Hospital Medicine

Introduction

There is a growing body of evidence which shows that optimal nutrition improves outcomes in hospitalized children. Malnutrition refers to any disorder of nutritional status resulting from a deficiency or excess of nutrient intake, imbalance of essential nutrients, or impaired nutrient metabolism. Malnutrition occurs in up to half of hospitalized children in the United States but varies considerably by age and disease state. Malnutrition in hospitalized children is a risk factor for unfavorable clinical outcome, prolonged hospital stays, delayed recovery, and increased care costs. An understanding of the fundamental nutritional requirements of pediatric patients is essential to providing optimal care for hospitalized children. Pediatric hospitalists must be able to reliably perform objective nutritional assessments and manage frequently encountered nutritional problems. They are in an optimal position to detect disorders of nutrition and improve the nutritional status of hospitalized pediatric patients.

Pediatric hospitalists should be able to:

• Describe the normal growth patterns for children at various ages and the potential effect of malnutrition on growth.
• Describe the anthropometric measurements commonly used to assess acute and chronic nutritional status.
• Describe the basic nutritional requirements for hospitalized pediatric patients, based on gestational age, chronologic age, weight, activity level, and other characteristics.
• Compare and contrast the composition of human milk versus commonly used commercial formulas and explain why human milk is superior nutrition for infants.
• Describe the differences in composition of and clinical indications for commonly used commercial formulas, as well as protein hydrolysate and other specialty formulas.
• Compare and contrast the benefits and costs of blended foods versus commonly used enteral formulas as complete nutritional sources for children receiving gastric, duodenal, or jejunal tube feedings.
• List the indications for specific vitamin and mineral supplementation, including exclusive breastfeeding in infants less than 6 months, infants consuming less than 27 ounces of formula per day, chronic anti-epileptic therapy, food allergies resulting in extreme dietary restrictions, and others.
• List the factors that place hospitalized pediatric patients at risk for poor nutrition.
• Compare and contrast marasmus and kwashiorkor.
• Define the term protein-calorie malnutrition.
• List the signs and symptoms of common vitamin and mineral deficiencies including iron, calcium, zinc, and Vitamin D.
• Compare and contrast commonly encountered nutritional needs and risks between different types of eating disorders, including anorexia nervosa, bulimia nervosa, rumination, and Avoidant/Restrictive Food Intake Disorder (ARFID).
• Discuss the indications and contraindications for both enteral and parenteral nutrition and describe the complications associated with each.
• Describe the monitoring needs for pediatric patients on chronic enteral or parenteral nutrition, attending to electrolyte and mineral disturbances, growth, and other parameters.
• Discuss refeeding syndrome, the risk factors associated with its development, and the treatment for its most common manifestations.
• Explain the importance of nutrition screening, as well as the indications for consultation with a register dietician, gastroenterologist, mental health professional, or other subspecialist.
• Discuss the maintenance and supplemental needs of patients with commonly encountered metabolic/mitochondrial disorders and inborn errors of metabolism, including Galactosemia, Phenylketonuria, Maple Syrup Urine Disease, and Hereditary Fructose Intolerance.

Pediatric hospitalists should be able to:

• Assess and utilize anthropometric data to determine the presence, degree, and chronicity of malnutrition.
• Perform a focused history and physical examination, attending to details that may indicate a particular nutrient, vitamin, or mineral deficiency.
• Conduct a directed laboratory evaluation to obtain information about nutritional status and vitamin or mineral deficiencies, as indicated.
• Determine the basic caloric, protein, fat, and fluid requirements for hospitalized pediatric patients, for both maintenance needs and catch up growth.
• Provide educational and clinical staff support for lactating mothers, including those having trouble initiating or maintaining breastfeeding or milk supply or those with a breastfeeding complication, including nipple pain or compression, poor milk transfer, low supply, plugged ducts, or mastitis.
• Choose an appropriate formula, delivery device, and method of administration when enteral nutrition is required.
• Emphasize the importance of using enteral nutrition over the parenteral route whenever possible.
• Initiate and advance parenteral nutrition using the appropriate initial composition of parenteral nutrition solution, delivery device, and method of administration when required.
• Appropriately monitor laboratory values to ensure the efficacy of supplemental nutrition support and to screen for complications.
• Identify and treat complications of both enteral and parenteral nutrition, such as metabolic derangements, infection, and delivery device malfunction.
• Identify the signs of and effectively treat refeeding syndrome.
• Identify, treat, and/or consult appropriate specialties and services for children with eating disorders.
• Engage consultants, including registered dieticians, lactation, gastroenterologists, mental health professionals, and other subspecialists as indicated.
• Arrange an effective and safe transition of care from inpatient to outpatient providers, preserving the multidisciplinary nature of the nutrition care team when appropriate.
• Collaborate with the primary care provider and subspecialists to ensure coordinated, longitudinal care for children requiring specialized nutrition support.

Pediatric hospitalists should be able to:

• Realize the importance of screening for malnutrition and optimizing nutritional status for hospitalized pediatric patients.
• Reflect on the value of effective communication with patients, the family/caregivers, and healthcare providers regarding the role of adequate nutrition in achieving optimal clinical outcomes.
• Acknowledge the importance of collaboration with registered dieticians and subspecialists to devise and implement a nutrition care plan.

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

• Lead, coordinate, or participate in efforts to develop systems that support the initiation and maintenance of breastfeeding for infants.
• Collaborate with hospital administration, hospital staff, subspecialists, and other services/consultants to promote prompt nutritional screening for all hospitalized patients and multidisciplinary team care to address nutritional problems when identified.
• Lead, coordinate, or participate in the development and implementation of cost-effective, evidence-based care pathways to standardize the evaluation and management of nutritional issues in hospitalized children.

