Hospital Medicine

Introduction

Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about patient care. This scientific evidence includes data obtained from many study types that are found in varied published manuscripts, society guidelines, or other reputable sources. Sources of evidence must be interpreted and applied to clinical decision-making in a thorough and thoughtful manner in order to achieve best practice. Clinical decisions are therefore made considering a combination of the value systems of patients and the family/caregivers, specific clinical circumstances, and a thorough assessment of the EBM literature regarding the clinical condition. Pediatric hospitalists address multiple clinical questions daily and should utilize EBM to make clinical care decisions, teach trainees and engage patients and the family/caregivers in shared decision-making, perform quality improvement (QI) and research studies, and advance personal lifelong learning.

Pediatric hospitalists should be able to:

• Define EBM and list databases and other resources commonly used to search for this medical evidence.
• Discuss the benefits and limitations of commonly used scientific medical resources, considering issues such as publication bias, consensus statement methodology used, national versus international web indexed articles, and others.
• State how EBM is integrated into clinical decision-making for a patient or a population.
• Review how EBM supports QI and patient safety efforts.
• List examples of where EBM may be integrated into common educational efforts for trainees and clinical groups or divisions, attending to scheduled and spontaneous sessions.
• Explain common classification systems used to grade the strength of evidence in a given published work and discuss how this can help guide clinical decision-making.
• Explain how each of the components of a well composed, searchable clinical question using a method such as patient-intervention-control-outcomes (PICO) aids in obtaining a more accurate and comprehensive list of references.
• Distinguish among commonly used study designs, such as retrospective, prospective, case control, randomized controlled trial, and others, and list the benefits and limitations of each.
• Define commonly used terms such as relative and absolute risk reduction, number needed to treat (NNT), sensitivity, specificity, positive and negative predictive values (PPV, NPV), and likelihood ratios (LR).
• Review how EBM is integrated into lifelong learning, including ongoing certification by professional certifying boards.

Pediatric hospitalists should be able to:

• Identify information deficits and perform accurate EBM review to address the deficits in the context of clinical practice.
• Translate a clinical question into a searchable PICO question or search string.
• Identify the most appropriate study designs to answer a specific clinical question.
• Demonstrate proficient performance of a literature search using electronic resources such as PubMed.
• Appraise the quality of varied published manuscripts, society guidelines, or other reputable sources of medical literature using a consistent method.
• Interpret the level of evidence and risk/benefit ratio of study results and utilize EBM methods to select appropriate tests and treatments for patients.
• Apply relevant results from the available evidence to assist with creating and implementing clinical guidelines for populations, within local context.
• Integrate the consistent use of EBM into activities for personal lifelong learning.
• Develop, implement, and maintain a personal strategy to consistently incorporate evidence, balance of harm and benefits, and values of patients and the family/caregivers into shared clinical decision-making to deliver the highest quality care.

Pediatric hospitalists should be able to:

• Recognize the importance of seeking the best available evidence to support clinical decision-making.
• Realize that acquiring and maintaining EBM skills requires integration into daily practice and pursuit of ongoing continuing education.
• Recognize how personal practice patterns are influenced by the integration of EBM.
• Role model use of EBM at the bedside.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of evidence-based care pathways to standardize the evaluation and management of hospitalized children in the local system.
• Engage with hospital staff, trainees, colleagues, subspecialists, and others in a multidisciplinary team approach toward integrating EBM into clinical decision-making processes.
• Collaborate with hospital administrators to acquire and maintain effective, efficient electronic resources for the performance of EBM.

Introduction

Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about patient care. This scientific evidence includes data obtained from many study types that are found in varied published manuscripts, society guidelines, or other reputable sources. Sources of evidence must be interpreted and applied to clinical decision-making in a thorough and thoughtful manner in order to achieve best practice. Clinical decisions are therefore made considering a combination of the value systems of patients and the family/caregivers, specific clinical circumstances, and a thorough assessment of the EBM literature regarding the clinical condition. Pediatric hospitalists address multiple clinical questions daily and should utilize EBM to make clinical care decisions, teach trainees and engage patients and the family/caregivers in shared decision-making, perform quality improvement (QI) and research studies, and advance personal lifelong learning.

Pediatric hospitalists should be able to:

• Define EBM and list databases and other resources commonly used to search for this medical evidence.
• Discuss the benefits and limitations of commonly used scientific medical resources, considering issues such as publication bias, consensus statement methodology used, national versus international web indexed articles, and others.
• State how EBM is integrated into clinical decision-making for a patient or a population.
• Review how EBM supports QI and patient safety efforts.
• List examples of where EBM may be integrated into common educational efforts for trainees and clinical groups or divisions, attending to scheduled and spontaneous sessions.
• Explain common classification systems used to grade the strength of evidence in a given published work and discuss how this can help guide clinical decision-making.
• Explain how each of the components of a well composed, searchable clinical question using a method such as patient-intervention-control-outcomes (PICO) aids in obtaining a more accurate and comprehensive list of references.
• Distinguish among commonly used study designs, such as retrospective, prospective, case control, randomized controlled trial, and others, and list the benefits and limitations of each.
• Define commonly used terms such as relative and absolute risk reduction, number needed to treat (NNT), sensitivity, specificity, positive and negative predictive values (PPV, NPV), and likelihood ratios (LR).
• Review how EBM is integrated into lifelong learning, including ongoing certification by professional certifying boards.

Pediatric hospitalists should be able to:

• Identify information deficits and perform accurate EBM review to address the deficits in the context of clinical practice.
• Translate a clinical question into a searchable PICO question or search string.
• Identify the most appropriate study designs to answer a specific clinical question.
• Demonstrate proficient performance of a literature search using electronic resources such as PubMed.
• Appraise the quality of varied published manuscripts, society guidelines, or other reputable sources of medical literature using a consistent method.
• Interpret the level of evidence and risk/benefit ratio of study results and utilize EBM methods to select appropriate tests and treatments for patients.
• Apply relevant results from the available evidence to assist with creating and implementing clinical guidelines for populations, within local context.
• Integrate the consistent use of EBM into activities for personal lifelong learning.
• Develop, implement, and maintain a personal strategy to consistently incorporate evidence, balance of harm and benefits, and values of patients and the family/caregivers into shared clinical decision-making to deliver the highest quality care.

Pediatric hospitalists should be able to:

• Recognize the importance of seeking the best available evidence to support clinical decision-making.
• Realize that acquiring and maintaining EBM skills requires integration into daily practice and pursuit of ongoing continuing education.
• Recognize how personal practice patterns are influenced by the integration of EBM.
• Role model use of EBM at the bedside.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of evidence-based care pathways to standardize the evaluation and management of hospitalized children in the local system.
• Engage with hospital staff, trainees, colleagues, subspecialists, and others in a multidisciplinary team approach toward integrating EBM into clinical decision-making processes.
• Collaborate with hospital administrators to acquire and maintain effective, efficient electronic resources for the performance of EBM.

Introduction

Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about patient care. This scientific evidence includes data obtained from many study types that are found in varied published manuscripts, society guidelines, or other reputable sources. Sources of evidence must be interpreted and applied to clinical decision-making in a thorough and thoughtful manner in order to achieve best practice. Clinical decisions are therefore made considering a combination of the value systems of patients and the family/caregivers, specific clinical circumstances, and a thorough assessment of the EBM literature regarding the clinical condition. Pediatric hospitalists address multiple clinical questions daily and should utilize EBM to make clinical care decisions, teach trainees and engage patients and the family/caregivers in shared decision-making, perform quality improvement (QI) and research studies, and advance personal lifelong learning.

Pediatric hospitalists should be able to:

• Define EBM and list databases and other resources commonly used to search for this medical evidence.
• Discuss the benefits and limitations of commonly used scientific medical resources, considering issues such as publication bias, consensus statement methodology used, national versus international web indexed articles, and others.
• State how EBM is integrated into clinical decision-making for a patient or a population.
• Review how EBM supports QI and patient safety efforts.
• List examples of where EBM may be integrated into common educational efforts for trainees and clinical groups or divisions, attending to scheduled and spontaneous sessions.
• Explain common classification systems used to grade the strength of evidence in a given published work and discuss how this can help guide clinical decision-making.
• Explain how each of the components of a well composed, searchable clinical question using a method such as patient-intervention-control-outcomes (PICO) aids in obtaining a more accurate and comprehensive list of references.
• Distinguish among commonly used study designs, such as retrospective, prospective, case control, randomized controlled trial, and others, and list the benefits and limitations of each.
• Define commonly used terms such as relative and absolute risk reduction, number needed to treat (NNT), sensitivity, specificity, positive and negative predictive values (PPV, NPV), and likelihood ratios (LR).
• Review how EBM is integrated into lifelong learning, including ongoing certification by professional certifying boards.

Pediatric hospitalists should be able to:

• Identify information deficits and perform accurate EBM review to address the deficits in the context of clinical practice.
• Translate a clinical question into a searchable PICO question or search string.
• Identify the most appropriate study designs to answer a specific clinical question.
• Demonstrate proficient performance of a literature search using electronic resources such as PubMed.
• Appraise the quality of varied published manuscripts, society guidelines, or other reputable sources of medical literature using a consistent method.
• Interpret the level of evidence and risk/benefit ratio of study results and utilize EBM methods to select appropriate tests and treatments for patients.
• Apply relevant results from the available evidence to assist with creating and implementing clinical guidelines for populations, within local context.
• Integrate the consistent use of EBM into activities for personal lifelong learning.
• Develop, implement, and maintain a personal strategy to consistently incorporate evidence, balance of harm and benefits, and values of patients and the family/caregivers into shared clinical decision-making to deliver the highest quality care.

Pediatric hospitalists should be able to:

• Recognize the importance of seeking the best available evidence to support clinical decision-making.
• Realize that acquiring and maintaining EBM skills requires integration into daily practice and pursuit of ongoing continuing education.
• Recognize how personal practice patterns are influenced by the integration of EBM.
• Role model use of EBM at the bedside.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of evidence-based care pathways to standardize the evaluation and management of hospitalized children in the local system.
• Engage with hospital staff, trainees, colleagues, subspecialists, and others in a multidisciplinary team approach toward integrating EBM into clinical decision-making processes.
• Collaborate with hospital administrators to acquire and maintain effective, efficient electronic resources for the performance of EBM.

Introduction

Medicine is a profession; it is not merely a composite of simple commercial transactions but is an inherently moral enterprise. Hospitalized patients are particularly vulnerable due to the impact of their illnesses and their dependence on healthcare providers who have specialized knowledge and control over its use. Physicians have fiduciary obligations to their patients and are expected to prioritize patients’ interests over their own. Physicians should make decisions that promote patients’ own interpretations of what are good or beneficial outcomes. Pediatric patients are even more vulnerable because their parents/guardians interpret what is good and make decisions on their behalf. Ethical dilemmas are increasingly encountered due to medical advances, patient complexity, questioning of science, and conflicts between cultures and societies. Pediatric hospitalists should have the knowledge, skills, and attitudes required to identify, analyze, and assist with resolving ethical issues, and to act ethically.

Pediatric hospitalists should be able to:

• Compare and contrast “business ethics” (the accountability of organizations to use policies and procedures to justify and take responsibility for their activities) with “professional ethics” (application of defined expertise [knowledge and skill] to the practical benefit of others).
• Describe the principles of respect for autonomy, beneficence, nonmaleficence, and justice.
• Distinguish between the concepts of privacy and confidentiality and describe an example of an ethically justifiable violation of a patient’s confidentiality.
• Discuss the differences between advance care planning, advance directives (such as durable powers of attorney for healthcare and living wills), Physician Orders for Life-Sustaining Treatment (POLST), and do not attempt resuscitation (DNAR) orders.
• Describe the elements of medical decision-making capacity and informed consent.
• Compare and contrast between informed consent and assent.
• Compare and contrast between the best interest and substituted judgment standards.
• Describe when it is ethically acceptable to withhold or withdraw life-sustaining treatment, including medically provided nutrition and hydration.
• Cite examples of differing types of futility, including physiologic (proposed intervention cannot achieve the desired effect), quantitative (proposed intervention is highly unlikely to achieve the desired effect or benefit the patient) and qualitative (the quality of benefit of the proposed intervention will produce is exceedingly poor), and review the response to requests for “potentially inappropriate treatments” as recommended by the American Thoracic Society and other professional organizations.
• Describe scenarios when ethics consultation may be of value, attending to conflicts around potentially life-changing decisions between any of the following: patient, family/caregivers, healthcare team members, and others.
• Articulate the criteria for justifiably overriding a parent’s or guardian’s refusal of recommended treatment, such as in cases of medical neglect.
• Review the process for requesting an ethics consult within the local context.
• Summarize the goals of and steps involved in an ethics consultation.
• Cite common reasons for consulting risk management and/or legal representatives.
• Discuss the different roles played by ethics consultants, risk managers, and lawyers.
• Compare and contrast the ethical obligations of clinicians versus researchers.
• Review the potential adverse effects of actual or perceived conflicts of interest in the various roles pediatric hospitalists perform, including clinical care, research, and administration, and discuss the strategies used to manage these conflicts.

Pediatric hospitalists should be able to:

• Provide competent care while fulfilling ethical duties to patients and the family/caregivers.
• Communicate honestly and compassionately, maintaining patient privacy and confidentiality.
• Demonstrate professionalism, completing all professional responsibilities in an ethical manner.
• Demonstrate skills in initiating an ethics consult and in collaborating with an ethics consulting team.
• Demonstrate basic skills in resolving ethical conflicts with patients and the family/caregivers, in collaboration with ethics consultants as appropriate.
• Demonstrate the ability to identify in oneself and among care team members any moral distress or conscientious objection and develop a plan for reasonable accommodation.
• Evaluate medical decision-making capacity and identify appropriate proxies as needed.
• Demonstrate skills in communicating indications, benefits, risks, and alternatives for various interventions consistent with the decision makers’ health literacy.
• Elicit goals of care and recommend treatments consistent with these goals and against treatments that conflict with them as appropriate.
• Identify patients for whom advance care planning is appropriate and collaborate in and/or refer for advance care planning.
• Complete and implement POLST forms, advance directives, and DNAR orders.
• Identify and manage potential conflicts of interests.
• Identify and avoid boundary violations.
• Identify personal biases and avoid unjust discrimination.
• Report impaired healthcare providers and those with unethical behavior to appropriate entities using pertinent procedures.
• Consistently adhere to appropriate documentation and coding practices.

Pediatric hospitalists should be able to:

• Respect patients and their family/caregivers and value their participation in shared decision-making.
• Recognize the importance of a patient’s own experiences on their quality of life.
• Reflect on and provide support for family/caregivers as they express their values and the goals they have for their children.
• Realize the need to include an ethical perspective in the approach toward healthcare decision-making, regardless of role in clinical care, administration, research, or education.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with hospital administration to develop and maintain ethically sound institutional practices, policies, and culture.
• Advocate for healthcare policy that improves the quality of and access to pediatric healthcare services.

Introduction

Medicine is a profession; it is not merely a composite of simple commercial transactions but is an inherently moral enterprise. Hospitalized patients are particularly vulnerable due to the impact of their illnesses and their dependence on healthcare providers who have specialized knowledge and control over its use. Physicians have fiduciary obligations to their patients and are expected to prioritize patients’ interests over their own. Physicians should make decisions that promote patients’ own interpretations of what are good or beneficial outcomes. Pediatric patients are even more vulnerable because their parents/guardians interpret what is good and make decisions on their behalf. Ethical dilemmas are increasingly encountered due to medical advances, patient complexity, questioning of science, and conflicts between cultures and societies. Pediatric hospitalists should have the knowledge, skills, and attitudes required to identify, analyze, and assist with resolving ethical issues, and to act ethically.

Pediatric hospitalists should be able to:

• Compare and contrast “business ethics” (the accountability of organizations to use policies and procedures to justify and take responsibility for their activities) with “professional ethics” (application of defined expertise [knowledge and skill] to the practical benefit of others).
• Describe the principles of respect for autonomy, beneficence, nonmaleficence, and justice.
• Distinguish between the concepts of privacy and confidentiality and describe an example of an ethically justifiable violation of a patient’s confidentiality.
• Discuss the differences between advance care planning, advance directives (such as durable powers of attorney for healthcare and living wills), Physician Orders for Life-Sustaining Treatment (POLST), and do not attempt resuscitation (DNAR) orders.
• Describe the elements of medical decision-making capacity and informed consent.
• Compare and contrast between informed consent and assent.
• Compare and contrast between the best interest and substituted judgment standards.
• Describe when it is ethically acceptable to withhold or withdraw life-sustaining treatment, including medically provided nutrition and hydration.
• Cite examples of differing types of futility, including physiologic (proposed intervention cannot achieve the desired effect), quantitative (proposed intervention is highly unlikely to achieve the desired effect or benefit the patient) and qualitative (the quality of benefit of the proposed intervention will produce is exceedingly poor), and review the response to requests for “potentially inappropriate treatments” as recommended by the American Thoracic Society and other professional organizations.
• Describe scenarios when ethics consultation may be of value, attending to conflicts around potentially life-changing decisions between any of the following: patient, family/caregivers, healthcare team members, and others.
• Articulate the criteria for justifiably overriding a parent’s or guardian’s refusal of recommended treatment, such as in cases of medical neglect.
• Review the process for requesting an ethics consult within the local context.
• Summarize the goals of and steps involved in an ethics consultation.
• Cite common reasons for consulting risk management and/or legal representatives.
• Discuss the different roles played by ethics consultants, risk managers, and lawyers.
• Compare and contrast the ethical obligations of clinicians versus researchers.
• Review the potential adverse effects of actual or perceived conflicts of interest in the various roles pediatric hospitalists perform, including clinical care, research, and administration, and discuss the strategies used to manage these conflicts.

Pediatric hospitalists should be able to:

• Provide competent care while fulfilling ethical duties to patients and the family/caregivers.
• Communicate honestly and compassionately, maintaining patient privacy and confidentiality.
• Demonstrate professionalism, completing all professional responsibilities in an ethical manner.
• Demonstrate skills in initiating an ethics consult and in collaborating with an ethics consulting team.
• Demonstrate basic skills in resolving ethical conflicts with patients and the family/caregivers, in collaboration with ethics consultants as appropriate.
• Demonstrate the ability to identify in oneself and among care team members any moral distress or conscientious objection and develop a plan for reasonable accommodation.
• Evaluate medical decision-making capacity and identify appropriate proxies as needed.
• Demonstrate skills in communicating indications, benefits, risks, and alternatives for various interventions consistent with the decision makers’ health literacy.
• Elicit goals of care and recommend treatments consistent with these goals and against treatments that conflict with them as appropriate.
• Identify patients for whom advance care planning is appropriate and collaborate in and/or refer for advance care planning.
• Complete and implement POLST forms, advance directives, and DNAR orders.
• Identify and manage potential conflicts of interests.
• Identify and avoid boundary violations.
• Identify personal biases and avoid unjust discrimination.
• Report impaired healthcare providers and those with unethical behavior to appropriate entities using pertinent procedures.
• Consistently adhere to appropriate documentation and coding practices.

