediatric hospitalists should be able to:
Compare and contrast the varied health information systems used to manage medical information across different hospital settings, especially with regard to the differences between adult and pediatric needs.
Describe the importance of proper storage and retrieval of protected health information.
Discuss the impact of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule on health information systems security.
Explain the value of clinical decision support in rendering patient care.
Compare and contrast the influence of electronic health information on practice management, clinical decision‐making, quality improvement projects and performance of research.
Identify at least one improvement in patient safety that can be realized with institution of an electronic medical record.
Describe how hospital policies and procedures impact information systems operations, and that in turn delivery of health care to children influences these policies, procedures, and systems.
Describe the basic organization of the information technology department.
Describe resources that can be accessed to address questions about information systems such as a hospital HELP desk, vendor support lines, or online access to other healthcare providers who use the system.
Delineate how staff dedicated to information technology support quality and safety efforts and data retrieval.
List information resources and tools available to support life‐long learning.
Discuss the importance of pediatric hospitalists in creating, modifying, and evaluating changes to health information systems.
Describe the unique needs of children in regard to information technology, and the importance of careful design and implementation of health information systems in hospitals and clinics that care for children.
Skills
Pediatric hospitalists should be able to:
Demonstrate proficiency with foundational computer skills (email, literature searching, downloading and uploading files.) and common computer applications (word processing, spreadsheet use, and presentation software) as well as the local provider order entry system.
Skillfully access and use web‐based educational resources for continuing education and enrichment of trainee learning experiences.
Effectively and efficiently utilize local health information systems for clinical care, education, and performance of projects as appropriate within the context of the local system.
Assist in creation of order sets and documentation templates.
Assess the value of rules and alerts and assist with editing these as appropriate.
Attitudes
Pediatric hospitalists should be able to:
Be accountable for working to ensure the successful functioning of health information systems.
Advocate for the proper alignment of health information systems choices with clinical needs.
Effectively communicate with information systems managers.
Respect patient confidentiality by using the security‐directed features of information systems.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Participate in appropriate hospital committees and assist with information technology solutions to address causes of unsafe care.
Work with hospital administrators and the Medical Staff to integrate new technologies to the practice of medicine (such as telemedicine, medical decision making, computerized medical records, electronic information networks and others).
Seek opportunities to improve the role of information technology in managing costs, quality improvement efforts, and research, if applicable.
Copyright © 2010 Society of Hospital Medicine