Introduction

There is a growing body of evidence which shows that optimal nutrition improves outcomes in hospitalized children. Malnutrition refers to any disorder of nutritional status resulting from a deficiency or excess of nutrient intake, imbalance of essential nutrients, or impaired nutrient metabolism. Malnutrition occurs in up to half of hospitalized children in the United States but varies considerably by age and disease state. Malnutrition in hospitalized children is a risk factor for unfavorable clinical outcome, prolonged hospital stays, delayed recovery, and increased care costs. An understanding of the fundamental nutritional requirements of pediatric patients is essential to providing optimal care for hospitalized children. Pediatric hospitalists must be able to reliably perform objective nutritional assessments and manage frequently encountered nutritional problems. They are in an optimal position to detect disorders of nutrition and improve the nutritional status of hospitalized pediatric patients.

Pediatric hospitalists should be able to:

• Describe the normal growth patterns for children at various ages and the potential effect of malnutrition on growth.
• Describe the anthropometric measurements commonly used to assess acute and chronic nutritional status.
• Describe the basic nutritional requirements for hospitalized pediatric patients, based on gestational age, chronologic age, weight, activity level, and other characteristics.
• Compare and contrast the composition of human milk versus commonly used commercial formulas and explain why human milk is superior nutrition for infants.
• Describe the differences in composition of and clinical indications for commonly used commercial formulas, as well as protein hydrolysate and other specialty formulas.
• Compare and contrast the benefits and costs of blended foods versus commonly used enteral formulas as complete nutritional sources for children receiving gastric, duodenal, or jejunal tube feedings.
• List the indications for specific vitamin and mineral supplementation, including exclusive breastfeeding in infants less than 6 months, infants consuming less than 27 ounces of formula per day, chronic anti-epileptic therapy, food allergies resulting in extreme dietary restrictions, and others.
• List the factors that place hospitalized pediatric patients at risk for poor nutrition.
• Compare and contrast marasmus and kwashiorkor.
• Define the term protein-calorie malnutrition.
• List the signs and symptoms of common vitamin and mineral deficiencies including iron, calcium, zinc, and Vitamin D.
• Compare and contrast commonly encountered nutritional needs and risks between different types of eating disorders, including anorexia nervosa, bulimia nervosa, rumination, and Avoidant/Restrictive Food Intake Disorder (ARFID).
• Discuss the indications and contraindications for both enteral and parenteral nutrition and describe the complications associated with each.
• Describe the monitoring needs for pediatric patients on chronic enteral or parenteral nutrition, attending to electrolyte and mineral disturbances, growth, and other parameters.
• Discuss refeeding syndrome, the risk factors associated with its development, and the treatment for its most common manifestations.
• Explain the importance of nutrition screening, as well as the indications for consultation with a register dietician, gastroenterologist, mental health professional, or other subspecialist.
• Discuss the maintenance and supplemental needs of patients with commonly encountered metabolic/mitochondrial disorders and inborn errors of metabolism, including Galactosemia, Phenylketonuria, Maple Syrup Urine Disease, and Hereditary Fructose Intolerance.

Pediatric hospitalists should be able to:

• Assess and utilize anthropometric data to determine the presence, degree, and chronicity of malnutrition.
• Perform a focused history and physical examination, attending to details that may indicate a particular nutrient, vitamin, or mineral deficiency.
• Conduct a directed laboratory evaluation to obtain information about nutritional status and vitamin or mineral deficiencies, as indicated.
• Determine the basic caloric, protein, fat, and fluid requirements for hospitalized pediatric patients, for both maintenance needs and catch up growth.
• Provide educational and clinical staff support for lactating mothers, including those having trouble initiating or maintaining breastfeeding or milk supply or those with a breastfeeding complication, including nipple pain or compression, poor milk transfer, low supply, plugged ducts, or mastitis.
• Choose an appropriate formula, delivery device, and method of administration when enteral nutrition is required.
• Emphasize the importance of using enteral nutrition over the parenteral route whenever possible.
• Initiate and advance parenteral nutrition using the appropriate initial composition of parenteral nutrition solution, delivery device, and method of administration when required.
• Appropriately monitor laboratory values to ensure the efficacy of supplemental nutrition support and to screen for complications.
• Identify and treat complications of both enteral and parenteral nutrition, such as metabolic derangements, infection, and delivery device malfunction.
• Identify the signs of and effectively treat refeeding syndrome.
• Identify, treat, and/or consult appropriate specialties and services for children with eating disorders.
• Engage consultants, including registered dieticians, lactation, gastroenterologists, mental health professionals, and other subspecialists as indicated.
• Arrange an effective and safe transition of care from inpatient to outpatient providers, preserving the multidisciplinary nature of the nutrition care team when appropriate.
• Collaborate with the primary care provider and subspecialists to ensure coordinated, longitudinal care for children requiring specialized nutrition support.

Pediatric hospitalists should be able to:

• Realize the importance of screening for malnutrition and optimizing nutritional status for hospitalized pediatric patients.
• Reflect on the value of effective communication with patients, the family/caregivers, and healthcare providers regarding the role of adequate nutrition in achieving optimal clinical outcomes.
• Acknowledge the importance of collaboration with registered dieticians and subspecialists to devise and implement a nutrition care plan.

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

• Lead, coordinate, or participate in efforts to develop systems that support the initiation and maintenance of breastfeeding for infants.
• Collaborate with hospital administration, hospital staff, subspecialists, and other services/consultants to promote prompt nutritional screening for all hospitalized patients and multidisciplinary team care to address nutritional problems when identified.
• Lead, coordinate, or participate in the development and implementation of cost-effective, evidence-based care pathways to standardize the evaluation and management of nutritional issues in hospitalized children.