Pediatric hospitalists should be able to:

• Respect patients and their family/caregivers and value their participation in shared decision-making.
• Recognize the importance of a patient’s own experiences on their quality of life.
• Reflect on and provide support for family/caregivers as they express their values and the goals they have for their children.
• Realize the need to include an ethical perspective in the approach toward healthcare decision-making, regardless of role in clinical care, administration, research, or education.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with hospital administration to develop and maintain ethically sound institutional practices, policies, and culture.
• Advocate for healthcare policy that improves the quality of and access to pediatric healthcare services.

Introduction

Medicine is a profession; it is not merely a composite of simple commercial transactions but is an inherently moral enterprise. Hospitalized patients are particularly vulnerable due to the impact of their illnesses and their dependence on healthcare providers who have specialized knowledge and control over its use. Physicians have fiduciary obligations to their patients and are expected to prioritize patients’ interests over their own. Physicians should make decisions that promote patients’ own interpretations of what are good or beneficial outcomes. Pediatric patients are even more vulnerable because their parents/guardians interpret what is good and make decisions on their behalf. Ethical dilemmas are increasingly encountered due to medical advances, patient complexity, questioning of science, and conflicts between cultures and societies. Pediatric hospitalists should have the knowledge, skills, and attitudes required to identify, analyze, and assist with resolving ethical issues, and to act ethically.

Pediatric hospitalists should be able to:

• Compare and contrast “business ethics” (the accountability of organizations to use policies and procedures to justify and take responsibility for their activities) with “professional ethics” (application of defined expertise [knowledge and skill] to the practical benefit of others).
• Describe the principles of respect for autonomy, beneficence, nonmaleficence, and justice.
• Distinguish between the concepts of privacy and confidentiality and describe an example of an ethically justifiable violation of a patient’s confidentiality.
• Discuss the differences between advance care planning, advance directives (such as durable powers of attorney for healthcare and living wills), Physician Orders for Life-Sustaining Treatment (POLST), and do not attempt resuscitation (DNAR) orders.
• Describe the elements of medical decision-making capacity and informed consent.
• Compare and contrast between informed consent and assent.
• Compare and contrast between the best interest and substituted judgment standards.
• Describe when it is ethically acceptable to withhold or withdraw life-sustaining treatment, including medically provided nutrition and hydration.
• Cite examples of differing types of futility, including physiologic (proposed intervention cannot achieve the desired effect), quantitative (proposed intervention is highly unlikely to achieve the desired effect or benefit the patient) and qualitative (the quality of benefit of the proposed intervention will produce is exceedingly poor), and review the response to requests for “potentially inappropriate treatments” as recommended by the American Thoracic Society and other professional organizations.
• Describe scenarios when ethics consultation may be of value, attending to conflicts around potentially life-changing decisions between any of the following: patient, family/caregivers, healthcare team members, and others.
• Articulate the criteria for justifiably overriding a parent’s or guardian’s refusal of recommended treatment, such as in cases of medical neglect.
• Review the process for requesting an ethics consult within the local context.
• Summarize the goals of and steps involved in an ethics consultation.
• Cite common reasons for consulting risk management and/or legal representatives.
• Discuss the different roles played by ethics consultants, risk managers, and lawyers.
• Compare and contrast the ethical obligations of clinicians versus researchers.
• Review the potential adverse effects of actual or perceived conflicts of interest in the various roles pediatric hospitalists perform, including clinical care, research, and administration, and discuss the strategies used to manage these conflicts.

Pediatric hospitalists should be able to:

• Provide competent care while fulfilling ethical duties to patients and the family/caregivers.
• Communicate honestly and compassionately, maintaining patient privacy and confidentiality.
• Demonstrate professionalism, completing all professional responsibilities in an ethical manner.
• Demonstrate skills in initiating an ethics consult and in collaborating with an ethics consulting team.
• Demonstrate basic skills in resolving ethical conflicts with patients and the family/caregivers, in collaboration with ethics consultants as appropriate.
• Demonstrate the ability to identify in oneself and among care team members any moral distress or conscientious objection and develop a plan for reasonable accommodation.
• Evaluate medical decision-making capacity and identify appropriate proxies as needed.
• Demonstrate skills in communicating indications, benefits, risks, and alternatives for various interventions consistent with the decision makers’ health literacy.
• Elicit goals of care and recommend treatments consistent with these goals and against treatments that conflict with them as appropriate.
• Identify patients for whom advance care planning is appropriate and collaborate in and/or refer for advance care planning.
• Complete and implement POLST forms, advance directives, and DNAR orders.
• Identify and manage potential conflicts of interests.
• Identify and avoid boundary violations.
• Identify personal biases and avoid unjust discrimination.
• Report impaired healthcare providers and those with unethical behavior to appropriate entities using pertinent procedures.
• Consistently adhere to appropriate documentation and coding practices.

Pediatric hospitalists should be able to:

• Respect patients and their family/caregivers and value their participation in shared decision-making.
• Recognize the importance of a patient’s own experiences on their quality of life.
• Reflect on and provide support for family/caregivers as they express their values and the goals they have for their children.
• Realize the need to include an ethical perspective in the approach toward healthcare decision-making, regardless of role in clinical care, administration, research, or education.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with hospital administration to develop and maintain ethically sound institutional practices, policies, and culture.
• Advocate for healthcare policy that improves the quality of and access to pediatric healthcare services.

Introduction

Pediatric hospitalists can serve many roles in education, including teaching others in clinical settings, creating curriculum, directing educational programs, and serving in formal roles in both undergraduate and graduate medical education administration. Additional educational opportunities include training future hospitalists and directing continuing medical education programs. Pediatric hospitalists are teachers, educating hospital staff, learners (medical students, other health profession students, residents, and fellows), community clinicians, organizations, patients and the family/caregivers, and colleagues. Hospitalists in community and university/children’s hospital systems serve a pivotal role in teaching learners and/or other healthcare providers on the hospital wards and via hospital related didactic or simulation sessions. In addition to educating others, lifelong learning requires hospitalists to engage in ongoing education targeting personal goals and career plans. Education is therefore essential for all pediatric hospitalists, with specific competencies addressed in the context of the specific learner-educator environment.

Pediatric hospitalists should be able to:

• Explain why a continuum of competencies throughout a professional career is required and illustrate the benefits and challenges of this expectation.
• Review the use of education for patients and the family/caregivers, attending to daily discussions around clinical care and transition of care needs.
• Cite examples of using of evidence-based medicine literature review for education, including discussions on ward rounds, journal club, and self-learning.
• List resources and activities for continuous learning to maintain current knowledge and skills.
• Compare and contrast teaching from supervision of learners.
• Compare and contrast different teaching and learning preferences, attending to elements such as sensory modes (visual, auditory, kinesthetic/motor), group size, setting, and other factors.
• Define common terms and phrases used in adult learning theory, including assessing learner needs, establishing learner goals, active learning, self-directed learning, reflection, and others.
• Discuss how the principles of adult learning theory can be used in leading daily learning activities in clinical and didactic settings.
• Cite the value of ongoing self-directed learning and continued use of an individualized learning plan at all career stages.
• Describe how competencies and performance indicators are used in the evaluation of physicians at all career stages.
• Describe the pediatric competencies currently required by regulatory agencies such as the Liaison Committee of Medical Education (LCME), Accreditation Council for Graduate Medical Education (ACGME), and the American Board of Pediatrics (ABP).
• Describe the six mandated ACGME competency domains: patient care, medical knowledge, practice-based learning and improvement, interpersonal skills and communications, professionalism, and systems-based practice.
• Articulate how pediatric hospitalists can use each of the six core competencies to educate in the context of the inpatient setting and the larger healthcare system.
• Explain how learners benefit from knowing their learning goals at the beginning of an educational experience.
• Compare and contrast the advantages and limitations of the following evaluation methods: oral exams, written tests, global evaluations, direct observations with checklists, and multi-source (360 degree) evaluations.
• Describe the elements of effective feedback.
• Define “formative feedback” and “summative evaluation,” identifying the similarities and differences in each.
• Describe the common effects of evaluation on the motivation and learning priorities of learners.
• Review the steps involved in curriculum development, including performing a needs assessment, creating competency-based goals and objectives, selecting teaching activities to match learning objectives, creating a learner assessment and a program evaluation, and securing resources.
• Summarize how a curriculum can be applied to a single learning activity, a longitudinal curriculum, or a comprehensive educational program.

Pediatric hospitalists should be able to:

• Orient learners to inpatient ward rotation expectations, including learning goals and objectives, patient care and team responsibilities, systems, policies, and procedures for the rotation.
• Integrate use of established clinical pathways and educate learners on their correct use.
• Educate learners about the important blend between service and education.
• Identify and abate potential issues related to patient safety, professionalism, and communication that may occur when learners are involved in care teams.
• Identify learner needs and deliver education to best match the individual or learner group.
• Determine the level of a learner’s ability and allow graduated autonomy in clinical decision-making.
• Utilize “teachable moments,” such as case-based learning and role modeling, in the context of teaching in the inpatient setting.
• Demonstrate efficient and flexible use of time when adaptively teaching and using self-directed learning activities.
• Demonstrate basic skills in teaching and supervision methods, including bedside teaching, teaching during rounds, and case-based discussions.
• Provide role modeling, with priming, articulation of thought process, and debriefing.
• Create and deliver didactic teaching on relevant topics in pediatric hospital medicine.
• Teach a specific skill or procedure in the clinical and/or simulation environments.
• Utilize basic skills in questioning, including broadening, justifying, hypothetical, and alternative.
• Educate patients and the family/caregivers about the diagnostic testing, management plan, and prognosis in an interactive, family centered manner.
• Promote and facilitate learner reflection on own performance at clinical encounters to enhance learning.
• Provide frequent, effective feedback based upon direct observation of learners’ clinical, communication, technical skills, and professionalism.
• Write effective learner summative evaluations that reflect verbal feedback given.

Pediatric hospitalists should be able to:

• Realize the importance of promoting a climate of continuous learning by acknowledging personal knowledge gaps and prompting learners to teach each other.
• Model effective and empathetic communication with patients and the family/caregivers when educating.
• Encourage learners to be self-directed and to learn independently.
• Exemplify professional behavior by being prompt, prepared, available, and approachable in educational efforts.
• Acknowledge the value of building and maintaining teamwork by providing reinforcing as well as corrective feedback.
• Role model effective balance of clinical care, communication, and teaching needs during family centered rounds.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Participate with training programs to create, maintain, and implement education in the hospital setting.
• Collaborate with hospital administrators to maintain adequate learner supervision to ensure patient safety, while encouraging development of autonomous practice.
• Lead, coordinate, or participate in multidisciplinary initiatives to promote quality improvement, patient safety, cost effective care, evidence-based medicine, and effective communication around inpatient pediatric care.
• Collaborate with hospital administration and training program directors to balance teaching, patient care responsibilities, and patient safety and maximize the effectiveness of each.
• Collaborate with hospital administration to ensure adequate teaching facilities.

Introduction

Pediatric hospitalists can serve many roles in education, including teaching others in clinical settings, creating curriculum, directing educational programs, and serving in formal roles in both undergraduate and graduate medical education administration. Additional educational opportunities include training future hospitalists and directing continuing medical education programs. Pediatric hospitalists are teachers, educating hospital staff, learners (medical students, other health profession students, residents, and fellows), community clinicians, organizations, patients and the family/caregivers, and colleagues. Hospitalists in community and university/children’s hospital systems serve a pivotal role in teaching learners and/or other healthcare providers on the hospital wards and via hospital related didactic or simulation sessions. In addition to educating others, lifelong learning requires hospitalists to engage in ongoing education targeting personal goals and career plans. Education is therefore essential for all pediatric hospitalists, with specific competencies addressed in the context of the specific learner-educator environment.

Pediatric hospitalists should be able to:

• Explain why a continuum of competencies throughout a professional career is required and illustrate the benefits and challenges of this expectation.
• Review the use of education for patients and the family/caregivers, attending to daily discussions around clinical care and transition of care needs.
• Cite examples of using of evidence-based medicine literature review for education, including discussions on ward rounds, journal club, and self-learning.
• List resources and activities for continuous learning to maintain current knowledge and skills.
• Compare and contrast teaching from supervision of learners.
• Compare and contrast different teaching and learning preferences, attending to elements such as sensory modes (visual, auditory, kinesthetic/motor), group size, setting, and other factors.
• Define common terms and phrases used in adult learning theory, including assessing learner needs, establishing learner goals, active learning, self-directed learning, reflection, and others.
• Discuss how the principles of adult learning theory can be used in leading daily learning activities in clinical and didactic settings.
• Cite the value of ongoing self-directed learning and continued use of an individualized learning plan at all career stages.
• Describe how competencies and performance indicators are used in the evaluation of physicians at all career stages.
• Describe the pediatric competencies currently required by regulatory agencies such as the Liaison Committee of Medical Education (LCME), Accreditation Council for Graduate Medical Education (ACGME), and the American Board of Pediatrics (ABP).
• Describe the six mandated ACGME competency domains: patient care, medical knowledge, practice-based learning and improvement, interpersonal skills and communications, professionalism, and systems-based practice.
• Articulate how pediatric hospitalists can use each of the six core competencies to educate in the context of the inpatient setting and the larger healthcare system.
• Explain how learners benefit from knowing their learning goals at the beginning of an educational experience.
• Compare and contrast the advantages and limitations of the following evaluation methods: oral exams, written tests, global evaluations, direct observations with checklists, and multi-source (360 degree) evaluations.
• Describe the elements of effective feedback.
• Define “formative feedback” and “summative evaluation,” identifying the similarities and differences in each.
• Describe the common effects of evaluation on the motivation and learning priorities of learners.
• Review the steps involved in curriculum development, including performing a needs assessment, creating competency-based goals and objectives, selecting teaching activities to match learning objectives, creating a learner assessment and a program evaluation, and securing resources.
• Summarize how a curriculum can be applied to a single learning activity, a longitudinal curriculum, or a comprehensive educational program.

Pediatric hospitalists should be able to:

• Orient learners to inpatient ward rotation expectations, including learning goals and objectives, patient care and team responsibilities, systems, policies, and procedures for the rotation.
• Integrate use of established clinical pathways and educate learners on their correct use.
• Educate learners about the important blend between service and education.
• Identify and abate potential issues related to patient safety, professionalism, and communication that may occur when learners are involved in care teams.
• Identify learner needs and deliver education to best match the individual or learner group.
• Determine the level of a learner’s ability and allow graduated autonomy in clinical decision-making.
• Utilize “teachable moments,” such as case-based learning and role modeling, in the context of teaching in the inpatient setting.
• Demonstrate efficient and flexible use of time when adaptively teaching and using self-directed learning activities.
• Demonstrate basic skills in teaching and supervision methods, including bedside teaching, teaching during rounds, and case-based discussions.
• Provide role modeling, with priming, articulation of thought process, and debriefing.
• Create and deliver didactic teaching on relevant topics in pediatric hospital medicine.
• Teach a specific skill or procedure in the clinical and/or simulation environments.
• Utilize basic skills in questioning, including broadening, justifying, hypothetical, and alternative.
• Educate patients and the family/caregivers about the diagnostic testing, management plan, and prognosis in an interactive, family centered manner.
• Promote and facilitate learner reflection on own performance at clinical encounters to enhance learning.
• Provide frequent, effective feedback based upon direct observation of learners’ clinical, communication, technical skills, and professionalism.
• Write effective learner summative evaluations that reflect verbal feedback given.

Pediatric hospitalists should be able to:

• Realize the importance of promoting a climate of continuous learning by acknowledging personal knowledge gaps and prompting learners to teach each other.
• Model effective and empathetic communication with patients and the family/caregivers when educating.
• Encourage learners to be self-directed and to learn independently.
• Exemplify professional behavior by being prompt, prepared, available, and approachable in educational efforts.
• Acknowledge the value of building and maintaining teamwork by providing reinforcing as well as corrective feedback.
• Role model effective balance of clinical care, communication, and teaching needs during family centered rounds.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Participate with training programs to create, maintain, and implement education in the hospital setting.
• Collaborate with hospital administrators to maintain adequate learner supervision to ensure patient safety, while encouraging development of autonomous practice.
• Lead, coordinate, or participate in multidisciplinary initiatives to promote quality improvement, patient safety, cost effective care, evidence-based medicine, and effective communication around inpatient pediatric care.
• Collaborate with hospital administration and training program directors to balance teaching, patient care responsibilities, and patient safety and maximize the effectiveness of each.
• Collaborate with hospital administration to ensure adequate teaching facilities.

Introduction

Pediatric hospitalists can serve many roles in education, including teaching others in clinical settings, creating curriculum, directing educational programs, and serving in formal roles in both undergraduate and graduate medical education administration. Additional educational opportunities include training future hospitalists and directing continuing medical education programs. Pediatric hospitalists are teachers, educating hospital staff, learners (medical students, other health profession students, residents, and fellows), community clinicians, organizations, patients and the family/caregivers, and colleagues. Hospitalists in community and university/children’s hospital systems serve a pivotal role in teaching learners and/or other healthcare providers on the hospital wards and via hospital related didactic or simulation sessions. In addition to educating others, lifelong learning requires hospitalists to engage in ongoing education targeting personal goals and career plans. Education is therefore essential for all pediatric hospitalists, with specific competencies addressed in the context of the specific learner-educator environment.