Introduction

There is a growing body of evidence which shows that optimal nutrition improves outcomes in hospitalized children. Malnutrition refers to any disorder of nutritional status resulting from a deficiency or excess of nutrient intake, imbalance of essential nutrients, or impaired nutrient metabolism. Malnutrition occurs in up to half of hospitalized children in the United States but varies considerably by age and disease state. Malnutrition in hospitalized children is a risk factor for unfavorable clinical outcome, prolonged hospital stays, delayed recovery, and increased care costs. An understanding of the fundamental nutritional requirements of pediatric patients is essential to providing optimal care for hospitalized children. Pediatric hospitalists must be able to reliably perform objective nutritional assessments and manage frequently encountered nutritional problems. They are in an optimal position to detect disorders of nutrition and improve the nutritional status of hospitalized pediatric patients.

Pediatric hospitalists should be able to:

• Describe the normal growth patterns for children at various ages and the potential effect of malnutrition on growth.
• Describe the anthropometric measurements commonly used to assess acute and chronic nutritional status.
• Describe the basic nutritional requirements for hospitalized pediatric patients, based on gestational age, chronologic age, weight, activity level, and other characteristics.
• Compare and contrast the composition of human milk versus commonly used commercial formulas and explain why human milk is superior nutrition for infants.
• Describe the differences in composition of and clinical indications for commonly used commercial formulas, as well as protein hydrolysate and other specialty formulas.
• Compare and contrast the benefits and costs of blended foods versus commonly used enteral formulas as complete nutritional sources for children receiving gastric, duodenal, or jejunal tube feedings.
• List the indications for specific vitamin and mineral supplementation, including exclusive breastfeeding in infants less than 6 months, infants consuming less than 27 ounces of formula per day, chronic anti-epileptic therapy, food allergies resulting in extreme dietary restrictions, and others.
• List the factors that place hospitalized pediatric patients at risk for poor nutrition.
• Compare and contrast marasmus and kwashiorkor.
• Define the term protein-calorie malnutrition.
• List the signs and symptoms of common vitamin and mineral deficiencies including iron, calcium, zinc, and Vitamin D.
• Compare and contrast commonly encountered nutritional needs and risks between different types of eating disorders, including anorexia nervosa, bulimia nervosa, rumination, and Avoidant/Restrictive Food Intake Disorder (ARFID).
• Discuss the indications and contraindications for both enteral and parenteral nutrition and describe the complications associated with each.
• Describe the monitoring needs for pediatric patients on chronic enteral or parenteral nutrition, attending to electrolyte and mineral disturbances, growth, and other parameters.
• Discuss refeeding syndrome, the risk factors associated with its development, and the treatment for its most common manifestations.
• Explain the importance of nutrition screening, as well as the indications for consultation with a register dietician, gastroenterologist, mental health professional, or other subspecialist.
• Discuss the maintenance and supplemental needs of patients with commonly encountered metabolic/mitochondrial disorders and inborn errors of metabolism, including Galactosemia, Phenylketonuria, Maple Syrup Urine Disease, and Hereditary Fructose Intolerance.

Pediatric hospitalists should be able to:

• Assess and utilize anthropometric data to determine the presence, degree, and chronicity of malnutrition.
• Perform a focused history and physical examination, attending to details that may indicate a particular nutrient, vitamin, or mineral deficiency.
• Conduct a directed laboratory evaluation to obtain information about nutritional status and vitamin or mineral deficiencies, as indicated.
• Determine the basic caloric, protein, fat, and fluid requirements for hospitalized pediatric patients, for both maintenance needs and catch up growth.
• Provide educational and clinical staff support for lactating mothers, including those having trouble initiating or maintaining breastfeeding or milk supply or those with a breastfeeding complication, including nipple pain or compression, poor milk transfer, low supply, plugged ducts, or mastitis.
• Choose an appropriate formula, delivery device, and method of administration when enteral nutrition is required.
• Emphasize the importance of using enteral nutrition over the parenteral route whenever possible.
• Initiate and advance parenteral nutrition using the appropriate initial composition of parenteral nutrition solution, delivery device, and method of administration when required.
• Appropriately monitor laboratory values to ensure the efficacy of supplemental nutrition support and to screen for complications.
• Identify and treat complications of both enteral and parenteral nutrition, such as metabolic derangements, infection, and delivery device malfunction.
• Identify the signs of and effectively treat refeeding syndrome.
• Identify, treat, and/or consult appropriate specialties and services for children with eating disorders.
• Engage consultants, including registered dieticians, lactation, gastroenterologists, mental health professionals, and other subspecialists as indicated.
• Arrange an effective and safe transition of care from inpatient to outpatient providers, preserving the multidisciplinary nature of the nutrition care team when appropriate.
• Collaborate with the primary care provider and subspecialists to ensure coordinated, longitudinal care for children requiring specialized nutrition support.

Pediatric hospitalists should be able to:

• Realize the importance of screening for malnutrition and optimizing nutritional status for hospitalized pediatric patients.
• Reflect on the value of effective communication with patients, the family/caregivers, and healthcare providers regarding the role of adequate nutrition in achieving optimal clinical outcomes.
• Acknowledge the importance of collaboration with registered dieticians and subspecialists to devise and implement a nutrition care plan.

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

• Lead, coordinate, or participate in efforts to develop systems that support the initiation and maintenance of breastfeeding for infants.
• Collaborate with hospital administration, hospital staff, subspecialists, and other services/consultants to promote prompt nutritional screening for all hospitalized patients and multidisciplinary team care to address nutritional problems when identified.
• Lead, coordinate, or participate in the development and implementation of cost-effective, evidence-based care pathways to standardize the evaluation and management of nutritional issues in hospitalized children.

Introduction

Noninvasive monitoring provides objective data that, when coupled with clinical assessments, is helpful in making therapeutic and diagnostic decisions. Knowledge of noninvasive monitoring techniques is necessary for accurate interpretation of the data generated. While the appropriate use of noninvasive monitoring is not controversial, there is increasing recognition of the importance of being selective in choosing the correct type and level of monitoring. Indiscriminant monitoring can lead to alarm fatigue, medical errors, patient harm, and may unnecessarily prolong the length of the hospitalization. Consequently, pediatric hospitalists should understand the various types of noninvasive monitoring techniques available, as well as the indications for and limitations of each.

Pediatric hospitalists should be able to:

• List the different types of noninvasive monitoring available and describe the indications for each.
• Compare and contrast the types and level of monitoring available on the inpatient ward compared to the intensive care unit or other care settings, attending to local context.
• Describe the proper procedures for common noninvasive monitoring techniques, including vital sign measurement, cardiopulmonary monitoring, pulse oximetry, capnography, and cardiac telemetry.
• List the limitations or complications associated with common noninvasive monitoring techniques, such as inadequate waveform for pulse oximetry.
• Compare and contrast the indications for cardiopulmonary monitoring and cardiac telemetry.
• Discuss the importance of accurate and timely interpretation of information generated by monitoring devices, as well as the importance of an immediate response when abnormal data is noted.
• Compare and contrast patients who need ongoing monitoring versus discontinuation of monitoring based on clinical course and established evidence when available.

Pediatric hospitalists should be able to:

• Select the type and level of monitoring needed based on the clinical situation and medical complexity of the patient in order to provide necessary data while limiting false alarms.
• Identify the need for a higher or lower level of monitoring as changes in the clinical status occur, including when transfers between clinical settings are indicated as a result.
• Ensure proper placement of monitoring equipment and execution of proper technique (including manual blood pressure measurement), in order to obtain accurate data.
• Interpret monitor data and respond with appropriate actions.

Pediatric hospitalists should be able to:

• Recognize that not all patients require intense monitoring and promote the judicious use of monitoring based on clinical assessments of patients.
• Recognize the importance of effective communication with patients and the family/caregivers regarding the use or discontinuation of noninvasive monitoring and how it relates to the care plan.
• Acknowledge the value of collaboration with nurses, respiratory therapists, subspecialists, and other healthcare providers to determine the appropriate level of monitoring and the corresponding care setting, especially when clinical changes occur.

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

• Lead, coordinate, and participate in the development and implementation of cost-effective, safe, evidence-based procedures and policies related to noninvasive monitoring, including implementation of strategies to limit alarm fatigue.
• Work with hospital administration, biomedical engineering, and others to obtain high quality and reliable monitoring equipment.
• Lead, coordinate, or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction with monitoring strategies.

Introduction

Noninvasive monitoring provides objective data that, when coupled with clinical assessments, is helpful in making therapeutic and diagnostic decisions. Knowledge of noninvasive monitoring techniques is necessary for accurate interpretation of the data generated. While the appropriate use of noninvasive monitoring is not controversial, there is increasing recognition of the importance of being selective in choosing the correct type and level of monitoring. Indiscriminant monitoring can lead to alarm fatigue, medical errors, patient harm, and may unnecessarily prolong the length of the hospitalization. Consequently, pediatric hospitalists should understand the various types of noninvasive monitoring techniques available, as well as the indications for and limitations of each.

Pediatric hospitalists should be able to:

• List the different types of noninvasive monitoring available and describe the indications for each.
• Compare and contrast the types and level of monitoring available on the inpatient ward compared to the intensive care unit or other care settings, attending to local context.
• Describe the proper procedures for common noninvasive monitoring techniques, including vital sign measurement, cardiopulmonary monitoring, pulse oximetry, capnography, and cardiac telemetry.
• List the limitations or complications associated with common noninvasive monitoring techniques, such as inadequate waveform for pulse oximetry.
• Compare and contrast the indications for cardiopulmonary monitoring and cardiac telemetry.
• Discuss the importance of accurate and timely interpretation of information generated by monitoring devices, as well as the importance of an immediate response when abnormal data is noted.
• Compare and contrast patients who need ongoing monitoring versus discontinuation of monitoring based on clinical course and established evidence when available.

Pediatric hospitalists should be able to:

• Select the type and level of monitoring needed based on the clinical situation and medical complexity of the patient in order to provide necessary data while limiting false alarms.
• Identify the need for a higher or lower level of monitoring as changes in the clinical status occur, including when transfers between clinical settings are indicated as a result.
• Ensure proper placement of monitoring equipment and execution of proper technique (including manual blood pressure measurement), in order to obtain accurate data.
• Interpret monitor data and respond with appropriate actions.

Pediatric hospitalists should be able to:

• Recognize that not all patients require intense monitoring and promote the judicious use of monitoring based on clinical assessments of patients.
• Recognize the importance of effective communication with patients and the family/caregivers regarding the use or discontinuation of noninvasive monitoring and how it relates to the care plan.
• Acknowledge the value of collaboration with nurses, respiratory therapists, subspecialists, and other healthcare providers to determine the appropriate level of monitoring and the corresponding care setting, especially when clinical changes occur.

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

• Lead, coordinate, and participate in the development and implementation of cost-effective, safe, evidence-based procedures and policies related to noninvasive monitoring, including implementation of strategies to limit alarm fatigue.
• Work with hospital administration, biomedical engineering, and others to obtain high quality and reliable monitoring equipment.
• Lead, coordinate, or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction with monitoring strategies.