Pediatric hospitalists should be able to:

• Explain why a continuum of competencies throughout a professional career is required and illustrate the benefits and challenges of this expectation.
• Review the use of education for patients and the family/caregivers, attending to daily discussions around clinical care and transition of care needs.
• Cite examples of using of evidence-based medicine literature review for education, including discussions on ward rounds, journal club, and self-learning.
• List resources and activities for continuous learning to maintain current knowledge and skills.
• Compare and contrast teaching from supervision of learners.
• Compare and contrast different teaching and learning preferences, attending to elements such as sensory modes (visual, auditory, kinesthetic/motor), group size, setting, and other factors.
• Define common terms and phrases used in adult learning theory, including assessing learner needs, establishing learner goals, active learning, self-directed learning, reflection, and others.
• Discuss how the principles of adult learning theory can be used in leading daily learning activities in clinical and didactic settings.
• Cite the value of ongoing self-directed learning and continued use of an individualized learning plan at all career stages.
• Describe how competencies and performance indicators are used in the evaluation of physicians at all career stages.
• Describe the pediatric competencies currently required by regulatory agencies such as the Liaison Committee of Medical Education (LCME), Accreditation Council for Graduate Medical Education (ACGME), and the American Board of Pediatrics (ABP).
• Describe the six mandated ACGME competency domains: patient care, medical knowledge, practice-based learning and improvement, interpersonal skills and communications, professionalism, and systems-based practice.
• Articulate how pediatric hospitalists can use each of the six core competencies to educate in the context of the inpatient setting and the larger healthcare system.
• Explain how learners benefit from knowing their learning goals at the beginning of an educational experience.
• Compare and contrast the advantages and limitations of the following evaluation methods: oral exams, written tests, global evaluations, direct observations with checklists, and multi-source (360 degree) evaluations.
• Describe the elements of effective feedback.
• Define “formative feedback” and “summative evaluation,” identifying the similarities and differences in each.
• Describe the common effects of evaluation on the motivation and learning priorities of learners.
• Review the steps involved in curriculum development, including performing a needs assessment, creating competency-based goals and objectives, selecting teaching activities to match learning objectives, creating a learner assessment and a program evaluation, and securing resources.
• Summarize how a curriculum can be applied to a single learning activity, a longitudinal curriculum, or a comprehensive educational program.

Pediatric hospitalists should be able to:

• Orient learners to inpatient ward rotation expectations, including learning goals and objectives, patient care and team responsibilities, systems, policies, and procedures for the rotation.
• Integrate use of established clinical pathways and educate learners on their correct use.
• Educate learners about the important blend between service and education.
• Identify and abate potential issues related to patient safety, professionalism, and communication that may occur when learners are involved in care teams.
• Identify learner needs and deliver education to best match the individual or learner group.
• Determine the level of a learner’s ability and allow graduated autonomy in clinical decision-making.
• Utilize “teachable moments,” such as case-based learning and role modeling, in the context of teaching in the inpatient setting.
• Demonstrate efficient and flexible use of time when adaptively teaching and using self-directed learning activities.
• Demonstrate basic skills in teaching and supervision methods, including bedside teaching, teaching during rounds, and case-based discussions.
• Provide role modeling, with priming, articulation of thought process, and debriefing.
• Create and deliver didactic teaching on relevant topics in pediatric hospital medicine.
• Teach a specific skill or procedure in the clinical and/or simulation environments.
• Utilize basic skills in questioning, including broadening, justifying, hypothetical, and alternative.
• Educate patients and the family/caregivers about the diagnostic testing, management plan, and prognosis in an interactive, family centered manner.
• Promote and facilitate learner reflection on own performance at clinical encounters to enhance learning.
• Provide frequent, effective feedback based upon direct observation of learners’ clinical, communication, technical skills, and professionalism.
• Write effective learner summative evaluations that reflect verbal feedback given.

Pediatric hospitalists should be able to:

• Realize the importance of promoting a climate of continuous learning by acknowledging personal knowledge gaps and prompting learners to teach each other.
• Model effective and empathetic communication with patients and the family/caregivers when educating.
• Encourage learners to be self-directed and to learn independently.
• Exemplify professional behavior by being prompt, prepared, available, and approachable in educational efforts.
• Acknowledge the value of building and maintaining teamwork by providing reinforcing as well as corrective feedback.
• Role model effective balance of clinical care, communication, and teaching needs during family centered rounds.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Participate with training programs to create, maintain, and implement education in the hospital setting.
• Collaborate with hospital administrators to maintain adequate learner supervision to ensure patient safety, while encouraging development of autonomous practice.
• Lead, coordinate, or participate in multidisciplinary initiatives to promote quality improvement, patient safety, cost effective care, evidence-based medicine, and effective communication around inpatient pediatric care.
• Collaborate with hospital administration and training program directors to balance teaching, patient care responsibilities, and patient safety and maximize the effectiveness of each.
• Collaborate with hospital administration to ensure adequate teaching facilities.

Introduction

Pediatric hospitalists are often asked to offer clinical guidance, recommendations, or support to healthcare providers in managing children in a variety of contexts. These providers are usually adult providers or other pediatric subspecialists. There are two general models for this arrangement: consultation and co-management. Consultation generally refers to a paradigm in which the primary team requests input to manage a specific clinical problem or set of problems that would benefit from specific expertise. Co-management describes a model in which a patient requires ongoing care served via a partnership between the primary team and another specialty service. Consultation and co-management roles for pediatric hospitalists involve caring for medical and surgical patients. Many different models exist within these two broad categories. These models vary based on setting, local needs, or local pediatric expertise. Regardless of model, similar skills are required, especially involving communication and coordination of care. Pediatric hospitalists are in a unique position to improve care delivery and advocate for the needs of children within consultation and co-management roles.

Pediatric hospitalists should be able to:

• Describe consultation and co-management models, including characteristics of local models.
• Articulate the responsibilities typically defined by consultation and co-management models.
• Review the importance of clear communication, multidisciplinary team engagement, and roles of different care providers within a consulting and co-management model.
• Compare and contrast the value of verbal versus written agreements for consultation and co-management relationships and discuss their impact on patient safety.
• Discuss the intent and impact of mandatory consultation for hospitalized children based on certain criteria, such as age or underlying condition, especially regarding patient safety and the role of pediatric hospitalists.
• Recognize opportunities for pediatric consultation to offer recommendations for the whole child, attending to immunizations, dental care, and other preventative needs.
• State examples where a one-time consultation may be appropriate.
• Describe common failures in consultation and co-management, especially regarding handoffs, patient communication, documentation, billing, and others.
• Summarize basic surgical conditions, indications for common surgical procedures, and list common complications of surgical procedures.
• Describe the principles of preoperative and perioperative care, including roles for anesthesiologists, subspecialists, surgeons, and pediatric hospitalists.
• Describe common pain management modalities, including medication and non-medication interventions, attending to potential side effects of medications including narcotics.
• Compare and contrast billing procedures for consultation and co-management from billing as primary attending of record, with attention to the impact of billing by other providers.

Pediatric hospitalists should be able to:

• Provide a timely and comprehensive evaluation of pediatric patients and pediatric-specific recommendations.
• Demonstrate strong diagnostic and management skills in the care of hospitalized children, including those with medical complexity and common surgical conditions.
• Communicate recommendations clearly and efficiently to other subspecialists and healthcare providers.
• Diagnose complications of common surgical procedures, including features of clinical deterioration.
• Communicate effectively with the primary team regarding complications or other declines in status and triage to a higher level of care as appropriate.
• Identify and abate pediatric-specific patient risks due to age, underlying condition, local resources, or other factors.
• Coordinate care and communicate clearly and effectively with patients, the family/caregivers, and all team members.
• Demonstrate expertise in pain management, especially in the perioperative patient.
• Describe principles of perioperative fluid management in the pediatric surgical patient.
• Explain the pediatric hospitalist’s role in consultation and co-management with the patient and the family/caregivers.
• Maintain clear, timely communication and documentation of clinical recommendations.
• Place patient care orders when appropriate.
• Educate trainees, including pediatric and surgical trainees, about models of consultation and co-management.
• Create a comprehensive discharge plan in partnership with the primary team.

Pediatric hospitalists should be able to:

• Exemplify responsible and accountable care of hospitalized children within the scope of the consultation and co-management relationship across differing clinical specialties.
• Reflect on the importance of providing timely patient care, documentation of recommendations, and written orders as appropriate.
• Realize the importance of communicating effectively with patients, the family/caregivers, subspecialists, and other healthcare providers.
• Respect the contributions of all healthcare team members.
• Recognize that gaps in knowledge and skills may adversely impact patient care and role model behaviors that promote patient safety and quality care.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with other subspecialist leaders by providing input to improve consultation and co-management programs.
• Identify opportunities to lead, coordinate, or participate in activities to enhance teamwork between healthcare professionals.
• Lead, coordinate, or participate in identifying and managing aspects of consultation and co-management care that may be targets for quality improvement.
• Collaborate with administrators and colleagues to optimize hospitalist value provided and assure practice is appropriately within the scope of the hospital medicine.
• Lead, coordinate, or participate in the development of guidelines for consultation and co-management programs.

Introduction

Pediatric hospitalists are often asked to offer clinical guidance, recommendations, or support to healthcare providers in managing children in a variety of contexts. These providers are usually adult providers or other pediatric subspecialists. There are two general models for this arrangement: consultation and co-management. Consultation generally refers to a paradigm in which the primary team requests input to manage a specific clinical problem or set of problems that would benefit from specific expertise. Co-management describes a model in which a patient requires ongoing care served via a partnership between the primary team and another specialty service. Consultation and co-management roles for pediatric hospitalists involve caring for medical and surgical patients. Many different models exist within these two broad categories. These models vary based on setting, local needs, or local pediatric expertise. Regardless of model, similar skills are required, especially involving communication and coordination of care. Pediatric hospitalists are in a unique position to improve care delivery and advocate for the needs of children within consultation and co-management roles.

Pediatric hospitalists should be able to:

• Describe consultation and co-management models, including characteristics of local models.
• Articulate the responsibilities typically defined by consultation and co-management models.
• Review the importance of clear communication, multidisciplinary team engagement, and roles of different care providers within a consulting and co-management model.
• Compare and contrast the value of verbal versus written agreements for consultation and co-management relationships and discuss their impact on patient safety.
• Discuss the intent and impact of mandatory consultation for hospitalized children based on certain criteria, such as age or underlying condition, especially regarding patient safety and the role of pediatric hospitalists.
• Recognize opportunities for pediatric consultation to offer recommendations for the whole child, attending to immunizations, dental care, and other preventative needs.
• State examples where a one-time consultation may be appropriate.
• Describe common failures in consultation and co-management, especially regarding handoffs, patient communication, documentation, billing, and others.
• Summarize basic surgical conditions, indications for common surgical procedures, and list common complications of surgical procedures.
• Describe the principles of preoperative and perioperative care, including roles for anesthesiologists, subspecialists, surgeons, and pediatric hospitalists.
• Describe common pain management modalities, including medication and non-medication interventions, attending to potential side effects of medications including narcotics.
• Compare and contrast billing procedures for consultation and co-management from billing as primary attending of record, with attention to the impact of billing by other providers.

Pediatric hospitalists should be able to:

• Provide a timely and comprehensive evaluation of pediatric patients and pediatric-specific recommendations.
• Demonstrate strong diagnostic and management skills in the care of hospitalized children, including those with medical complexity and common surgical conditions.
• Communicate recommendations clearly and efficiently to other subspecialists and healthcare providers.
• Diagnose complications of common surgical procedures, including features of clinical deterioration.
• Communicate effectively with the primary team regarding complications or other declines in status and triage to a higher level of care as appropriate.
• Identify and abate pediatric-specific patient risks due to age, underlying condition, local resources, or other factors.
• Coordinate care and communicate clearly and effectively with patients, the family/caregivers, and all team members.
• Demonstrate expertise in pain management, especially in the perioperative patient.
• Describe principles of perioperative fluid management in the pediatric surgical patient.
• Explain the pediatric hospitalist’s role in consultation and co-management with the patient and the family/caregivers.
• Maintain clear, timely communication and documentation of clinical recommendations.
• Place patient care orders when appropriate.
• Educate trainees, including pediatric and surgical trainees, about models of consultation and co-management.
• Create a comprehensive discharge plan in partnership with the primary team.

Pediatric hospitalists should be able to:

• Exemplify responsible and accountable care of hospitalized children within the scope of the consultation and co-management relationship across differing clinical specialties.
• Reflect on the importance of providing timely patient care, documentation of recommendations, and written orders as appropriate.
• Realize the importance of communicating effectively with patients, the family/caregivers, subspecialists, and other healthcare providers.
• Respect the contributions of all healthcare team members.
• Recognize that gaps in knowledge and skills may adversely impact patient care and role model behaviors that promote patient safety and quality care.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with other subspecialist leaders by providing input to improve consultation and co-management programs.
• Identify opportunities to lead, coordinate, or participate in activities to enhance teamwork between healthcare professionals.
• Lead, coordinate, or participate in identifying and managing aspects of consultation and co-management care that may be targets for quality improvement.
• Collaborate with administrators and colleagues to optimize hospitalist value provided and assure practice is appropriately within the scope of the hospital medicine.
• Lead, coordinate, or participate in the development of guidelines for consultation and co-management programs.

Introduction

Pediatric hospitalists are often asked to offer clinical guidance, recommendations, or support to healthcare providers in managing children in a variety of contexts. These providers are usually adult providers or other pediatric subspecialists. There are two general models for this arrangement: consultation and co-management. Consultation generally refers to a paradigm in which the primary team requests input to manage a specific clinical problem or set of problems that would benefit from specific expertise. Co-management describes a model in which a patient requires ongoing care served via a partnership between the primary team and another specialty service. Consultation and co-management roles for pediatric hospitalists involve caring for medical and surgical patients. Many different models exist within these two broad categories. These models vary based on setting, local needs, or local pediatric expertise. Regardless of model, similar skills are required, especially involving communication and coordination of care. Pediatric hospitalists are in a unique position to improve care delivery and advocate for the needs of children within consultation and co-management roles.

Pediatric hospitalists should be able to:

• Describe consultation and co-management models, including characteristics of local models.
• Articulate the responsibilities typically defined by consultation and co-management models.
• Review the importance of clear communication, multidisciplinary team engagement, and roles of different care providers within a consulting and co-management model.
• Compare and contrast the value of verbal versus written agreements for consultation and co-management relationships and discuss their impact on patient safety.
• Discuss the intent and impact of mandatory consultation for hospitalized children based on certain criteria, such as age or underlying condition, especially regarding patient safety and the role of pediatric hospitalists.
• Recognize opportunities for pediatric consultation to offer recommendations for the whole child, attending to immunizations, dental care, and other preventative needs.
• State examples where a one-time consultation may be appropriate.
• Describe common failures in consultation and co-management, especially regarding handoffs, patient communication, documentation, billing, and others.
• Summarize basic surgical conditions, indications for common surgical procedures, and list common complications of surgical procedures.
• Describe the principles of preoperative and perioperative care, including roles for anesthesiologists, subspecialists, surgeons, and pediatric hospitalists.
• Describe common pain management modalities, including medication and non-medication interventions, attending to potential side effects of medications including narcotics.
• Compare and contrast billing procedures for consultation and co-management from billing as primary attending of record, with attention to the impact of billing by other providers.

Pediatric hospitalists should be able to:

• Provide a timely and comprehensive evaluation of pediatric patients and pediatric-specific recommendations.
• Demonstrate strong diagnostic and management skills in the care of hospitalized children, including those with medical complexity and common surgical conditions.
• Communicate recommendations clearly and efficiently to other subspecialists and healthcare providers.
• Diagnose complications of common surgical procedures, including features of clinical deterioration.
• Communicate effectively with the primary team regarding complications or other declines in status and triage to a higher level of care as appropriate.
• Identify and abate pediatric-specific patient risks due to age, underlying condition, local resources, or other factors.
• Coordinate care and communicate clearly and effectively with patients, the family/caregivers, and all team members.
• Demonstrate expertise in pain management, especially in the perioperative patient.
• Describe principles of perioperative fluid management in the pediatric surgical patient.
• Explain the pediatric hospitalist’s role in consultation and co-management with the patient and the family/caregivers.
• Maintain clear, timely communication and documentation of clinical recommendations.
• Place patient care orders when appropriate.
• Educate trainees, including pediatric and surgical trainees, about models of consultation and co-management.
• Create a comprehensive discharge plan in partnership with the primary team.

Pediatric hospitalists should be able to:

• Exemplify responsible and accountable care of hospitalized children within the scope of the consultation and co-management relationship across differing clinical specialties.
• Reflect on the importance of providing timely patient care, documentation of recommendations, and written orders as appropriate.
• Realize the importance of communicating effectively with patients, the family/caregivers, subspecialists, and other healthcare providers.
• Respect the contributions of all healthcare team members.
• Recognize that gaps in knowledge and skills may adversely impact patient care and role model behaviors that promote patient safety and quality care.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with other subspecialist leaders by providing input to improve consultation and co-management programs.
• Identify opportunities to lead, coordinate, or participate in activities to enhance teamwork between healthcare professionals.
• Lead, coordinate, or participate in identifying and managing aspects of consultation and co-management care that may be targets for quality improvement.
• Collaborate with administrators and colleagues to optimize hospitalist value provided and assure practice is appropriately within the scope of the hospital medicine.
• Lead, coordinate, or participate in the development of guidelines for consultation and co-management programs.

Introduction

Sound business practices are the foundation for the growth and effective development of pediatric hospital medicine programs. Business practice refers to program development, management, contract negotiation, and optimizing financial performance. Healthcare systems need physician leaders with the skills to improve operational efficiency while providing safe, high quality care. Pediatric hospitalists must acquire and maintain business skills to represent and define hospitalist roles within the hospital, expand practices intelligently, anticipate change, and respond effectively to sustain financial success.

Pediatric hospitalists should be able to:

General

• Discuss the elements of mission and vision statements and the importance of strategic alignment of these with stakeholder goals.
• Compare and contrast between the basic structure of hospital employed, university employed, and private practice pediatric hospital medicine program models.
• Identify basic business differences between freestanding children’s hospitals versus pediatric health systems that partner with or are included within adult systems.
• Explain the necessity for a sound business plan, professional management, and strategic planning.
• Identify the basic components of the budget for a pediatric hospital medicine group and consider how these may differ based on practice location.
• Define basic terms such as diagnostic related group (DRG), average daily census (ADC), length of stay (LOS), payment to charge ratio (PCR), case mixed index (CMI), and payor mix.

Payment Models

• Describe the difference between hospital cost and hospital charge.
• Compare and contrast payment methods for pediatric hospitalists with those for hospitals and describe the effect of payer mix on payments to each.
• Define commonly used payment models such as capitation, fee for service, pay for performance, shared savings, and others.
• Identify the impact of specific features of some models of healthcare, such as carve-outs, case-, disease-, and demand-management, on quality of care and cost-control.
• List the key components of the Affordable Care Act and state implications of its implementation on hospital care and healthcare systems, such as managed care organizations, HMOs, ACOs, and others.
• List examples of non-clinical responsibilities that should be included in pediatric hospital medicine program payment models as appropriate, such as committee work, administration, research, and trainee education, possibly incorporating use of educational value units (EVU).
• Distinguish between pediatric hospitalist compensation structures, including those based on salary, productivity incentive, and case rate models.
• Describe the role of the work relative value unit (wRVU) and its utility in physician workload, assignment metrics, and compensation.