Introduction

Noninvasive monitoring provides objective data that, when coupled with clinical assessments, is helpful in making therapeutic and diagnostic decisions. Knowledge of noninvasive monitoring techniques is necessary for accurate interpretation of the data generated. While the appropriate use of noninvasive monitoring is not controversial, there is increasing recognition of the importance of being selective in choosing the correct type and level of monitoring. Indiscriminant monitoring can lead to alarm fatigue, medical errors, patient harm, and may unnecessarily prolong the length of the hospitalization. Consequently, pediatric hospitalists should understand the various types of noninvasive monitoring techniques available, as well as the indications for and limitations of each.

Pediatric hospitalists should be able to:

• List the different types of noninvasive monitoring available and describe the indications for each.
• Compare and contrast the types and level of monitoring available on the inpatient ward compared to the intensive care unit or other care settings, attending to local context.
• Describe the proper procedures for common noninvasive monitoring techniques, including vital sign measurement, cardiopulmonary monitoring, pulse oximetry, capnography, and cardiac telemetry.
• List the limitations or complications associated with common noninvasive monitoring techniques, such as inadequate waveform for pulse oximetry.
• Compare and contrast the indications for cardiopulmonary monitoring and cardiac telemetry.
• Discuss the importance of accurate and timely interpretation of information generated by monitoring devices, as well as the importance of an immediate response when abnormal data is noted.
• Compare and contrast patients who need ongoing monitoring versus discontinuation of monitoring based on clinical course and established evidence when available.

Pediatric hospitalists should be able to:

• Select the type and level of monitoring needed based on the clinical situation and medical complexity of the patient in order to provide necessary data while limiting false alarms.
• Identify the need for a higher or lower level of monitoring as changes in the clinical status occur, including when transfers between clinical settings are indicated as a result.
• Ensure proper placement of monitoring equipment and execution of proper technique (including manual blood pressure measurement), in order to obtain accurate data.
• Interpret monitor data and respond with appropriate actions.

Pediatric hospitalists should be able to:

• Recognize that not all patients require intense monitoring and promote the judicious use of monitoring based on clinical assessments of patients.
• Recognize the importance of effective communication with patients and the family/caregivers regarding the use or discontinuation of noninvasive monitoring and how it relates to the care plan.
• Acknowledge the value of collaboration with nurses, respiratory therapists, subspecialists, and other healthcare providers to determine the appropriate level of monitoring and the corresponding care setting, especially when clinical changes occur.

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

• Lead, coordinate, and participate in the development and implementation of cost-effective, safe, evidence-based procedures and policies related to noninvasive monitoring, including implementation of strategies to limit alarm fatigue.
• Work with hospital administration, biomedical engineering, and others to obtain high quality and reliable monitoring equipment.
• Lead, coordinate, or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction with monitoring strategies.

Introduction

Lumbar puncture (also called “spinal tap”) is a common procedure that involves obtaining cerebral spinal fluid via needle from the spinal canal. It is generally performed for diagnostic purposes, most often to assess for central nervous system infections, including meningitis. Other indications include the evaluation of idiopathic intracranial hypertension (IIH), altered mental status or neurologic deterioration, subarachnoid hemorrhage, and demyelinating diseases such as Guillain Barré. Lumbar puncture may also be performed for therapeutic purposes, including management of IIH or administration of intrathecal medications. A lumbar puncture often elicits great concern from both patients and the family/caregivers due to concerns of pain and a misunderstanding of risk to the spinal cord. Adequate discussion with patients and the family/caregivers and appropriate use of topical anesthesia, anxiolysis, or sedation can create the environment needed for a successful procedure. Pediatric hospitalists frequently encounter patients requiring lumbar puncture and should be adept at performing lumbar puncture in all appropriately selected pediatric patients.

Pediatric hospitalists should be able to:

• List the indications for lumbar puncture, such as confirmation of pleocytosis or pathogen, therapeutic removal of fluid, assessment of response to treatment, performance of neurometabolic studies, and others.
• Review the basic anatomy of the spine and spinal column.
• List the indications for obtaining an imaging study of the brain or spinal cord prior to performing a lumbar puncture.
• Describe the relative contraindications to lumbar puncture, such as pre-existing ventriculoperitoneal shunt, previous spinal surgeries, and others, and discuss the options for safely obtaining cerebrospinal fluid in these patients.
• List the absolute contraindications to lumbar puncture, such as increased intracranial pressure, unstable cardiorespiratory status, unstable coagulopathies, and others.
• Describe the risks and complications of lumbar puncture attending to infection, bleeding, nerve injury, pain, post-procedure headache, and others.
• Summarize factors that may increase risk for complications, including age, disease process, and anatomy.
• Review the steps in performing a lumbar puncture, attending to aspects such as infection control, patient identification, positioning options, monitoring, presence of the family/caregivers, and others.
• Discuss the roles of each member of the healthcare team during lumbar puncture, attending to responsibility for performing proper level of monitoring to maximize safety, timeout, documentation, specimen labeling and transport to the laboratory, and communication with patients and the family/caregivers.

Pediatric hospitalists should be able to:

• Perform a pre-procedural evaluation to determine risks and benefits of lumbar puncture.
• Obtain informed consent from the family/caregivers.
• Order and ensure proper performance of procedural sedation if indicated, including assurance of adequate staff presence for both the lumbar puncture and the sedation.
• Demonstrate proficiency in performance of lumbar puncture on infants, children, and adolescents.
• Identify the need for and efficiently offer education to healthcare providers on proper techniques for holding and calming patients before, during, and after lumbar puncture attempts.
• Adhere to infection control practices.
• Order appropriate monitoring and correctly interpret monitor data.
• Identify complications and respond with appropriate actions.
• Use the pressure manometer as appropriate.
• Identify the need for and efficiently access appropriate consultants and support services for assistance with pain management, sedation, and performance of a lumbar puncture, as indicated.