Billing

• Review physician Current Procedural Terminology (CPT) billing codes commonly used by pediatric hospitalists and summarize the criteria for each.
• Compare and contrast how work relative value units (wRVUs) versus patient encounters demonstrate productivity.
• Describe the impact of documentation on coding for both pediatric hospitalists and the hospital.
• Summarize the International Classification of Diseases-10 (ICD-10) system.
• Articulate the importance of billing and coding compliance and its relevance to physician compensation, physician-hospital contracting, and working with trainees.

Structure

• Identify factors that can impact a hospital medicine program staffing plan, such as census, patient acuity, trainee responsibility, and coverage requirements (services, shifts).
• Identify key elements of business compliance by the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (DHHS).
• State the importance of professional credentialing, licensing, and liability coverage on the ability to maintain a successful business model for both the pediatric hospital medicine program and the hospital.

Pediatric hospitalists should be able to:

• Participate in review of basic business reports, including income statements and performance reports.
• Assist with creating a basic budget for a pediatric hospital medicine program in a community or a university/children’s hospital site.
• Demonstrate basic negotiation skills through role play or attendance at negotiation sessions with third party payors, the institution, department chair, or other contracted entity.
• Consistently complete clinical documentation in a manner that meets expectations of regulatory agencies.
• Complete coding and billing processes efficiently and accurately.

Pediatric hospitalists should be able to:

• Advocate for a business model that encourages retention of pediatric hospitalists and allows for adequate staffing to support high quality care, patient safety, and physician wellness.
• Role model accountability with regard to billing, coding, and business regulations.
• Support the business of pediatric hospitalists by maintaining fiscal awareness and proactively managing stakeholder expectations.
• Seek opportunities to acquire basic business skills.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with colleagues and business leaders to make sound business decisions, using performance feedback, peer review, and quality improvement information.
• Engage with hospital administration on strategic business planning wherever possible.

Introduction

Sound business practices are the foundation for the growth and effective development of pediatric hospital medicine programs. Business practice refers to program development, management, contract negotiation, and optimizing financial performance. Healthcare systems need physician leaders with the skills to improve operational efficiency while providing safe, high quality care. Pediatric hospitalists must acquire and maintain business skills to represent and define hospitalist roles within the hospital, expand practices intelligently, anticipate change, and respond effectively to sustain financial success.

Pediatric hospitalists should be able to:

General

• Discuss the elements of mission and vision statements and the importance of strategic alignment of these with stakeholder goals.
• Compare and contrast between the basic structure of hospital employed, university employed, and private practice pediatric hospital medicine program models.
• Identify basic business differences between freestanding children’s hospitals versus pediatric health systems that partner with or are included within adult systems.
• Explain the necessity for a sound business plan, professional management, and strategic planning.
• Identify the basic components of the budget for a pediatric hospital medicine group and consider how these may differ based on practice location.
• Define basic terms such as diagnostic related group (DRG), average daily census (ADC), length of stay (LOS), payment to charge ratio (PCR), case mixed index (CMI), and payor mix.

Payment Models

• Describe the difference between hospital cost and hospital charge.
• Compare and contrast payment methods for pediatric hospitalists with those for hospitals and describe the effect of payer mix on payments to each.
• Define commonly used payment models such as capitation, fee for service, pay for performance, shared savings, and others.
• Identify the impact of specific features of some models of healthcare, such as carve-outs, case-, disease-, and demand-management, on quality of care and cost-control.
• List the key components of the Affordable Care Act and state implications of its implementation on hospital care and healthcare systems, such as managed care organizations, HMOs, ACOs, and others.
• List examples of non-clinical responsibilities that should be included in pediatric hospital medicine program payment models as appropriate, such as committee work, administration, research, and trainee education, possibly incorporating use of educational value units (EVU).
• Distinguish between pediatric hospitalist compensation structures, including those based on salary, productivity incentive, and case rate models.
• Describe the role of the work relative value unit (wRVU) and its utility in physician workload, assignment metrics, and compensation.

Billing

• Review physician Current Procedural Terminology (CPT) billing codes commonly used by pediatric hospitalists and summarize the criteria for each.
• Compare and contrast how work relative value units (wRVUs) versus patient encounters demonstrate productivity.
• Describe the impact of documentation on coding for both pediatric hospitalists and the hospital.
• Summarize the International Classification of Diseases-10 (ICD-10) system.
• Articulate the importance of billing and coding compliance and its relevance to physician compensation, physician-hospital contracting, and working with trainees.

Structure

• Identify factors that can impact a hospital medicine program staffing plan, such as census, patient acuity, trainee responsibility, and coverage requirements (services, shifts).
• Identify key elements of business compliance by the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (DHHS).
• State the importance of professional credentialing, licensing, and liability coverage on the ability to maintain a successful business model for both the pediatric hospital medicine program and the hospital.

Pediatric hospitalists should be able to:

• Participate in review of basic business reports, including income statements and performance reports.
• Assist with creating a basic budget for a pediatric hospital medicine program in a community or a university/children’s hospital site.
• Demonstrate basic negotiation skills through role play or attendance at negotiation sessions with third party payors, the institution, department chair, or other contracted entity.
• Consistently complete clinical documentation in a manner that meets expectations of regulatory agencies.
• Complete coding and billing processes efficiently and accurately.

Pediatric hospitalists should be able to:

• Advocate for a business model that encourages retention of pediatric hospitalists and allows for adequate staffing to support high quality care, patient safety, and physician wellness.
• Role model accountability with regard to billing, coding, and business regulations.
• Support the business of pediatric hospitalists by maintaining fiscal awareness and proactively managing stakeholder expectations.
• Seek opportunities to acquire basic business skills.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with colleagues and business leaders to make sound business decisions, using performance feedback, peer review, and quality improvement information.
• Engage with hospital administration on strategic business planning wherever possible.

Introduction

Sound business practices are the foundation for the growth and effective development of pediatric hospital medicine programs. Business practice refers to program development, management, contract negotiation, and optimizing financial performance. Healthcare systems need physician leaders with the skills to improve operational efficiency while providing safe, high quality care. Pediatric hospitalists must acquire and maintain business skills to represent and define hospitalist roles within the hospital, expand practices intelligently, anticipate change, and respond effectively to sustain financial success.

Pediatric hospitalists should be able to:

General

• Discuss the elements of mission and vision statements and the importance of strategic alignment of these with stakeholder goals.
• Compare and contrast between the basic structure of hospital employed, university employed, and private practice pediatric hospital medicine program models.
• Identify basic business differences between freestanding children’s hospitals versus pediatric health systems that partner with or are included within adult systems.
• Explain the necessity for a sound business plan, professional management, and strategic planning.
• Identify the basic components of the budget for a pediatric hospital medicine group and consider how these may differ based on practice location.
• Define basic terms such as diagnostic related group (DRG), average daily census (ADC), length of stay (LOS), payment to charge ratio (PCR), case mixed index (CMI), and payor mix.

Payment Models

• Describe the difference between hospital cost and hospital charge.
• Compare and contrast payment methods for pediatric hospitalists with those for hospitals and describe the effect of payer mix on payments to each.
• Define commonly used payment models such as capitation, fee for service, pay for performance, shared savings, and others.
• Identify the impact of specific features of some models of healthcare, such as carve-outs, case-, disease-, and demand-management, on quality of care and cost-control.
• List the key components of the Affordable Care Act and state implications of its implementation on hospital care and healthcare systems, such as managed care organizations, HMOs, ACOs, and others.
• List examples of non-clinical responsibilities that should be included in pediatric hospital medicine program payment models as appropriate, such as committee work, administration, research, and trainee education, possibly incorporating use of educational value units (EVU).
• Distinguish between pediatric hospitalist compensation structures, including those based on salary, productivity incentive, and case rate models.
• Describe the role of the work relative value unit (wRVU) and its utility in physician workload, assignment metrics, and compensation.

Billing

• Review physician Current Procedural Terminology (CPT) billing codes commonly used by pediatric hospitalists and summarize the criteria for each.
• Compare and contrast how work relative value units (wRVUs) versus patient encounters demonstrate productivity.
• Describe the impact of documentation on coding for both pediatric hospitalists and the hospital.
• Summarize the International Classification of Diseases-10 (ICD-10) system.
• Articulate the importance of billing and coding compliance and its relevance to physician compensation, physician-hospital contracting, and working with trainees.

Structure

• Identify factors that can impact a hospital medicine program staffing plan, such as census, patient acuity, trainee responsibility, and coverage requirements (services, shifts).
• Identify key elements of business compliance by the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (DHHS).
• State the importance of professional credentialing, licensing, and liability coverage on the ability to maintain a successful business model for both the pediatric hospital medicine program and the hospital.

Pediatric hospitalists should be able to:

• Participate in review of basic business reports, including income statements and performance reports.
• Assist with creating a basic budget for a pediatric hospital medicine program in a community or a university/children’s hospital site.
• Demonstrate basic negotiation skills through role play or attendance at negotiation sessions with third party payors, the institution, department chair, or other contracted entity.
• Consistently complete clinical documentation in a manner that meets expectations of regulatory agencies.
• Complete coding and billing processes efficiently and accurately.

Pediatric hospitalists should be able to:

• Advocate for a business model that encourages retention of pediatric hospitalists and allows for adequate staffing to support high quality care, patient safety, and physician wellness.
• Role model accountability with regard to billing, coding, and business regulations.
• Support the business of pediatric hospitalists by maintaining fiscal awareness and proactively managing stakeholder expectations.
• Seek opportunities to acquire basic business skills.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with colleagues and business leaders to make sound business decisions, using performance feedback, peer review, and quality improvement information.
• Engage with hospital administration on strategic business planning wherever possible.

Introduction

Advocacy for children is fundamental to the practice of pediatric medicine. It is particularly significant for pediatric hospitalists who primarily care for children and their family/caregivers during acute illness when they are most vulnerable. Pediatric hospitalists have a unique opportunity to leverage the healthcare system to advocate at the individual, population, hospital, and community levels. Advocacy for children, an activity which takes many forms, embraces the desire to ensure children, particularly those from vulnerable populations, have their interests promoted, their rights safeguarded, and their voices heard on issues which affect them. Advocacy includes family centeredness and empowerment; it requires leadership skills to ensure care for children is promoted in varied healthcare settings.

Pediatric hospitalists should be able to:

• Identify principles of advocacy for children and families/caregivers.
• Define the role of the pediatric hospitalist as advocate within the community, the healthcare system, and an individual child’s medical home.
• List strategic foci for advocacy, such as age, gender identity, sexual orientation, diagnosis, socioeconomic status, cultural or demographic group, access to healthcare, chronic healthcare needs, mental health concerns, and additional social determinants of health.
• Discuss methods by which pediatric hospitalists can approach common advocacy issues affecting hospitalized children, such as securing pediatric-specific needs (medications, equipment, or pediatric subspecialty services) or obtaining approval for recommended post-discharge care.
• Describe the unique challenges of advocating for the needs of children within an adult-oriented system.
• Review the role of the pediatric hospitalist as advocate for the child in the context of child abuse, neglect, and other situations where the child’s needs may not be met by the family/caregivers.
• Discuss how collaboration with social workers, law enforcement, school system members, and other non-clinicians is important for both individual patient and systems advocacy.
• Distinguish different payment systems, types of healthcare expenditures, and means of financing healthcare (including government and private payors) that affect the delivery of care to children.
• List local, regional, and/or national organizations involved in pediatric advocacy with which pediatric hospitalists collaborate.
• Cite examples of opportunities to engage in advocacy for children at the individual, population health, hospital, community, and national levels.
• Describe the legislative process by which advocacy issues are converted to policy and identify opportunities within this process for hospitalists to advocate directly with policymakers.

Pediatric hospitalists should be able to:

• Utilize evidence-based methods to identify physical, social, emotional, and environmental factors that may negatively impact physical and mental health and well-being.
• Demonstrate the ability to advocate for the needs of hospitalized children and the family/caregivers, attending to the acute condition, as well as preventive health concerns.
• Utilize tools to access local, state, and national data on factors impacting the health of communities.
• Assist in creating group- and hospital-wide policies that encourage social inclusion, equality, and justice for children.

Pediatric hospitalists should be able to:

• Exemplify collaborative practice with members of hospital administration, the healthcare system, and community groups to advocate for the needs of children.
• Advocate for the health and well-being of children in all encounters.
• Recognize the potential disparities effecting healthcare in all encounters, reflect on their impact, and employ sensitivity in communications with patients, the family/caregivers, and healthcare providers.
• Maintain awareness of political, cultural, and socioeconomic trends affecting the physical and mental health of children.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Ensure the principles of child advocacy are promoted for every hospitalized child and the family/caregivers.
• Work with hospital administration to align advocacy efforts with the hospital system’s mission, vision, and values.
• Work with educational leaders to incorporate advocacy topics into healthcare provider, hospital staff, and trainee curricula.
• Lead, coordinate, or participate in developing effective partnerships between hospital administration and community partners to improve child welfare.
• Lead, coordinate, support, or participate in efforts to defend and promote the welfare of children and the family/caregivers in media of different formats.

Introduction

Advocacy for children is fundamental to the practice of pediatric medicine. It is particularly significant for pediatric hospitalists who primarily care for children and their family/caregivers during acute illness when they are most vulnerable. Pediatric hospitalists have a unique opportunity to leverage the healthcare system to advocate at the individual, population, hospital, and community levels. Advocacy for children, an activity which takes many forms, embraces the desire to ensure children, particularly those from vulnerable populations, have their interests promoted, their rights safeguarded, and their voices heard on issues which affect them. Advocacy includes family centeredness and empowerment; it requires leadership skills to ensure care for children is promoted in varied healthcare settings.

Pediatric hospitalists should be able to:

• Identify principles of advocacy for children and families/caregivers.
• Define the role of the pediatric hospitalist as advocate within the community, the healthcare system, and an individual child’s medical home.
• List strategic foci for advocacy, such as age, gender identity, sexual orientation, diagnosis, socioeconomic status, cultural or demographic group, access to healthcare, chronic healthcare needs, mental health concerns, and additional social determinants of health.
• Discuss methods by which pediatric hospitalists can approach common advocacy issues affecting hospitalized children, such as securing pediatric-specific needs (medications, equipment, or pediatric subspecialty services) or obtaining approval for recommended post-discharge care.
• Describe the unique challenges of advocating for the needs of children within an adult-oriented system.
• Review the role of the pediatric hospitalist as advocate for the child in the context of child abuse, neglect, and other situations where the child’s needs may not be met by the family/caregivers.
• Discuss how collaboration with social workers, law enforcement, school system members, and other non-clinicians is important for both individual patient and systems advocacy.
• Distinguish different payment systems, types of healthcare expenditures, and means of financing healthcare (including government and private payors) that affect the delivery of care to children.
• List local, regional, and/or national organizations involved in pediatric advocacy with which pediatric hospitalists collaborate.
• Cite examples of opportunities to engage in advocacy for children at the individual, population health, hospital, community, and national levels.
• Describe the legislative process by which advocacy issues are converted to policy and identify opportunities within this process for hospitalists to advocate directly with policymakers.

Pediatric hospitalists should be able to:

• Utilize evidence-based methods to identify physical, social, emotional, and environmental factors that may negatively impact physical and mental health and well-being.
• Demonstrate the ability to advocate for the needs of hospitalized children and the family/caregivers, attending to the acute condition, as well as preventive health concerns.
• Utilize tools to access local, state, and national data on factors impacting the health of communities.
• Assist in creating group- and hospital-wide policies that encourage social inclusion, equality, and justice for children.

Pediatric hospitalists should be able to:

• Exemplify collaborative practice with members of hospital administration, the healthcare system, and community groups to advocate for the needs of children.
• Advocate for the health and well-being of children in all encounters.
• Recognize the potential disparities effecting healthcare in all encounters, reflect on their impact, and employ sensitivity in communications with patients, the family/caregivers, and healthcare providers.
• Maintain awareness of political, cultural, and socioeconomic trends affecting the physical and mental health of children.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Ensure the principles of child advocacy are promoted for every hospitalized child and the family/caregivers.
• Work with hospital administration to align advocacy efforts with the hospital system’s mission, vision, and values.
• Work with educational leaders to incorporate advocacy topics into healthcare provider, hospital staff, and trainee curricula.
• Lead, coordinate, or participate in developing effective partnerships between hospital administration and community partners to improve child welfare.
• Lead, coordinate, support, or participate in efforts to defend and promote the welfare of children and the family/caregivers in media of different formats.

Introduction

Advocacy for children is fundamental to the practice of pediatric medicine. It is particularly significant for pediatric hospitalists who primarily care for children and their family/caregivers during acute illness when they are most vulnerable. Pediatric hospitalists have a unique opportunity to leverage the healthcare system to advocate at the individual, population, hospital, and community levels. Advocacy for children, an activity which takes many forms, embraces the desire to ensure children, particularly those from vulnerable populations, have their interests promoted, their rights safeguarded, and their voices heard on issues which affect them. Advocacy includes family centeredness and empowerment; it requires leadership skills to ensure care for children is promoted in varied healthcare settings.

Pediatric hospitalists should be able to:

• Identify principles of advocacy for children and families/caregivers.
• Define the role of the pediatric hospitalist as advocate within the community, the healthcare system, and an individual child’s medical home.
• List strategic foci for advocacy, such as age, gender identity, sexual orientation, diagnosis, socioeconomic status, cultural or demographic group, access to healthcare, chronic healthcare needs, mental health concerns, and additional social determinants of health.
• Discuss methods by which pediatric hospitalists can approach common advocacy issues affecting hospitalized children, such as securing pediatric-specific needs (medications, equipment, or pediatric subspecialty services) or obtaining approval for recommended post-discharge care.
• Describe the unique challenges of advocating for the needs of children within an adult-oriented system.
• Review the role of the pediatric hospitalist as advocate for the child in the context of child abuse, neglect, and other situations where the child’s needs may not be met by the family/caregivers.
• Discuss how collaboration with social workers, law enforcement, school system members, and other non-clinicians is important for both individual patient and systems advocacy.
• Distinguish different payment systems, types of healthcare expenditures, and means of financing healthcare (including government and private payors) that affect the delivery of care to children.
• List local, regional, and/or national organizations involved in pediatric advocacy with which pediatric hospitalists collaborate.
• Cite examples of opportunities to engage in advocacy for children at the individual, population health, hospital, community, and national levels.
• Describe the legislative process by which advocacy issues are converted to policy and identify opportunities within this process for hospitalists to advocate directly with policymakers.

Pediatric hospitalists should be able to:

• Utilize evidence-based methods to identify physical, social, emotional, and environmental factors that may negatively impact physical and mental health and well-being.
• Demonstrate the ability to advocate for the needs of hospitalized children and the family/caregivers, attending to the acute condition, as well as preventive health concerns.
• Utilize tools to access local, state, and national data on factors impacting the health of communities.
• Assist in creating group- and hospital-wide policies that encourage social inclusion, equality, and justice for children.