Pediatric hospitalists should be able to:

• Appreciate the importance of working collaboratively with hospital staff and subspecialists to ensure coordinated planning and performance of lumbar punctures.
• Realize the importance of effective communication with patients and the family/caregivers regarding the indications for, risks, benefits, and steps of the procedure.
• Role model and advocate for strict adherence to infection control practices.

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

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based procedures and policies for performance of lumbar punctures for children.
• Work with hospital administration, hospital staff, and others to develop and implement standardized documentation tools for the procedure.
• Lead, coordinate, or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction into procedural strategies.
• Lead, coordinate, or participate in the development and implementation of educational initiatives designed to teach the proper technique for lumbar puncture to trainees and other healthcare providers.

Introduction

Lumbar puncture (also called “spinal tap”) is a common procedure that involves obtaining cerebral spinal fluid via needle from the spinal canal. It is generally performed for diagnostic purposes, most often to assess for central nervous system infections, including meningitis. Other indications include the evaluation of idiopathic intracranial hypertension (IIH), altered mental status or neurologic deterioration, subarachnoid hemorrhage, and demyelinating diseases such as Guillain Barré. Lumbar puncture may also be performed for therapeutic purposes, including management of IIH or administration of intrathecal medications. A lumbar puncture often elicits great concern from both patients and the family/caregivers due to concerns of pain and a misunderstanding of risk to the spinal cord. Adequate discussion with patients and the family/caregivers and appropriate use of topical anesthesia, anxiolysis, or sedation can create the environment needed for a successful procedure. Pediatric hospitalists frequently encounter patients requiring lumbar puncture and should be adept at performing lumbar puncture in all appropriately selected pediatric patients.

Pediatric hospitalists should be able to:

• List the indications for lumbar puncture, such as confirmation of pleocytosis or pathogen, therapeutic removal of fluid, assessment of response to treatment, performance of neurometabolic studies, and others.
• Review the basic anatomy of the spine and spinal column.
• List the indications for obtaining an imaging study of the brain or spinal cord prior to performing a lumbar puncture.
• Describe the relative contraindications to lumbar puncture, such as pre-existing ventriculoperitoneal shunt, previous spinal surgeries, and others, and discuss the options for safely obtaining cerebrospinal fluid in these patients.
• List the absolute contraindications to lumbar puncture, such as increased intracranial pressure, unstable cardiorespiratory status, unstable coagulopathies, and others.
• Describe the risks and complications of lumbar puncture attending to infection, bleeding, nerve injury, pain, post-procedure headache, and others.
• Summarize factors that may increase risk for complications, including age, disease process, and anatomy.
• Review the steps in performing a lumbar puncture, attending to aspects such as infection control, patient identification, positioning options, monitoring, presence of the family/caregivers, and others.
• Discuss the roles of each member of the healthcare team during lumbar puncture, attending to responsibility for performing proper level of monitoring to maximize safety, timeout, documentation, specimen labeling and transport to the laboratory, and communication with patients and the family/caregivers.

Pediatric hospitalists should be able to:

• Perform a pre-procedural evaluation to determine risks and benefits of lumbar puncture.
• Obtain informed consent from the family/caregivers.
• Order and ensure proper performance of procedural sedation if indicated, including assurance of adequate staff presence for both the lumbar puncture and the sedation.
• Demonstrate proficiency in performance of lumbar puncture on infants, children, and adolescents.
• Identify the need for and efficiently offer education to healthcare providers on proper techniques for holding and calming patients before, during, and after lumbar puncture attempts.
• Adhere to infection control practices.
• Order appropriate monitoring and correctly interpret monitor data.
• Identify complications and respond with appropriate actions.
• Use the pressure manometer as appropriate.
• Identify the need for and efficiently access appropriate consultants and support services for assistance with pain management, sedation, and performance of a lumbar puncture, as indicated.

Pediatric hospitalists should be able to:

• Appreciate the importance of working collaboratively with hospital staff and subspecialists to ensure coordinated planning and performance of lumbar punctures.
• Realize the importance of effective communication with patients and the family/caregivers regarding the indications for, risks, benefits, and steps of the procedure.
• Role model and advocate for strict adherence to infection control practices.

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

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based procedures and policies for performance of lumbar punctures for children.
• Work with hospital administration, hospital staff, and others to develop and implement standardized documentation tools for the procedure.
• Lead, coordinate, or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction into procedural strategies.
• Lead, coordinate, or participate in the development and implementation of educational initiatives designed to teach the proper technique for lumbar puncture to trainees and other healthcare providers.

Introduction

Lumbar puncture (also called “spinal tap”) is a common procedure that involves obtaining cerebral spinal fluid via needle from the spinal canal. It is generally performed for diagnostic purposes, most often to assess for central nervous system infections, including meningitis. Other indications include the evaluation of idiopathic intracranial hypertension (IIH), altered mental status or neurologic deterioration, subarachnoid hemorrhage, and demyelinating diseases such as Guillain Barré. Lumbar puncture may also be performed for therapeutic purposes, including management of IIH or administration of intrathecal medications. A lumbar puncture often elicits great concern from both patients and the family/caregivers due to concerns of pain and a misunderstanding of risk to the spinal cord. Adequate discussion with patients and the family/caregivers and appropriate use of topical anesthesia, anxiolysis, or sedation can create the environment needed for a successful procedure. Pediatric hospitalists frequently encounter patients requiring lumbar puncture and should be adept at performing lumbar puncture in all appropriately selected pediatric patients.