Pediatric hospitalists should be able to:

• Exemplify collaborative practice with members of hospital administration, the healthcare system, and community groups to advocate for the needs of children.
• Advocate for the health and well-being of children in all encounters.
• Recognize the potential disparities effecting healthcare in all encounters, reflect on their impact, and employ sensitivity in communications with patients, the family/caregivers, and healthcare providers.
• Maintain awareness of political, cultural, and socioeconomic trends affecting the physical and mental health of children.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Ensure the principles of child advocacy are promoted for every hospitalized child and the family/caregivers.
• Work with hospital administration to align advocacy efforts with the hospital system’s mission, vision, and values.
• Work with educational leaders to incorporate advocacy topics into healthcare provider, hospital staff, and trainee curricula.
• Lead, coordinate, or participate in developing effective partnerships between hospital administration and community partners to improve child welfare.
• Lead, coordinate, support, or participate in efforts to defend and promote the welfare of children and the family/caregivers in media of different formats.

Introduction

Acute care pediatric services continue to be centralized, causing pediatric inter-facility transport programs to progress and evolve. Evidence has shown that specialty transport teams capable of delivering state of the art care improve patient outcomes. This has resulted in a paradigm shift in pediatric transport programs to emphasize delivery of definitive care both at the referring facility and throughout transport. Over the past years the number of institutionally sponsored hospital based pediatric specialty transport programs has increased in response to this need. Pediatric hospitalists may serve as the referring or accepting physician, transport physician, or medical control physician (transport coordinator) for these patients. Through each of these roles pediatric hospitalists fulfill an essential function in ensuring the safe and timely transport of ill children.

Pediatric hospitalists should be able to:

• Compare and contrast advantages and disadvantages between transport modalities including non-medical, Basic Life Support (BLS), Advanced Life Support (ALS), Critical Care Team (CCT), and specialized Neonatal/Pediatric Critical Care Transport service.
• Describe features of the medical history and physical examination that necessitate emergent or urgent patient transfer.
• Cite common transport team members and discuss the proficiency and expertise required to safely provide effective triage and stabilization for differing pediatric diseases and conditions, attending to the roles of physician, nurse, respiratory therapist, and others.
• Review the role of pediatric hospitalists serving as the referring and/or accepting physician, attending to communications with and documentation for the referring physician, accepting site, local healthcare team, and the family/caregivers.
• Discuss how pediatric hospitalists may serve as the physician on transport, attending to local context and scope of practice.
• Summarize the role of the Medical Control Officer and review the responsibilities related to triage, team management, and maintaining ongoing consistent care through assistance with treatment decisions and planning from referring to accepting sites.
• Explain how the selection of transport modality and team composition are influenced by the patient’s clinical status as well as environmental and logistical factors.
• Describe the benefits of various monitoring techniques commonly used on transport, including oximetry, capnography, venous and arterial pressure, electrocardiography (ECG), and others.
• Discuss the indications, benefits, and risks of various interventions commonly utilized during transport such as high flow oxygen delivery, non-invasive positive pressure ventilation systems, artificial airways, medications, and others.
• Describe the importance of collaboration between hospitalists, subspecialists, and intensivists in stabilization and management during transport and upon arrival to the destination facility.
• Describe the knowledge base and skill set of non-physician transport team members.
• Discuss the use of standardized protocols and procedures on transport, including how they are used by non-physician team members and the process for implementation and oversight.
• Review how technologies such as telemedicine or other devices can aid in communication, patient assessment, and care delivery.

Pediatric hospitalists should be able to:

• Efficiently obtain and communicate critical clinical information, placing emphasis on cardiac, pulmonary, and neurologic disease that could impact the transport process.
• Formulate accurate rapid assessments and provide recommendations regarding laboratory studies and imaging, as well as therapeutic interventions that are evidence based and in accordance with Pediatric Advanced Life Support/Neonatal Resuscitation Program guidelines.
• Select modality of transport and team composition based on patient acuity and potential for deterioration, in the context of local logistical and environmental factors, such as time of day, traffic, and weather conditions.
• Effectively communicate with the transport team members to anticipate possible complications during the transport and create action plans prior to transport.
• Provide ongoing recommendations for management throughout the transport process to ensure optimal patient outcomes and safety.
• Identify patients whose illness severity is outside of hospital medicine’s scope of practice and adjust transport plan appropriately, according to local context.
• Consult intensivists and subspecialists effectively and efficiently during the pre-transport, transport, and/or post-transport process as clinically indicated, whether serving as referring or accepting physician, transport physician, or Medical Control Officer.
• Ensure effective and efficient communication at each transition of care.
• Coordinate care between facilities that is timely yet also reduces unnecessary testing and/or radiation exposure through engagement of pediatric subspecialists and diagnostic testing equipment.
• Demonstrate skills in effective, efficient, and respectful phone communications.
• Identify patient-specific monitoring and immediate care needs, and secure best patient placement from the referring emergency department, such as to a pediatric emergency department, operating room, ward, or critical care unit within local context.
• Perform effective verbal handoffs and transfer of relevant written or electronically accessible patient information.
• Communicate effectively with patients and the family/caregivers regarding the transport process, adhering to the principles of patient and family centered care.

Pediatric hospitalists should be able to:

• Exemplify professionalism when responding to all calls and requests for transport.
• Realize the importance of educating and mentoring trainees and other healthcare providers regarding aspects of transport including clinical decision-making, risk management, customer service, and operational issues.
• Realize the importance of establishing and maintaining collegial relationships with referral sources and transport team members.
• Reflect on the importance of maintaining ongoing care for the child throughout the transport process.
• Recognize the added stress and fear felt by the family/caregivers when a child is being transported, including the fear of separation.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Work with hospital administration, transport team members and transport program leadership to promote financially sound growth and development of pediatric transport services and corresponding policies, including those governing maintenance of competency and scope of practice.
• Lead, coordinate, or participate in ongoing educational and training opportunities to maintain the skill set of transport team members and medical control physicians.
• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways or protocols to standardize the management of common diagnoses for children transported between facilities.
• Lead, coordinate, or participate in multidisciplinary group forums of stakeholders involved in pediatric transport, to establish and/or track transport-specific benchmarks, ensure quality of care, and improve system-wide processes.
• Lead, coordinate, or participate in review of transport cases to promote improvement opportunities, identification of systems issues, and education.

Introduction

Acute care pediatric services continue to be centralized, causing pediatric inter-facility transport programs to progress and evolve. Evidence has shown that specialty transport teams capable of delivering state of the art care improve patient outcomes. This has resulted in a paradigm shift in pediatric transport programs to emphasize delivery of definitive care both at the referring facility and throughout transport. Over the past years the number of institutionally sponsored hospital based pediatric specialty transport programs has increased in response to this need. Pediatric hospitalists may serve as the referring or accepting physician, transport physician, or medical control physician (transport coordinator) for these patients. Through each of these roles pediatric hospitalists fulfill an essential function in ensuring the safe and timely transport of ill children.

Pediatric hospitalists should be able to:

• Compare and contrast advantages and disadvantages between transport modalities including non-medical, Basic Life Support (BLS), Advanced Life Support (ALS), Critical Care Team (CCT), and specialized Neonatal/Pediatric Critical Care Transport service.
• Describe features of the medical history and physical examination that necessitate emergent or urgent patient transfer.
• Cite common transport team members and discuss the proficiency and expertise required to safely provide effective triage and stabilization for differing pediatric diseases and conditions, attending to the roles of physician, nurse, respiratory therapist, and others.
• Review the role of pediatric hospitalists serving as the referring and/or accepting physician, attending to communications with and documentation for the referring physician, accepting site, local healthcare team, and the family/caregivers.
• Discuss how pediatric hospitalists may serve as the physician on transport, attending to local context and scope of practice.
• Summarize the role of the Medical Control Officer and review the responsibilities related to triage, team management, and maintaining ongoing consistent care through assistance with treatment decisions and planning from referring to accepting sites.
• Explain how the selection of transport modality and team composition are influenced by the patient’s clinical status as well as environmental and logistical factors.
• Describe the benefits of various monitoring techniques commonly used on transport, including oximetry, capnography, venous and arterial pressure, electrocardiography (ECG), and others.
• Discuss the indications, benefits, and risks of various interventions commonly utilized during transport such as high flow oxygen delivery, non-invasive positive pressure ventilation systems, artificial airways, medications, and others.
• Describe the importance of collaboration between hospitalists, subspecialists, and intensivists in stabilization and management during transport and upon arrival to the destination facility.
• Describe the knowledge base and skill set of non-physician transport team members.
• Discuss the use of standardized protocols and procedures on transport, including how they are used by non-physician team members and the process for implementation and oversight.
• Review how technologies such as telemedicine or other devices can aid in communication, patient assessment, and care delivery.

Pediatric hospitalists should be able to:

• Efficiently obtain and communicate critical clinical information, placing emphasis on cardiac, pulmonary, and neurologic disease that could impact the transport process.
• Formulate accurate rapid assessments and provide recommendations regarding laboratory studies and imaging, as well as therapeutic interventions that are evidence based and in accordance with Pediatric Advanced Life Support/Neonatal Resuscitation Program guidelines.
• Select modality of transport and team composition based on patient acuity and potential for deterioration, in the context of local logistical and environmental factors, such as time of day, traffic, and weather conditions.
• Effectively communicate with the transport team members to anticipate possible complications during the transport and create action plans prior to transport.
• Provide ongoing recommendations for management throughout the transport process to ensure optimal patient outcomes and safety.
• Identify patients whose illness severity is outside of hospital medicine’s scope of practice and adjust transport plan appropriately, according to local context.
• Consult intensivists and subspecialists effectively and efficiently during the pre-transport, transport, and/or post-transport process as clinically indicated, whether serving as referring or accepting physician, transport physician, or Medical Control Officer.
• Ensure effective and efficient communication at each transition of care.
• Coordinate care between facilities that is timely yet also reduces unnecessary testing and/or radiation exposure through engagement of pediatric subspecialists and diagnostic testing equipment.
• Demonstrate skills in effective, efficient, and respectful phone communications.
• Identify patient-specific monitoring and immediate care needs, and secure best patient placement from the referring emergency department, such as to a pediatric emergency department, operating room, ward, or critical care unit within local context.
• Perform effective verbal handoffs and transfer of relevant written or electronically accessible patient information.
• Communicate effectively with patients and the family/caregivers regarding the transport process, adhering to the principles of patient and family centered care.

Pediatric hospitalists should be able to:

• Exemplify professionalism when responding to all calls and requests for transport.
• Realize the importance of educating and mentoring trainees and other healthcare providers regarding aspects of transport including clinical decision-making, risk management, customer service, and operational issues.
• Realize the importance of establishing and maintaining collegial relationships with referral sources and transport team members.
• Reflect on the importance of maintaining ongoing care for the child throughout the transport process.
• Recognize the added stress and fear felt by the family/caregivers when a child is being transported, including the fear of separation.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Work with hospital administration, transport team members and transport program leadership to promote financially sound growth and development of pediatric transport services and corresponding policies, including those governing maintenance of competency and scope of practice.
• Lead, coordinate, or participate in ongoing educational and training opportunities to maintain the skill set of transport team members and medical control physicians.
• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways or protocols to standardize the management of common diagnoses for children transported between facilities.
• Lead, coordinate, or participate in multidisciplinary group forums of stakeholders involved in pediatric transport, to establish and/or track transport-specific benchmarks, ensure quality of care, and improve system-wide processes.
• Lead, coordinate, or participate in review of transport cases to promote improvement opportunities, identification of systems issues, and education.

Introduction

Acute care pediatric services continue to be centralized, causing pediatric inter-facility transport programs to progress and evolve. Evidence has shown that specialty transport teams capable of delivering state of the art care improve patient outcomes. This has resulted in a paradigm shift in pediatric transport programs to emphasize delivery of definitive care both at the referring facility and throughout transport. Over the past years the number of institutionally sponsored hospital based pediatric specialty transport programs has increased in response to this need. Pediatric hospitalists may serve as the referring or accepting physician, transport physician, or medical control physician (transport coordinator) for these patients. Through each of these roles pediatric hospitalists fulfill an essential function in ensuring the safe and timely transport of ill children.

Pediatric hospitalists should be able to:

• Compare and contrast advantages and disadvantages between transport modalities including non-medical, Basic Life Support (BLS), Advanced Life Support (ALS), Critical Care Team (CCT), and specialized Neonatal/Pediatric Critical Care Transport service.
• Describe features of the medical history and physical examination that necessitate emergent or urgent patient transfer.
• Cite common transport team members and discuss the proficiency and expertise required to safely provide effective triage and stabilization for differing pediatric diseases and conditions, attending to the roles of physician, nurse, respiratory therapist, and others.
• Review the role of pediatric hospitalists serving as the referring and/or accepting physician, attending to communications with and documentation for the referring physician, accepting site, local healthcare team, and the family/caregivers.
• Discuss how pediatric hospitalists may serve as the physician on transport, attending to local context and scope of practice.
• Summarize the role of the Medical Control Officer and review the responsibilities related to triage, team management, and maintaining ongoing consistent care through assistance with treatment decisions and planning from referring to accepting sites.
• Explain how the selection of transport modality and team composition are influenced by the patient’s clinical status as well as environmental and logistical factors.
• Describe the benefits of various monitoring techniques commonly used on transport, including oximetry, capnography, venous and arterial pressure, electrocardiography (ECG), and others.
• Discuss the indications, benefits, and risks of various interventions commonly utilized during transport such as high flow oxygen delivery, non-invasive positive pressure ventilation systems, artificial airways, medications, and others.
• Describe the importance of collaboration between hospitalists, subspecialists, and intensivists in stabilization and management during transport and upon arrival to the destination facility.
• Describe the knowledge base and skill set of non-physician transport team members.
• Discuss the use of standardized protocols and procedures on transport, including how they are used by non-physician team members and the process for implementation and oversight.
• Review how technologies such as telemedicine or other devices can aid in communication, patient assessment, and care delivery.

Pediatric hospitalists should be able to:

• Efficiently obtain and communicate critical clinical information, placing emphasis on cardiac, pulmonary, and neurologic disease that could impact the transport process.
• Formulate accurate rapid assessments and provide recommendations regarding laboratory studies and imaging, as well as therapeutic interventions that are evidence based and in accordance with Pediatric Advanced Life Support/Neonatal Resuscitation Program guidelines.
• Select modality of transport and team composition based on patient acuity and potential for deterioration, in the context of local logistical and environmental factors, such as time of day, traffic, and weather conditions.
• Effectively communicate with the transport team members to anticipate possible complications during the transport and create action plans prior to transport.
• Provide ongoing recommendations for management throughout the transport process to ensure optimal patient outcomes and safety.
• Identify patients whose illness severity is outside of hospital medicine’s scope of practice and adjust transport plan appropriately, according to local context.
• Consult intensivists and subspecialists effectively and efficiently during the pre-transport, transport, and/or post-transport process as clinically indicated, whether serving as referring or accepting physician, transport physician, or Medical Control Officer.
• Ensure effective and efficient communication at each transition of care.
• Coordinate care between facilities that is timely yet also reduces unnecessary testing and/or radiation exposure through engagement of pediatric subspecialists and diagnostic testing equipment.
• Demonstrate skills in effective, efficient, and respectful phone communications.
• Identify patient-specific monitoring and immediate care needs, and secure best patient placement from the referring emergency department, such as to a pediatric emergency department, operating room, ward, or critical care unit within local context.
• Perform effective verbal handoffs and transfer of relevant written or electronically accessible patient information.
• Communicate effectively with patients and the family/caregivers regarding the transport process, adhering to the principles of patient and family centered care.

Pediatric hospitalists should be able to:

• Exemplify professionalism when responding to all calls and requests for transport.
• Realize the importance of educating and mentoring trainees and other healthcare providers regarding aspects of transport including clinical decision-making, risk management, customer service, and operational issues.
• Realize the importance of establishing and maintaining collegial relationships with referral sources and transport team members.
• Reflect on the importance of maintaining ongoing care for the child throughout the transport process.
• Recognize the added stress and fear felt by the family/caregivers when a child is being transported, including the fear of separation.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Work with hospital administration, transport team members and transport program leadership to promote financially sound growth and development of pediatric transport services and corresponding policies, including those governing maintenance of competency and scope of practice.
• Lead, coordinate, or participate in ongoing educational and training opportunities to maintain the skill set of transport team members and medical control physicians.
• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways or protocols to standardize the management of common diagnoses for children transported between facilities.
• Lead, coordinate, or participate in multidisciplinary group forums of stakeholders involved in pediatric transport, to establish and/or track transport-specific benchmarks, ensure quality of care, and improve system-wide processes.
• Lead, coordinate, or participate in review of transport cases to promote improvement opportunities, identification of systems issues, and education.

Introduction

Pediatric palliative care (PPC) is comprehensive, specialized care for children facing serious or life-threatening illness, with the goal of improving quality of life for the child and the family/caregivers. Palliative care represents both a philosophy and an organized method for delivering care focused on addressing physical, psychosocial, and spiritual needs to prevent and relieve suffering. Pediatric hospice care (PHC) is a particular type of palliative care traditionally provided to patients with a more limited prognosis and carried out by licensed hospice agencies. Pediatric palliative care and PHC are delivered through interdisciplinary collaboration, across care settings, integrated throughout the course of the illness from diagnosis to bereavement, and provided alongside life-prolonging or curative interventions. Patients who may benefit from PPC or PHC are frequently hospitalized; however, PPC resources may be limited and may vary by geographic location. Pediatric hospitalists are often caring for these patients and well positioned to provide basic PPC needs and assist with accessing PPC resources.

Pediatric hospitalists should be able to:

• Compare and contrast between PPC and PHC, attending to scope, patient population, services, optimal timing, and goals of care, among other items.
• Cite key elements of PPC, including facilitation of informed decision-making; enhancing care coordination and communication among medical team members, the child, and family/caregivers; improving comfort through expert symptom management; and optimizing quality of life.
• Review the importance of appropriate timing of PHC referral when the child’s expected prognosis is 6 months or less, and list basic steps in the referral process.
• Summarize why PPC and PHC are optimally provided by an interdisciplinary team consisting of a pediatrician, pediatric nurse, social worker, chaplain, and others.
• Describe the value of conducting proactive discussions of goals of care (GOC), which may include forgoing or withdrawing life-sustaining treatment prior to a child becoming critically ill.
• Explain how PPC can be integrated with appropriate medical treatments, including curative and life-prolonging treatment, starting at diagnosis of serious illness.
• Discuss the benefits of items commonly included in a PPC treatment plan such as symptom management, spiritual counseling, and physical therapy, among others.
• Give examples of local, regional, and national resources for PPC and PHC that are accessible to patients, the family/caregivers, and healthcare providers.
• Describe ethical principles related to end-of-life (EOL) care and the role of the hospital ethics committee in these scenarios.
• Describe the processes for writing “allow natural death” (AND), orders, advanced directives, the “Physician Orders for Life-Sustaining Treatment” (POLST) form, pronouncement of death, and completion of a death certificate.

Pediatric hospitalists should be able to:

• Identify children who may benefit from complex decision-making, advanced symptom management, or higher level psychosocial and spiritual support and refer them to PPC or PHC services.
• Engage in difficult conversations, including communicating “bad news” with compassion.
• Describe and introduce PPC and PHC to patients, the family/caregivers, other subspecialists, and other healthcare providers.
• Lead a basic discussion of prognosis and GOC with patients, the family/caregivers, and the healthcare team.
• Manage ethical dilemmas encountered in the care of the dying patient in the hospital, in collaboration with other healthcare providers as appropriate.
• Provide care that respects the cultural, social, and spiritual preferences of patients and the family/caregivers.
• Screen and provide basic treatment for pain and other distressing symptoms experienced by seriously ill or dying patients, such as dyspnea, nausea, anxiety, delirium, and others.
• Prescribe indicated pharmacologic and non-pharmacologic therapies in collaboration with appropriate consultants, including pain specialists, PPC teams, child-life providers, and integrative therapies.
• Educate healthcare providers and the family/caregivers about symptoms related to active dying.
• Provide counseling regarding life-prolonging interventions, addition of medical technology, and code status.
• Refer patients to other available disciplines for psychosocial and spiritual support, such as pastoral care, social work, and child life, if local PPC and PHC resources are not immediately available.
• Collaborate with an interdisciplinary team including PPC, PHC, nursing, social work, pastoral care, case management, pharmacy, medical/surgical subspecialists, and primary care provider to ensure coordinated, longitudinal care consistent with GOC for this population.
• Manage care needs for this population across facilities where needed, including remotely accessing palliative specialists at tertiary care sites and organizing best plans for patients and the family/caregivers who wish to return for care to their local community center.
• Communicate autopsy and donor options for actively dying children and access immediate support for the family/caregivers and staff related to this decision-making process.

Pediatric hospitalists should be able to:

• Appreciate the key role hospitalists play in ensuring that PPC needs of seriously ill children are addressed.
• Recognize that PPC is appropriate throughout the course of serious illness and should be equitably provided to all children who may benefit from these services.
• Recognize the importance of empathetic, culturally sensitive communication.
• Acknowledge personal attitudes and biases and their influence on care of seriously ill or dying patients from a physical, psychosocial, and spiritual perspective.
• Exemplify ethical behavior in rendering care for these patients and their family/caregivers.
• Reflect on the value of and engage in self-care to cope with the stress of caring for seriously ill patients.
• Realize and address gaps in personal knowledge, skills, and attitudes regarding PPC through professional education.
• Recognize the importance of building therapeutic relationships with seriously ill children and the family/caregivers.
• Recognize that PPC is patient- and family-centered and that treatment plans should be aligned with GOC of patients and the family/caregivers.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in organizational efforts to provide PPC/PHC education.
• Collaborate with hospital administration and community partners to ensure efficient access to appropriate consultants necessary for success of these programs for children.
• Advocate for development of PPC and PHC resources within the institution and local community.
• Lead, coordinate, or participate in institutional initiatives aimed at improving care of seriously ill children, including improved advanced care planning or symptom management care pathways.

Introduction

Pediatric palliative care (PPC) is comprehensive, specialized care for children facing serious or life-threatening illness, with the goal of improving quality of life for the child and the family/caregivers. Palliative care represents both a philosophy and an organized method for delivering care focused on addressing physical, psychosocial, and spiritual needs to prevent and relieve suffering. Pediatric hospice care (PHC) is a particular type of palliative care traditionally provided to patients with a more limited prognosis and carried out by licensed hospice agencies. Pediatric palliative care and PHC are delivered through interdisciplinary collaboration, across care settings, integrated throughout the course of the illness from diagnosis to bereavement, and provided alongside life-prolonging or curative interventions. Patients who may benefit from PPC or PHC are frequently hospitalized; however, PPC resources may be limited and may vary by geographic location. Pediatric hospitalists are often caring for these patients and well positioned to provide basic PPC needs and assist with accessing PPC resources.

Pediatric hospitalists should be able to:

• Compare and contrast between PPC and PHC, attending to scope, patient population, services, optimal timing, and goals of care, among other items.
• Cite key elements of PPC, including facilitation of informed decision-making; enhancing care coordination and communication among medical team members, the child, and family/caregivers; improving comfort through expert symptom management; and optimizing quality of life.
• Review the importance of appropriate timing of PHC referral when the child’s expected prognosis is 6 months or less, and list basic steps in the referral process.
• Summarize why PPC and PHC are optimally provided by an interdisciplinary team consisting of a pediatrician, pediatric nurse, social worker, chaplain, and others.
• Describe the value of conducting proactive discussions of goals of care (GOC), which may include forgoing or withdrawing life-sustaining treatment prior to a child becoming critically ill.
• Explain how PPC can be integrated with appropriate medical treatments, including curative and life-prolonging treatment, starting at diagnosis of serious illness.
• Discuss the benefits of items commonly included in a PPC treatment plan such as symptom management, spiritual counseling, and physical therapy, among others.
• Give examples of local, regional, and national resources for PPC and PHC that are accessible to patients, the family/caregivers, and healthcare providers.
• Describe ethical principles related to end-of-life (EOL) care and the role of the hospital ethics committee in these scenarios.
• Describe the processes for writing “allow natural death” (AND), orders, advanced directives, the “Physician Orders for Life-Sustaining Treatment” (POLST) form, pronouncement of death, and completion of a death certificate.

Pediatric hospitalists should be able to:

• Identify children who may benefit from complex decision-making, advanced symptom management, or higher level psychosocial and spiritual support and refer them to PPC or PHC services.
• Engage in difficult conversations, including communicating “bad news” with compassion.
• Describe and introduce PPC and PHC to patients, the family/caregivers, other subspecialists, and other healthcare providers.
• Lead a basic discussion of prognosis and GOC with patients, the family/caregivers, and the healthcare team.
• Manage ethical dilemmas encountered in the care of the dying patient in the hospital, in collaboration with other healthcare providers as appropriate.
• Provide care that respects the cultural, social, and spiritual preferences of patients and the family/caregivers.
• Screen and provide basic treatment for pain and other distressing symptoms experienced by seriously ill or dying patients, such as dyspnea, nausea, anxiety, delirium, and others.
• Prescribe indicated pharmacologic and non-pharmacologic therapies in collaboration with appropriate consultants, including pain specialists, PPC teams, child-life providers, and integrative therapies.
• Educate healthcare providers and the family/caregivers about symptoms related to active dying.
• Provide counseling regarding life-prolonging interventions, addition of medical technology, and code status.
• Refer patients to other available disciplines for psychosocial and spiritual support, such as pastoral care, social work, and child life, if local PPC and PHC resources are not immediately available.
• Collaborate with an interdisciplinary team including PPC, PHC, nursing, social work, pastoral care, case management, pharmacy, medical/surgical subspecialists, and primary care provider to ensure coordinated, longitudinal care consistent with GOC for this population.
• Manage care needs for this population across facilities where needed, including remotely accessing palliative specialists at tertiary care sites and organizing best plans for patients and the family/caregivers who wish to return for care to their local community center.
• Communicate autopsy and donor options for actively dying children and access immediate support for the family/caregivers and staff related to this decision-making process.

Pediatric hospitalists should be able to:

• Appreciate the key role hospitalists play in ensuring that PPC needs of seriously ill children are addressed.
• Recognize that PPC is appropriate throughout the course of serious illness and should be equitably provided to all children who may benefit from these services.
• Recognize the importance of empathetic, culturally sensitive communication.
• Acknowledge personal attitudes and biases and their influence on care of seriously ill or dying patients from a physical, psychosocial, and spiritual perspective.
• Exemplify ethical behavior in rendering care for these patients and their family/caregivers.
• Reflect on the value of and engage in self-care to cope with the stress of caring for seriously ill patients.
• Realize and address gaps in personal knowledge, skills, and attitudes regarding PPC through professional education.
• Recognize the importance of building therapeutic relationships with seriously ill children and the family/caregivers.
• Recognize that PPC is patient- and family-centered and that treatment plans should be aligned with GOC of patients and the family/caregivers.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in organizational efforts to provide PPC/PHC education.
• Collaborate with hospital administration and community partners to ensure efficient access to appropriate consultants necessary for success of these programs for children.
• Advocate for development of PPC and PHC resources within the institution and local community.
• Lead, coordinate, or participate in institutional initiatives aimed at improving care of seriously ill children, including improved advanced care planning or symptom management care pathways.

Introduction

Pediatric palliative care (PPC) is comprehensive, specialized care for children facing serious or life-threatening illness, with the goal of improving quality of life for the child and the family/caregivers. Palliative care represents both a philosophy and an organized method for delivering care focused on addressing physical, psychosocial, and spiritual needs to prevent and relieve suffering. Pediatric hospice care (PHC) is a particular type of palliative care traditionally provided to patients with a more limited prognosis and carried out by licensed hospice agencies. Pediatric palliative care and PHC are delivered through interdisciplinary collaboration, across care settings, integrated throughout the course of the illness from diagnosis to bereavement, and provided alongside life-prolonging or curative interventions. Patients who may benefit from PPC or PHC are frequently hospitalized; however, PPC resources may be limited and may vary by geographic location. Pediatric hospitalists are often caring for these patients and well positioned to provide basic PPC needs and assist with accessing PPC resources.

Pediatric hospitalists should be able to:

• Compare and contrast between PPC and PHC, attending to scope, patient population, services, optimal timing, and goals of care, among other items.
• Cite key elements of PPC, including facilitation of informed decision-making; enhancing care coordination and communication among medical team members, the child, and family/caregivers; improving comfort through expert symptom management; and optimizing quality of life.
• Review the importance of appropriate timing of PHC referral when the child’s expected prognosis is 6 months or less, and list basic steps in the referral process.
• Summarize why PPC and PHC are optimally provided by an interdisciplinary team consisting of a pediatrician, pediatric nurse, social worker, chaplain, and others.
• Describe the value of conducting proactive discussions of goals of care (GOC), which may include forgoing or withdrawing life-sustaining treatment prior to a child becoming critically ill.
• Explain how PPC can be integrated with appropriate medical treatments, including curative and life-prolonging treatment, starting at diagnosis of serious illness.
• Discuss the benefits of items commonly included in a PPC treatment plan such as symptom management, spiritual counseling, and physical therapy, among others.
• Give examples of local, regional, and national resources for PPC and PHC that are accessible to patients, the family/caregivers, and healthcare providers.
• Describe ethical principles related to end-of-life (EOL) care and the role of the hospital ethics committee in these scenarios.
• Describe the processes for writing “allow natural death” (AND), orders, advanced directives, the “Physician Orders for Life-Sustaining Treatment” (POLST) form, pronouncement of death, and completion of a death certificate.

Pediatric hospitalists should be able to:

• Identify children who may benefit from complex decision-making, advanced symptom management, or higher level psychosocial and spiritual support and refer them to PPC or PHC services.
• Engage in difficult conversations, including communicating “bad news” with compassion.
• Describe and introduce PPC and PHC to patients, the family/caregivers, other subspecialists, and other healthcare providers.
• Lead a basic discussion of prognosis and GOC with patients, the family/caregivers, and the healthcare team.
• Manage ethical dilemmas encountered in the care of the dying patient in the hospital, in collaboration with other healthcare providers as appropriate.
• Provide care that respects the cultural, social, and spiritual preferences of patients and the family/caregivers.
• Screen and provide basic treatment for pain and other distressing symptoms experienced by seriously ill or dying patients, such as dyspnea, nausea, anxiety, delirium, and others.
• Prescribe indicated pharmacologic and non-pharmacologic therapies in collaboration with appropriate consultants, including pain specialists, PPC teams, child-life providers, and integrative therapies.
• Educate healthcare providers and the family/caregivers about symptoms related to active dying.
• Provide counseling regarding life-prolonging interventions, addition of medical technology, and code status.
• Refer patients to other available disciplines for psychosocial and spiritual support, such as pastoral care, social work, and child life, if local PPC and PHC resources are not immediately available.
• Collaborate with an interdisciplinary team including PPC, PHC, nursing, social work, pastoral care, case management, pharmacy, medical/surgical subspecialists, and primary care provider to ensure coordinated, longitudinal care consistent with GOC for this population.
• Manage care needs for this population across facilities where needed, including remotely accessing palliative specialists at tertiary care sites and organizing best plans for patients and the family/caregivers who wish to return for care to their local community center.
• Communicate autopsy and donor options for actively dying children and access immediate support for the family/caregivers and staff related to this decision-making process.

Pediatric hospitalists should be able to:

• Appreciate the key role hospitalists play in ensuring that PPC needs of seriously ill children are addressed.
• Recognize that PPC is appropriate throughout the course of serious illness and should be equitably provided to all children who may benefit from these services.
• Recognize the importance of empathetic, culturally sensitive communication.
• Acknowledge personal attitudes and biases and their influence on care of seriously ill or dying patients from a physical, psychosocial, and spiritual perspective.
• Exemplify ethical behavior in rendering care for these patients and their family/caregivers.
• Reflect on the value of and engage in self-care to cope with the stress of caring for seriously ill patients.
• Realize and address gaps in personal knowledge, skills, and attitudes regarding PPC through professional education.
• Recognize the importance of building therapeutic relationships with seriously ill children and the family/caregivers.
• Recognize that PPC is patient- and family-centered and that treatment plans should be aligned with GOC of patients and the family/caregivers.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in organizational efforts to provide PPC/PHC education.
• Collaborate with hospital administration and community partners to ensure efficient access to appropriate consultants necessary for success of these programs for children.
• Advocate for development of PPC and PHC resources within the institution and local community.
• Lead, coordinate, or participate in institutional initiatives aimed at improving care of seriously ill children, including improved advanced care planning or symptom management care pathways.

Introduction

Pediatric hospitalists are increasingly called upon to provide care for the immediate newborn. For those who provide these services, the components of this care vary and may include any combination of routine newborn care, level II and above neonatal intensive care, delivery room management, neonatal resuscitation and stabilization, or neonatal transport services. Rendering this care requires medical and procedural skills, as well as leadership and team skills while working with neonatologists, obstetricians, nurses, nurse midwives, advanced practice practitioners, primary care providers, and the family/caregivers. Pediatric hospitalists are well positioned to provide quality care for the newborn and to assure effective transition of care to home or to higher levels of support as needed.

Pediatric hospitalists should be able to:

• Describe the role of each team member commonly involved in newborn care, including the obstetricians, perinatologists, prenatal ultrasonographers/radiologists, nurses, advanced practice practitioners, lactation consultants, social workers, primary care providers, and others.
• Describe the skills needed to be an effective neonatal resuscitation team leader, including critical thinking, evidence-based decision-making, and effective communication.
• Define nursery care levels and the conditions that can be cared for at each level of acuity, while demonstrating knowledge and awareness of available resources.
• Describe the normal delivery process and the physiologic transitions of a newborn.
• Summarize the components of a complete newborn exam.
• Review the steps of neonatal resuscitation as recommended by the Neonatal Resuscitation Program (NRP).
• Describe the basic physiologic differences between preterm, late preterm, and term infants.
• Discuss common issues for preterm and late preterm infants including respiratory complications, temperature instability, feeding difficulties, hypoglycemia, infection, hyperbilirubinemia, and others.
• Discuss the impact of maternal factors and conditions on the fetus and newborn, including abnormal prenatal labs, diabetes, thyroid disorders, hypertension, and others.
• Discuss the impact of maternal use of prescription, non-prescription, and illicit drugs on the fetus and newborn.
• List symptoms of drug withdrawal and summarize the appropriate monitoring and management of the newborn at risk for neonatal abstinence syndrome (NAS).
• Compare and contrast the nutritional requirements of term versus preterm infants.
• Compare and contrast the benefits of breast milk, formulas, and supplements (Vitamin D, Iron) for term versus preterm infants.
• Cite examples where use of nutrition other than breast milk may be medically indicated.
• Identify when breastfeeding difficulties warrant additional support from lactation consultants.
• Review the components of common newborn screening tests, including state metabolic screening, hearing screening, critical congenital heart disease screening, car seat tolerance testing, and bilirubin screening.
• Review guidelines and recommendations for common newborn medications, such as immunizations for Hepatitis B, Vitamin K, and eye prophylaxis.
• Describe and differentiate between risk factors and pathophysiologic causes of hyperbilirubinemia requiring treatment for immediate newborns (first 1- 2 days of life) versus older infants.
• Discuss key elements in the assessment and management of newborns at risk for early onset sepsis, such as maternal antibiotic prophylaxis, presence of fever in the newborn, rupture of membranes, gestational age, and other factors.
• Describe the diagnostic and therapeutic approach toward newborns with common dysmorphisms including features associated with trisomies, ear pits, cleft-lip/palate, supernumerary digits, spinal dysraphisms, clubfoot, and others.
• Review risk factors for and pathophysiology of persistent fetal circulation/pulmonary hypertension of the newborn.
• Describe the diagnostic approach and differential diagnosis for a newborn with tachypnea, hypoxia, or cyanosis.
• Discuss the approach toward the newborn with hypoglycemia, including a summary of pathophysiology of glucose homeostasis, risk factors, diagnosis, and treatment.
• Discuss presentation and management of common birth traumas including clavicle fractures, brachial plexus injuries, and others.
• Describe the initial management and differential diagnosis for newborns with seizures.
• Review the role of prenatal ultrasound and describe appropriate post-birth follow-up of common findings including renal abnormalities, heart lesions, and others.
• List common clinical indications for an acute metabolic or endocrine work-up in newborns.
• Compare and contrast the characteristics of benign versus pathologic cardiac murmurs in this population, and give examples of indications for emergent echocardiogram and/or cardiology consultation.
• Describe the risk factors for developmental dysplasia of the hip, and the diagnostic and therapeutic approach to this condition.
• Explain specific goals that should be met to ensure safe transitions of care for this population, including recommendations for and timing of follow-up appointments.
• List commonly utilized resources to support the family/caregivers after hospital discharge, attending to global and potential special needs due to infant condition or the family/caregivers’ needs.