Pediatric hospitalists should be able to:

• List the indications for lumbar puncture, such as confirmation of pleocytosis or pathogen, therapeutic removal of fluid, assessment of response to treatment, performance of neurometabolic studies, and others.
• Review the basic anatomy of the spine and spinal column.
• List the indications for obtaining an imaging study of the brain or spinal cord prior to performing a lumbar puncture.
• Describe the relative contraindications to lumbar puncture, such as pre-existing ventriculoperitoneal shunt, previous spinal surgeries, and others, and discuss the options for safely obtaining cerebrospinal fluid in these patients.
• List the absolute contraindications to lumbar puncture, such as increased intracranial pressure, unstable cardiorespiratory status, unstable coagulopathies, and others.
• Describe the risks and complications of lumbar puncture attending to infection, bleeding, nerve injury, pain, post-procedure headache, and others.
• Summarize factors that may increase risk for complications, including age, disease process, and anatomy.
• Review the steps in performing a lumbar puncture, attending to aspects such as infection control, patient identification, positioning options, monitoring, presence of the family/caregivers, and others.
• Discuss the roles of each member of the healthcare team during lumbar puncture, attending to responsibility for performing proper level of monitoring to maximize safety, timeout, documentation, specimen labeling and transport to the laboratory, and communication with patients and the family/caregivers.

Pediatric hospitalists should be able to:

• Perform a pre-procedural evaluation to determine risks and benefits of lumbar puncture.
• Obtain informed consent from the family/caregivers.
• Order and ensure proper performance of procedural sedation if indicated, including assurance of adequate staff presence for both the lumbar puncture and the sedation.
• Demonstrate proficiency in performance of lumbar puncture on infants, children, and adolescents.
• Identify the need for and efficiently offer education to healthcare providers on proper techniques for holding and calming patients before, during, and after lumbar puncture attempts.
• Adhere to infection control practices.
• Order appropriate monitoring and correctly interpret monitor data.
• Identify complications and respond with appropriate actions.
• Use the pressure manometer as appropriate.
• Identify the need for and efficiently access appropriate consultants and support services for assistance with pain management, sedation, and performance of a lumbar puncture, as indicated.

Pediatric hospitalists should be able to:

• Appreciate the importance of working collaboratively with hospital staff and subspecialists to ensure coordinated planning and performance of lumbar punctures.
• Realize the importance of effective communication with patients and the family/caregivers regarding the indications for, risks, benefits, and steps of the procedure.
• Role model and advocate for strict adherence to infection control practices.

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

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based procedures and policies for performance of lumbar punctures for children.
• Work with hospital administration, hospital staff, and others to develop and implement standardized documentation tools for the procedure.
• Lead, coordinate, or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction into procedural strategies.
• Lead, coordinate, or participate in the development and implementation of educational initiatives designed to teach the proper technique for lumbar puncture to trainees and other healthcare providers.

Introduction

Intravenous (IV) line placement is the most common procedure performed on hospitalized children. Common indications include fluid resuscitation, parenteral medication, or nutrition delivery. Pediatric hospitalists should be knowledgeable about obtaining peripheral IV access in all pediatric patients and IV or intraosseous (IO) access in critically ill patients. Although not a requirement, many pediatric hospitalists may also obtain skills in the placement of central venous catheters and peripherally inserted central catheters (PICC). Pediatric hospitalists may also be called upon to obtain venous and arterial blood samples from pediatric patients. Preparation and counseling of the patient and family/caregivers, along with the appropriate use of pharmacologic and nonpharmacologic anxiolysis and pain control, can create the environment needed for a successful procedure.

Pediatric hospitalists should be able to:

• List the indications for IV access, such as rehydration, resuscitation, parenteral administration of medications or nutrition, and others.
• Compare and contrast the risks and benefits of using peripheral versus central sites for IV access, including indications and complications for each.
• Describe the indications, risks, benefits, and alternatives for PICC placement, including prolonged medication and/or nutrition needs.
• Compare and contrast risks and benefits of PICC versus midline central catheters and appropriate indications for each.
• Describe common complications of both peripheral and central IV access, including infiltration, bleeding, infection, and venous thrombosis.
• State the indications and contraindications for IO access.
• Discuss how factors such as age, disease process, and individual patient anatomy influence the choice of IV site.
• Summarize current literature and national best practices regarding avoidance of catheter-related bloodstream infections.
• Discuss strategies to minimize the number of IV attempts and common complications from multiple IV attempts.
• Describe use of modalities, such as vein-finding illuminators and ultrasound guidance, which can lead to higher rates of procedural success.
• Review the common radiographic modalities used to assess proper PICC placement and function.
• Review the options for procedural pain and sedation management by age and developmental stage, including pharmacologic and nonpharmacologic interventions.
• Review the indications for subspecialty consultation for IV access or blood sampling.
• Describe the contraindications for use of certain venous sites for IV access or phlebotomy (such as hemodialysis catheters, limb with neurovascular compromise, jugular vein with a neighboring ventriculo-peritoneal shunt, and others.)
• List the indications for arterial blood sampling.
• Describe the proper method for and common complications of obtaining venous and arterial blood samples.