Pediatric hospitalists should be able to:

• Lead a team in an NRP-based resuscitation for term and preterm infants.
• Provide initial care and stabilization for newborns requiring a higher level of care.
• Perform a physician exam to elicit signs related to conditions requiring subspecialty consultation and counseling, including cardiac anomalies, ambiguous genitalia, dysmorphisms, and others.
• Identify and provide initial care and stabilization for newborns with surgical emergencies such as gastrointestinal obstruction, diaphragmatic hernia, cardiac anomalies, and others.
• Identify newborns with respiratory and cardiac instability and initiate appropriate cardiorespiratory support.
• Order and correctly interpret expanded newborn vital signs, including 4-extremity blood pressure and pre/post ductal oxygenation testing.
• Select appropriate diagnostic studies and therapeutics for common newborn conditions such as jaundice, tachypnea, hypoxia, altered mental status, hypoglycemia, neonatal sepsis, jitteriness, and others.
• Interpret basic studies (such as laboratory tests and radiographs) and identify abnormal finding that require further testing or consultation.
• Demonstrate basic competency in performing procedures on this population according to local context, including lumbar puncture, intravenous and intraosseous access, intubation, placement of enteral tubes, placement of umbilical catheters, frenotomy, needle thoracentesis, circumcision, and others.
• Order and manage enteral and parenteral nutrition for term and preterm infants.
• Demonstrate skills in counseling mothers and the family/caregivers, based on current evidence and recommendations, about common topics, such as immunizations, circumcision, breast-feeding, vitamin K administration, provision of erythromycin ophthalmic ointment, and others.
• Demonstrate skills in communicating with the family/caregivers to diffuse anxiety and provide support, particularly when discussing the need for consultation or emergency care.
• Coordinate care with the primary care provider and subspecialists as indicated to arrange for the referral, transfer or hospital discharge for this population.
• Identify when maternal, familial, and/or environmental factors warrant social work consultation or other support and initiate appropriate referrals.

Pediatric hospitalists should be able to:

• Role model a high level of commitment, responsibility, and accountability in rendering care for newborns.
• Exemplify professional and compassionate behavior towards the family/caregivers at all times while providing care and discussing care options, including during the delivery process and in the nursery.
• Reflect on the importance of and benefits from coordinating care with other multidisciplinary members of the health care team, including social workers, case managers, developmental specialists, and lactation consultants.
• Recognize the importance of utilizing shared decision-making with the family/caregivers when addressing care options for newborns with complex issues, such as extreme prematurity, congenital anomalies, and other conditions.

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, evidence-based care pathways to standardize the evaluation, management, and discharge process for newborns.
• Work with hospital administration, hospital staff, subspecialists, and other services/consultants to provide appropriate newborn resuscitation services and newborn care at all levels of acuity according to local context.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and tertiary care centers for newborns requiring higher levels of care.
• Promote or provide leadership for a newborn nursery or level II neonatal intensive care unit, in partnership with neonatologists and other subspecialists as indicated.
• Lead, coordinate, or participate in efforts to create and sustain in a process of continuous quality improvement in the nursery.

Introduction

Pediatric hospitalists are increasingly called upon to provide care for the immediate newborn. For those who provide these services, the components of this care vary and may include any combination of routine newborn care, level II and above neonatal intensive care, delivery room management, neonatal resuscitation and stabilization, or neonatal transport services. Rendering this care requires medical and procedural skills, as well as leadership and team skills while working with neonatologists, obstetricians, nurses, nurse midwives, advanced practice practitioners, primary care providers, and the family/caregivers. Pediatric hospitalists are well positioned to provide quality care for the newborn and to assure effective transition of care to home or to higher levels of support as needed.

Pediatric hospitalists should be able to:

• Describe the role of each team member commonly involved in newborn care, including the obstetricians, perinatologists, prenatal ultrasonographers/radiologists, nurses, advanced practice practitioners, lactation consultants, social workers, primary care providers, and others.
• Describe the skills needed to be an effective neonatal resuscitation team leader, including critical thinking, evidence-based decision-making, and effective communication.
• Define nursery care levels and the conditions that can be cared for at each level of acuity, while demonstrating knowledge and awareness of available resources.
• Describe the normal delivery process and the physiologic transitions of a newborn.
• Summarize the components of a complete newborn exam.
• Review the steps of neonatal resuscitation as recommended by the Neonatal Resuscitation Program (NRP).
• Describe the basic physiologic differences between preterm, late preterm, and term infants.
• Discuss common issues for preterm and late preterm infants including respiratory complications, temperature instability, feeding difficulties, hypoglycemia, infection, hyperbilirubinemia, and others.
• Discuss the impact of maternal factors and conditions on the fetus and newborn, including abnormal prenatal labs, diabetes, thyroid disorders, hypertension, and others.
• Discuss the impact of maternal use of prescription, non-prescription, and illicit drugs on the fetus and newborn.
• List symptoms of drug withdrawal and summarize the appropriate monitoring and management of the newborn at risk for neonatal abstinence syndrome (NAS).
• Compare and contrast the nutritional requirements of term versus preterm infants.
• Compare and contrast the benefits of breast milk, formulas, and supplements (Vitamin D, Iron) for term versus preterm infants.
• Cite examples where use of nutrition other than breast milk may be medically indicated.
• Identify when breastfeeding difficulties warrant additional support from lactation consultants.
• Review the components of common newborn screening tests, including state metabolic screening, hearing screening, critical congenital heart disease screening, car seat tolerance testing, and bilirubin screening.
• Review guidelines and recommendations for common newborn medications, such as immunizations for Hepatitis B, Vitamin K, and eye prophylaxis.
• Describe and differentiate between risk factors and pathophysiologic causes of hyperbilirubinemia requiring treatment for immediate newborns (first 1- 2 days of life) versus older infants.
• Discuss key elements in the assessment and management of newborns at risk for early onset sepsis, such as maternal antibiotic prophylaxis, presence of fever in the newborn, rupture of membranes, gestational age, and other factors.
• Describe the diagnostic and therapeutic approach toward newborns with common dysmorphisms including features associated with trisomies, ear pits, cleft-lip/palate, supernumerary digits, spinal dysraphisms, clubfoot, and others.
• Review risk factors for and pathophysiology of persistent fetal circulation/pulmonary hypertension of the newborn.
• Describe the diagnostic approach and differential diagnosis for a newborn with tachypnea, hypoxia, or cyanosis.
• Discuss the approach toward the newborn with hypoglycemia, including a summary of pathophysiology of glucose homeostasis, risk factors, diagnosis, and treatment.
• Discuss presentation and management of common birth traumas including clavicle fractures, brachial plexus injuries, and others.
• Describe the initial management and differential diagnosis for newborns with seizures.
• Review the role of prenatal ultrasound and describe appropriate post-birth follow-up of common findings including renal abnormalities, heart lesions, and others.
• List common clinical indications for an acute metabolic or endocrine work-up in newborns.
• Compare and contrast the characteristics of benign versus pathologic cardiac murmurs in this population, and give examples of indications for emergent echocardiogram and/or cardiology consultation.
• Describe the risk factors for developmental dysplasia of the hip, and the diagnostic and therapeutic approach to this condition.
• Explain specific goals that should be met to ensure safe transitions of care for this population, including recommendations for and timing of follow-up appointments.
• List commonly utilized resources to support the family/caregivers after hospital discharge, attending to global and potential special needs due to infant condition or the family/caregivers’ needs.

Pediatric hospitalists should be able to:

• Lead a team in an NRP-based resuscitation for term and preterm infants.
• Provide initial care and stabilization for newborns requiring a higher level of care.
• Perform a physician exam to elicit signs related to conditions requiring subspecialty consultation and counseling, including cardiac anomalies, ambiguous genitalia, dysmorphisms, and others.
• Identify and provide initial care and stabilization for newborns with surgical emergencies such as gastrointestinal obstruction, diaphragmatic hernia, cardiac anomalies, and others.
• Identify newborns with respiratory and cardiac instability and initiate appropriate cardiorespiratory support.
• Order and correctly interpret expanded newborn vital signs, including 4-extremity blood pressure and pre/post ductal oxygenation testing.
• Select appropriate diagnostic studies and therapeutics for common newborn conditions such as jaundice, tachypnea, hypoxia, altered mental status, hypoglycemia, neonatal sepsis, jitteriness, and others.
• Interpret basic studies (such as laboratory tests and radiographs) and identify abnormal finding that require further testing or consultation.
• Demonstrate basic competency in performing procedures on this population according to local context, including lumbar puncture, intravenous and intraosseous access, intubation, placement of enteral tubes, placement of umbilical catheters, frenotomy, needle thoracentesis, circumcision, and others.
• Order and manage enteral and parenteral nutrition for term and preterm infants.
• Demonstrate skills in counseling mothers and the family/caregivers, based on current evidence and recommendations, about common topics, such as immunizations, circumcision, breast-feeding, vitamin K administration, provision of erythromycin ophthalmic ointment, and others.
• Demonstrate skills in communicating with the family/caregivers to diffuse anxiety and provide support, particularly when discussing the need for consultation or emergency care.
• Coordinate care with the primary care provider and subspecialists as indicated to arrange for the referral, transfer or hospital discharge for this population.
• Identify when maternal, familial, and/or environmental factors warrant social work consultation or other support and initiate appropriate referrals.

Pediatric hospitalists should be able to:

• Role model a high level of commitment, responsibility, and accountability in rendering care for newborns.
• Exemplify professional and compassionate behavior towards the family/caregivers at all times while providing care and discussing care options, including during the delivery process and in the nursery.
• Reflect on the importance of and benefits from coordinating care with other multidisciplinary members of the health care team, including social workers, case managers, developmental specialists, and lactation consultants.
• Recognize the importance of utilizing shared decision-making with the family/caregivers when addressing care options for newborns with complex issues, such as extreme prematurity, congenital anomalies, and other conditions.

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, evidence-based care pathways to standardize the evaluation, management, and discharge process for newborns.
• Work with hospital administration, hospital staff, subspecialists, and other services/consultants to provide appropriate newborn resuscitation services and newborn care at all levels of acuity according to local context.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and tertiary care centers for newborns requiring higher levels of care.
• Promote or provide leadership for a newborn nursery or level II neonatal intensive care unit, in partnership with neonatologists and other subspecialists as indicated.
• Lead, coordinate, or participate in efforts to create and sustain in a process of continuous quality improvement in the nursery.

Introduction

Pediatric hospitalists are increasingly called upon to provide care for the immediate newborn. For those who provide these services, the components of this care vary and may include any combination of routine newborn care, level II and above neonatal intensive care, delivery room management, neonatal resuscitation and stabilization, or neonatal transport services. Rendering this care requires medical and procedural skills, as well as leadership and team skills while working with neonatologists, obstetricians, nurses, nurse midwives, advanced practice practitioners, primary care providers, and the family/caregivers. Pediatric hospitalists are well positioned to provide quality care for the newborn and to assure effective transition of care to home or to higher levels of support as needed.

Pediatric hospitalists should be able to:

• Describe the role of each team member commonly involved in newborn care, including the obstetricians, perinatologists, prenatal ultrasonographers/radiologists, nurses, advanced practice practitioners, lactation consultants, social workers, primary care providers, and others.
• Describe the skills needed to be an effective neonatal resuscitation team leader, including critical thinking, evidence-based decision-making, and effective communication.
• Define nursery care levels and the conditions that can be cared for at each level of acuity, while demonstrating knowledge and awareness of available resources.
• Describe the normal delivery process and the physiologic transitions of a newborn.
• Summarize the components of a complete newborn exam.
• Review the steps of neonatal resuscitation as recommended by the Neonatal Resuscitation Program (NRP).
• Describe the basic physiologic differences between preterm, late preterm, and term infants.
• Discuss common issues for preterm and late preterm infants including respiratory complications, temperature instability, feeding difficulties, hypoglycemia, infection, hyperbilirubinemia, and others.
• Discuss the impact of maternal factors and conditions on the fetus and newborn, including abnormal prenatal labs, diabetes, thyroid disorders, hypertension, and others.
• Discuss the impact of maternal use of prescription, non-prescription, and illicit drugs on the fetus and newborn.
• List symptoms of drug withdrawal and summarize the appropriate monitoring and management of the newborn at risk for neonatal abstinence syndrome (NAS).
• Compare and contrast the nutritional requirements of term versus preterm infants.
• Compare and contrast the benefits of breast milk, formulas, and supplements (Vitamin D, Iron) for term versus preterm infants.
• Cite examples where use of nutrition other than breast milk may be medically indicated.
• Identify when breastfeeding difficulties warrant additional support from lactation consultants.
• Review the components of common newborn screening tests, including state metabolic screening, hearing screening, critical congenital heart disease screening, car seat tolerance testing, and bilirubin screening.
• Review guidelines and recommendations for common newborn medications, such as immunizations for Hepatitis B, Vitamin K, and eye prophylaxis.
• Describe and differentiate between risk factors and pathophysiologic causes of hyperbilirubinemia requiring treatment for immediate newborns (first 1- 2 days of life) versus older infants.
• Discuss key elements in the assessment and management of newborns at risk for early onset sepsis, such as maternal antibiotic prophylaxis, presence of fever in the newborn, rupture of membranes, gestational age, and other factors.
• Describe the diagnostic and therapeutic approach toward newborns with common dysmorphisms including features associated with trisomies, ear pits, cleft-lip/palate, supernumerary digits, spinal dysraphisms, clubfoot, and others.
• Review risk factors for and pathophysiology of persistent fetal circulation/pulmonary hypertension of the newborn.
• Describe the diagnostic approach and differential diagnosis for a newborn with tachypnea, hypoxia, or cyanosis.
• Discuss the approach toward the newborn with hypoglycemia, including a summary of pathophysiology of glucose homeostasis, risk factors, diagnosis, and treatment.
• Discuss presentation and management of common birth traumas including clavicle fractures, brachial plexus injuries, and others.
• Describe the initial management and differential diagnosis for newborns with seizures.
• Review the role of prenatal ultrasound and describe appropriate post-birth follow-up of common findings including renal abnormalities, heart lesions, and others.
• List common clinical indications for an acute metabolic or endocrine work-up in newborns.
• Compare and contrast the characteristics of benign versus pathologic cardiac murmurs in this population, and give examples of indications for emergent echocardiogram and/or cardiology consultation.
• Describe the risk factors for developmental dysplasia of the hip, and the diagnostic and therapeutic approach to this condition.
• Explain specific goals that should be met to ensure safe transitions of care for this population, including recommendations for and timing of follow-up appointments.
• List commonly utilized resources to support the family/caregivers after hospital discharge, attending to global and potential special needs due to infant condition or the family/caregivers’ needs.

Pediatric hospitalists should be able to:

• Lead a team in an NRP-based resuscitation for term and preterm infants.
• Provide initial care and stabilization for newborns requiring a higher level of care.
• Perform a physician exam to elicit signs related to conditions requiring subspecialty consultation and counseling, including cardiac anomalies, ambiguous genitalia, dysmorphisms, and others.
• Identify and provide initial care and stabilization for newborns with surgical emergencies such as gastrointestinal obstruction, diaphragmatic hernia, cardiac anomalies, and others.
• Identify newborns with respiratory and cardiac instability and initiate appropriate cardiorespiratory support.
• Order and correctly interpret expanded newborn vital signs, including 4-extremity blood pressure and pre/post ductal oxygenation testing.
• Select appropriate diagnostic studies and therapeutics for common newborn conditions such as jaundice, tachypnea, hypoxia, altered mental status, hypoglycemia, neonatal sepsis, jitteriness, and others.
• Interpret basic studies (such as laboratory tests and radiographs) and identify abnormal finding that require further testing or consultation.
• Demonstrate basic competency in performing procedures on this population according to local context, including lumbar puncture, intravenous and intraosseous access, intubation, placement of enteral tubes, placement of umbilical catheters, frenotomy, needle thoracentesis, circumcision, and others.
• Order and manage enteral and parenteral nutrition for term and preterm infants.
• Demonstrate skills in counseling mothers and the family/caregivers, based on current evidence and recommendations, about common topics, such as immunizations, circumcision, breast-feeding, vitamin K administration, provision of erythromycin ophthalmic ointment, and others.
• Demonstrate skills in communicating with the family/caregivers to diffuse anxiety and provide support, particularly when discussing the need for consultation or emergency care.
• Coordinate care with the primary care provider and subspecialists as indicated to arrange for the referral, transfer or hospital discharge for this population.
• Identify when maternal, familial, and/or environmental factors warrant social work consultation or other support and initiate appropriate referrals.

Pediatric hospitalists should be able to:

• Role model a high level of commitment, responsibility, and accountability in rendering care for newborns.
• Exemplify professional and compassionate behavior towards the family/caregivers at all times while providing care and discussing care options, including during the delivery process and in the nursery.
• Reflect on the importance of and benefits from coordinating care with other multidisciplinary members of the health care team, including social workers, case managers, developmental specialists, and lactation consultants.
• Recognize the importance of utilizing shared decision-making with the family/caregivers when addressing care options for newborns with complex issues, such as extreme prematurity, congenital anomalies, and other conditions.

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, evidence-based care pathways to standardize the evaluation, management, and discharge process for newborns.
• Work with hospital administration, hospital staff, subspecialists, and other services/consultants to provide appropriate newborn resuscitation services and newborn care at all levels of acuity according to local context.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and tertiary care centers for newborns requiring higher levels of care.
• Promote or provide leadership for a newborn nursery or level II neonatal intensive care unit, in partnership with neonatologists and other subspecialists as indicated.
• Lead, coordinate, or participate in efforts to create and sustain in a process of continuous quality improvement in the nursery.

Introduction

Behavioral issues are increasingly noted in hospitalized children, either as comorbidity or as the primary focus for admission. Yearly, 1 out of 5 children living in the United States experiences a mental disorder. Chronic mental health disorders can affect many children but may manifest differently when occurring in children with chronic medical conditions. Because of different etiologies and contexts, the approach toward inpatient care and treatment may also differ. Hospital systems vary in resources and, in particular, the availability of mental health units, including specialized units needed for children with eating disorders. Pediatric hospitalists often encounter children with behavioral needs and play a key role in the advocacy and care for these patients.

Pediatric hospitalists should be able to:

• List chronic neurodevelopmental disorders that may require acute behavioral and/or psychiatric management in the hospital setting, such as global developmental delay or intellectual disability due to varied etiologies, genetic disorders such as Rett syndrome or Down syndrome, neurodevelopmental conditions such as autism spectrum disorders, and others.
• Cite commonly encountered mood disorders (such as depression and anxiety) and chronic psychiatric conditions (such as conduct disorder, oppositional defiant disorder, attention deficit hyperactivity disorder (ADHD), eating disorders, and others).
• Summarize the relationship between mental health conditions (such as autism spectrum disorder, disruptive behavior disorder, anxiety, or depression) and common chronic medical conditions (such as diabetes, cystic fibrosis, sickle cell and others).
• Define disruptive behavior disorders and discuss strategies to mitigate the impact of these on care team members.
• Review the differences between “internalizing” and “externalizing” behaviors.
• Identify underlying triggers for escalating behavioral problems in these patients which are commonly encountered in the hospital setting, such as overstimulation from environmental cues, sleep loss, changes in routine and daily structure, fear of a new environment, and others.
• Describe safety precautions needed for the patient, staff, and the family/caregivers when a patient is agitated or emotionally dysregulated, including awareness of surroundings, objects that can be used for self-harm or harm to others, and others.
• Give examples of behaviors that may manifest from child abuse or neglect in this population, including aggression, withdrawal, and refusal of treatment or care.
• Identify some commonly used evidence-based treatments for different behavioral conditions, such as Applied Behavioral Analysis (behavior modification for autism spectrum disorder), Parent-Child Interaction Therapy (PCIT) (parenting skills training for behavior disorders and trauma), Cognitive Behavioral Therapy (CBT), Exposure therapy, and Dialectical Behavioral Therapy (DBT).
• List indications and possible side effects of medications commonly used in this population, including antidepressants, antipsychotics, psychostimulants, and others.
• Discuss basic characteristics of each of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM)-5 eating disorder diagnoses including anorexia nervosa - restricting type (AN-R), anorexia nervosa - binge-eating/purging type (AN-BP), bulimia nervosa (BN), Avoidant Restrictive Food Intake Disorder (ARFID), and Other Specified Feeding and Eating Disorder (OSFED).
• Cite examples of laboratory testing commonly used to identify organic causes of feeding intolerance, growth delay, and malnutrition.
• State the signs and symptoms of eating disorders that require hospitalization, including hemodynamic instability, bradycardia, and severe malnutrition.
• Give examples of potential maladaptive behaviors that may occur in family members of patients with chronic behavioral and psychiatric conditions, such as maternal or paternal psychopathology, poor parent relationships, and sibling conflicts.
• Review alternative communication modes that may be of value in this population such as drawing, use of symbols, sign language, photos, and computers.
• Identify examples of secondary gain underlying behavioral problems for some children, including school or home avoidance.
• Summarize medical and mental health care treatment needed for this population after hospital discharge, including access to mental health providers, residential or partial hospitalization programs, and coordination of care with the medical home.

Pediatric hospitalists should be able to:

• Utilize locally available screening tools to identify patients with potential for behavioral and psychiatric disorders.
• Identify adverse drug events related to medications used for behavioral health conditions.
• Order appropriate monitoring, medications, and treatments to prevent or manage escalation of chronic maladaptive behaviors.
• Coordinate care, with patients, the family/caregivers, and healthcare providers to ensure a safe environment for the child within the hospital setting, with attention to elective admission, procedures, and surgical events.
• Consult, collaborate with, and/or coordinate an interdisciplinary team in the management of this population, including child life, social work, psychology, psychiatry, rehabilitation medicine, physical therapy, occupational therapy, speech therapy, and others within local context.
• Diagnose conditions with both medical and behavioral/psychiatric components and create an effective, safe, and integrated management plan to address each.
• Consult other subspecialists and appropriately refer or coordinate transfer of patients.
• Identify patients who may benefit from evidence-based testing, such as imaging, genetic testing, hormonal testing, and others, and initiate orders as appropriate.
• Demonstrate the use of physical exam and communication skills that are appropriate for the patients’ cognitive and developmental abilities.
• Deliver care that is consistent and effective using behavioral and communication skills to support positive behavior choices.
• Identify the potential for and manage aggressive or maladaptive behavior using environmental, behavioral, and medication modalities as appropriate.
• Order and interpret common data including intake, output, vital signs, sleep habits, and nutritional needs for this population, and make care plan changes to address concerns.
• Create a comprehensive discharge plan in coordination with the patient, the family/caregivers, primary care provider, mental health providers, residential or partial hospitalization programs, and others.
• Provide support and empathy for health care providers and hospital staff facing challenging behaviors.

Pediatric hospitalists should be able to:

• Reflect on the importance of maintaining respect and compassion when speaking with and caring for this population.
• Role model professionalism by exemplifying patience and creating a positive therapeutic environment for patients, the family/caregivers, colleagues, and hospital staff.
• Recognize that care plans may need to be adapted to accommodate a child’s changing medical and behavioral needs.
• Realize that eating disorders occur in all genders, cultures, ethnicities, and socioeconomic classes.
• Reflect on the importance of education and advocacy for the population of patients with eating disorders, noting that eating disorders are mental health disorders with physiological manifestations.
• Recognize that children with neurodevelopmental disorders and disruptive behavioral disorders are at higher risk for abuse.
• Reflect on the value of acquiring and utilizing coping skills for patients, the family/caregivers, colleagues, hospital staff, and self.

In order to improve efficiency and quality within their organization, pediatric hospitalists should:

• Work with hospital administration to develop and implement training for healthcare providers, hospital staff, and trainees around the approach toward care for this population.
• Work with hospital administration to develop and provide a safe and non-judgmental environment of care for this population.
• Collaborate with healthcare providers and hospital staff to determine roles and responsibilities that optimize each member’s strengths and training when managing patient behaviors.
• Collaborate with hospital administration and community partners to develop and sustain referral networks for family members to appropriate community resources, including respite care, social services, and therapy.
• Lead, coordinate, or participate in organizational efforts to educate community providers on recognition of and criteria for hospitalization for children with eating disorders.

Introduction

Behavioral issues are increasingly noted in hospitalized children, either as comorbidity or as the primary focus for admission. Yearly, 1 out of 5 children living in the United States experiences a mental disorder. Chronic mental health disorders can affect many children but may manifest differently when occurring in children with chronic medical conditions. Because of different etiologies and contexts, the approach toward inpatient care and treatment may also differ. Hospital systems vary in resources and, in particular, the availability of mental health units, including specialized units needed for children with eating disorders. Pediatric hospitalists often encounter children with behavioral needs and play a key role in the advocacy and care for these patients.

Pediatric hospitalists should be able to:

• List chronic neurodevelopmental disorders that may require acute behavioral and/or psychiatric management in the hospital setting, such as global developmental delay or intellectual disability due to varied etiologies, genetic disorders such as Rett syndrome or Down syndrome, neurodevelopmental conditions such as autism spectrum disorders, and others.
• Cite commonly encountered mood disorders (such as depression and anxiety) and chronic psychiatric conditions (such as conduct disorder, oppositional defiant disorder, attention deficit hyperactivity disorder (ADHD), eating disorders, and others).
• Summarize the relationship between mental health conditions (such as autism spectrum disorder, disruptive behavior disorder, anxiety, or depression) and common chronic medical conditions (such as diabetes, cystic fibrosis, sickle cell and others).
• Define disruptive behavior disorders and discuss strategies to mitigate the impact of these on care team members.
• Review the differences between “internalizing” and “externalizing” behaviors.
• Identify underlying triggers for escalating behavioral problems in these patients which are commonly encountered in the hospital setting, such as overstimulation from environmental cues, sleep loss, changes in routine and daily structure, fear of a new environment, and others.
• Describe safety precautions needed for the patient, staff, and the family/caregivers when a patient is agitated or emotionally dysregulated, including awareness of surroundings, objects that can be used for self-harm or harm to others, and others.
• Give examples of behaviors that may manifest from child abuse or neglect in this population, including aggression, withdrawal, and refusal of treatment or care.
• Identify some commonly used evidence-based treatments for different behavioral conditions, such as Applied Behavioral Analysis (behavior modification for autism spectrum disorder), Parent-Child Interaction Therapy (PCIT) (parenting skills training for behavior disorders and trauma), Cognitive Behavioral Therapy (CBT), Exposure therapy, and Dialectical Behavioral Therapy (DBT).
• List indications and possible side effects of medications commonly used in this population, including antidepressants, antipsychotics, psychostimulants, and others.
• Discuss basic characteristics of each of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM)-5 eating disorder diagnoses including anorexia nervosa - restricting type (AN-R), anorexia nervosa - binge-eating/purging type (AN-BP), bulimia nervosa (BN), Avoidant Restrictive Food Intake Disorder (ARFID), and Other Specified Feeding and Eating Disorder (OSFED).
• Cite examples of laboratory testing commonly used to identify organic causes of feeding intolerance, growth delay, and malnutrition.
• State the signs and symptoms of eating disorders that require hospitalization, including hemodynamic instability, bradycardia, and severe malnutrition.
• Give examples of potential maladaptive behaviors that may occur in family members of patients with chronic behavioral and psychiatric conditions, such as maternal or paternal psychopathology, poor parent relationships, and sibling conflicts.
• Review alternative communication modes that may be of value in this population such as drawing, use of symbols, sign language, photos, and computers.
• Identify examples of secondary gain underlying behavioral problems for some children, including school or home avoidance.
• Summarize medical and mental health care treatment needed for this population after hospital discharge, including access to mental health providers, residential or partial hospitalization programs, and coordination of care with the medical home.

Pediatric hospitalists should be able to:

• Utilize locally available screening tools to identify patients with potential for behavioral and psychiatric disorders.
• Identify adverse drug events related to medications used for behavioral health conditions.
• Order appropriate monitoring, medications, and treatments to prevent or manage escalation of chronic maladaptive behaviors.
• Coordinate care, with patients, the family/caregivers, and healthcare providers to ensure a safe environment for the child within the hospital setting, with attention to elective admission, procedures, and surgical events.
• Consult, collaborate with, and/or coordinate an interdisciplinary team in the management of this population, including child life, social work, psychology, psychiatry, rehabilitation medicine, physical therapy, occupational therapy, speech therapy, and others within local context.
• Diagnose conditions with both medical and behavioral/psychiatric components and create an effective, safe, and integrated management plan to address each.
• Consult other subspecialists and appropriately refer or coordinate transfer of patients.
• Identify patients who may benefit from evidence-based testing, such as imaging, genetic testing, hormonal testing, and others, and initiate orders as appropriate.
• Demonstrate the use of physical exam and communication skills that are appropriate for the patients’ cognitive and developmental abilities.
• Deliver care that is consistent and effective using behavioral and communication skills to support positive behavior choices.
• Identify the potential for and manage aggressive or maladaptive behavior using environmental, behavioral, and medication modalities as appropriate.
• Order and interpret common data including intake, output, vital signs, sleep habits, and nutritional needs for this population, and make care plan changes to address concerns.
• Create a comprehensive discharge plan in coordination with the patient, the family/caregivers, primary care provider, mental health providers, residential or partial hospitalization programs, and others.
• Provide support and empathy for health care providers and hospital staff facing challenging behaviors.

Pediatric hospitalists should be able to:

• Reflect on the importance of maintaining respect and compassion when speaking with and caring for this population.
• Role model professionalism by exemplifying patience and creating a positive therapeutic environment for patients, the family/caregivers, colleagues, and hospital staff.
• Recognize that care plans may need to be adapted to accommodate a child’s changing medical and behavioral needs.
• Realize that eating disorders occur in all genders, cultures, ethnicities, and socioeconomic classes.
• Reflect on the importance of education and advocacy for the population of patients with eating disorders, noting that eating disorders are mental health disorders with physiological manifestations.
• Recognize that children with neurodevelopmental disorders and disruptive behavioral disorders are at higher risk for abuse.
• Reflect on the value of acquiring and utilizing coping skills for patients, the family/caregivers, colleagues, hospital staff, and self.

In order to improve efficiency and quality within their organization, pediatric hospitalists should:

• Work with hospital administration to develop and implement training for healthcare providers, hospital staff, and trainees around the approach toward care for this population.
• Work with hospital administration to develop and provide a safe and non-judgmental environment of care for this population.
• Collaborate with healthcare providers and hospital staff to determine roles and responsibilities that optimize each member’s strengths and training when managing patient behaviors.
• Collaborate with hospital administration and community partners to develop and sustain referral networks for family members to appropriate community resources, including respite care, social services, and therapy.
• Lead, coordinate, or participate in organizational efforts to educate community providers on recognition of and criteria for hospitalization for children with eating disorders.

Introduction

Behavioral issues are increasingly noted in hospitalized children, either as comorbidity or as the primary focus for admission. Yearly, 1 out of 5 children living in the United States experiences a mental disorder. Chronic mental health disorders can affect many children but may manifest differently when occurring in children with chronic medical conditions. Because of different etiologies and contexts, the approach toward inpatient care and treatment may also differ. Hospital systems vary in resources and, in particular, the availability of mental health units, including specialized units needed for children with eating disorders. Pediatric hospitalists often encounter children with behavioral needs and play a key role in the advocacy and care for these patients.

Pediatric hospitalists should be able to:

• List chronic neurodevelopmental disorders that may require acute behavioral and/or psychiatric management in the hospital setting, such as global developmental delay or intellectual disability due to varied etiologies, genetic disorders such as Rett syndrome or Down syndrome, neurodevelopmental conditions such as autism spectrum disorders, and others.
• Cite commonly encountered mood disorders (such as depression and anxiety) and chronic psychiatric conditions (such as conduct disorder, oppositional defiant disorder, attention deficit hyperactivity disorder (ADHD), eating disorders, and others).
• Summarize the relationship between mental health conditions (such as autism spectrum disorder, disruptive behavior disorder, anxiety, or depression) and common chronic medical conditions (such as diabetes, cystic fibrosis, sickle cell and others).
• Define disruptive behavior disorders and discuss strategies to mitigate the impact of these on care team members.
• Review the differences between “internalizing” and “externalizing” behaviors.
• Identify underlying triggers for escalating behavioral problems in these patients which are commonly encountered in the hospital setting, such as overstimulation from environmental cues, sleep loss, changes in routine and daily structure, fear of a new environment, and others.
• Describe safety precautions needed for the patient, staff, and the family/caregivers when a patient is agitated or emotionally dysregulated, including awareness of surroundings, objects that can be used for self-harm or harm to others, and others.
• Give examples of behaviors that may manifest from child abuse or neglect in this population, including aggression, withdrawal, and refusal of treatment or care.
• Identify some commonly used evidence-based treatments for different behavioral conditions, such as Applied Behavioral Analysis (behavior modification for autism spectrum disorder), Parent-Child Interaction Therapy (PCIT) (parenting skills training for behavior disorders and trauma), Cognitive Behavioral Therapy (CBT), Exposure therapy, and Dialectical Behavioral Therapy (DBT).
• List indications and possible side effects of medications commonly used in this population, including antidepressants, antipsychotics, psychostimulants, and others.
• Discuss basic characteristics of each of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM)-5 eating disorder diagnoses including anorexia nervosa - restricting type (AN-R), anorexia nervosa - binge-eating/purging type (AN-BP), bulimia nervosa (BN), Avoidant Restrictive Food Intake Disorder (ARFID), and Other Specified Feeding and Eating Disorder (OSFED).
• Cite examples of laboratory testing commonly used to identify organic causes of feeding intolerance, growth delay, and malnutrition.
• State the signs and symptoms of eating disorders that require hospitalization, including hemodynamic instability, bradycardia, and severe malnutrition.
• Give examples of potential maladaptive behaviors that may occur in family members of patients with chronic behavioral and psychiatric conditions, such as maternal or paternal psychopathology, poor parent relationships, and sibling conflicts.
• Review alternative communication modes that may be of value in this population such as drawing, use of symbols, sign language, photos, and computers.
• Identify examples of secondary gain underlying behavioral problems for some children, including school or home avoidance.
• Summarize medical and mental health care treatment needed for this population after hospital discharge, including access to mental health providers, residential or partial hospitalization programs, and coordination of care with the medical home.

Pediatric hospitalists should be able to:

• Utilize locally available screening tools to identify patients with potential for behavioral and psychiatric disorders.
• Identify adverse drug events related to medications used for behavioral health conditions.
• Order appropriate monitoring, medications, and treatments to prevent or manage escalation of chronic maladaptive behaviors.
• Coordinate care, with patients, the family/caregivers, and healthcare providers to ensure a safe environment for the child within the hospital setting, with attention to elective admission, procedures, and surgical events.
• Consult, collaborate with, and/or coordinate an interdisciplinary team in the management of this population, including child life, social work, psychology, psychiatry, rehabilitation medicine, physical therapy, occupational therapy, speech therapy, and others within local context.
• Diagnose conditions with both medical and behavioral/psychiatric components and create an effective, safe, and integrated management plan to address each.
• Consult other subspecialists and appropriately refer or coordinate transfer of patients.
• Identify patients who may benefit from evidence-based testing, such as imaging, genetic testing, hormonal testing, and others, and initiate orders as appropriate.
• Demonstrate the use of physical exam and communication skills that are appropriate for the patients’ cognitive and developmental abilities.
• Deliver care that is consistent and effective using behavioral and communication skills to support positive behavior choices.
• Identify the potential for and manage aggressive or maladaptive behavior using environmental, behavioral, and medication modalities as appropriate.
• Order and interpret common data including intake, output, vital signs, sleep habits, and nutritional needs for this population, and make care plan changes to address concerns.
• Create a comprehensive discharge plan in coordination with the patient, the family/caregivers, primary care provider, mental health providers, residential or partial hospitalization programs, and others.
• Provide support and empathy for health care providers and hospital staff facing challenging behaviors.

Pediatric hospitalists should be able to:

• Reflect on the importance of maintaining respect and compassion when speaking with and caring for this population.
• Role model professionalism by exemplifying patience and creating a positive therapeutic environment for patients, the family/caregivers, colleagues, and hospital staff.
• Recognize that care plans may need to be adapted to accommodate a child’s changing medical and behavioral needs.
• Realize that eating disorders occur in all genders, cultures, ethnicities, and socioeconomic classes.
• Reflect on the importance of education and advocacy for the population of patients with eating disorders, noting that eating disorders are mental health disorders with physiological manifestations.
• Recognize that children with neurodevelopmental disorders and disruptive behavioral disorders are at higher risk for abuse.
• Reflect on the value of acquiring and utilizing coping skills for patients, the family/caregivers, colleagues, hospital staff, and self.

In order to improve efficiency and quality within their organization, pediatric hospitalists should:

• Work with hospital administration to develop and implement training for healthcare providers, hospital staff, and trainees around the approach toward care for this population.
• Work with hospital administration to develop and provide a safe and non-judgmental environment of care for this population.
• Collaborate with healthcare providers and hospital staff to determine roles and responsibilities that optimize each member’s strengths and training when managing patient behaviors.
• Collaborate with hospital administration and community partners to develop and sustain referral networks for family members to appropriate community resources, including respite care, social services, and therapy.
• Lead, coordinate, or participate in organizational efforts to educate community providers on recognition of and criteria for hospitalization for children with eating disorders.