Pediatric hospitalists should be able to:

• Perform a pre-procedural evaluation to determine risks and benefits of IV placement.
• Assess the need for and order appropriate pain and sedation medication and nonmedication interventions.
• Demonstrate the ability to obtain IV access on children of all ages via accessing appropriate personnel or safe performance of the procedure, according to local practice parameters.
• Obtain venous and arterial blood sampling (phlebotomy), with and without IV access, via accessing appropriate personnel or safe performance of the procedure, according to local practice parameters.
• Identify proper techniques for holding and calming patients before, during, and after access attempts and educate other healthcare providers in those techniques.
• Adhere to infection control practices.
• Utilize available modalities where available, such as vein-finding illuminators and ultrasound guidance, to achieve higher rates of procedural success.
• Demonstrate proficiency with intraosseous needle placement as evidenced by successful insertion of the IO needle in a simulated mock code situation.
• Identify barriers to efficient, effective IV access and engage subspecialists, including interventional radiology, anesthesiology, and surgery, to assist as appropriate.
• Identify common complications of IVs and blood sampling and respond with appropriate actions.
• Identify and initiate actions to limit unnecessary intravenous access or sampling by using strategies such as batching of lab tests, transition to oral medication, enteral rehydration, discouraging routine daily lab draws, and daily documentation of need for intravenous access.
• Obtain central venous access and PICCs when indicated via accessing appropriate consultants or safe performance of the procedure, according to local practice parameters.
• Demonstrate proficiency in addressing complications associated with peripheral and central lines (such as infiltrations, clots, displacements, and others) by prompt identification of the problem, initiation of indicated therapy, and consultation with appropriate subspecialists as indicated.

Pediatric hospitalists should be able to:

• Exemplify effective communication with patients and the family/caregivers regarding the indications for, and risks, benefits, and steps of the procedure.
• Role model and advocate for safety during procedures, by strict adherence to infection control practices and use of the “time-out for safety” verification process.
• Acknowledge the importance of revising the IV access plan as appropriate given patient and system limitations.
• Recognize the importance of limiting attempts at IV access in young children, with a need for an alternative plan when indicated.

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

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based procedures and policies for IV access, adhering to national guidelines for infection control.
• Collaborate with hospital administration and clinical leaders to ensure adherence to modern procedural sedation and pain control guidelines, including limiting IV access attempts when an alternative plan is clinically feasible.
• Lead, coordinate, or participate in the development and implementation of a system for review of the efficacy, efficiency, and outcomes of intravenous access procedures.
• Lead, coordinate, or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction related to venous access procedures.

Introduction

Intravenous (IV) line placement is the most common procedure performed on hospitalized children. Common indications include fluid resuscitation, parenteral medication, or nutrition delivery. Pediatric hospitalists should be knowledgeable about obtaining peripheral IV access in all pediatric patients and IV or intraosseous (IO) access in critically ill patients. Although not a requirement, many pediatric hospitalists may also obtain skills in the placement of central venous catheters and peripherally inserted central catheters (PICC). Pediatric hospitalists may also be called upon to obtain venous and arterial blood samples from pediatric patients. Preparation and counseling of the patient and family/caregivers, along with the appropriate use of pharmacologic and nonpharmacologic anxiolysis and pain control, can create the environment needed for a successful procedure.

Pediatric hospitalists should be able to:

• List the indications for IV access, such as rehydration, resuscitation, parenteral administration of medications or nutrition, and others.
• Compare and contrast the risks and benefits of using peripheral versus central sites for IV access, including indications and complications for each.
• Describe the indications, risks, benefits, and alternatives for PICC placement, including prolonged medication and/or nutrition needs.
• Compare and contrast risks and benefits of PICC versus midline central catheters and appropriate indications for each.
• Describe common complications of both peripheral and central IV access, including infiltration, bleeding, infection, and venous thrombosis.
• State the indications and contraindications for IO access.
• Discuss how factors such as age, disease process, and individual patient anatomy influence the choice of IV site.
• Summarize current literature and national best practices regarding avoidance of catheter-related bloodstream infections.
• Discuss strategies to minimize the number of IV attempts and common complications from multiple IV attempts.
• Describe use of modalities, such as vein-finding illuminators and ultrasound guidance, which can lead to higher rates of procedural success.
• Review the common radiographic modalities used to assess proper PICC placement and function.
• Review the options for procedural pain and sedation management by age and developmental stage, including pharmacologic and nonpharmacologic interventions.
• Review the indications for subspecialty consultation for IV access or blood sampling.
• Describe the contraindications for use of certain venous sites for IV access or phlebotomy (such as hemodialysis catheters, limb with neurovascular compromise, jugular vein with a neighboring ventriculo-peritoneal shunt, and others.)
• List the indications for arterial blood sampling.
• Describe the proper method for and common complications of obtaining venous and arterial blood samples.

Pediatric hospitalists should be able to:

• Perform a pre-procedural evaluation to determine risks and benefits of IV placement.
• Assess the need for and order appropriate pain and sedation medication and nonmedication interventions.
• Demonstrate the ability to obtain IV access on children of all ages via accessing appropriate personnel or safe performance of the procedure, according to local practice parameters.
• Obtain venous and arterial blood sampling (phlebotomy), with and without IV access, via accessing appropriate personnel or safe performance of the procedure, according to local practice parameters.
• Identify proper techniques for holding and calming patients before, during, and after access attempts and educate other healthcare providers in those techniques.
• Adhere to infection control practices.
• Utilize available modalities where available, such as vein-finding illuminators and ultrasound guidance, to achieve higher rates of procedural success.
• Demonstrate proficiency with intraosseous needle placement as evidenced by successful insertion of the IO needle in a simulated mock code situation.
• Identify barriers to efficient, effective IV access and engage subspecialists, including interventional radiology, anesthesiology, and surgery, to assist as appropriate.
• Identify common complications of IVs and blood sampling and respond with appropriate actions.
• Identify and initiate actions to limit unnecessary intravenous access or sampling by using strategies such as batching of lab tests, transition to oral medication, enteral rehydration, discouraging routine daily lab draws, and daily documentation of need for intravenous access.
• Obtain central venous access and PICCs when indicated via accessing appropriate consultants or safe performance of the procedure, according to local practice parameters.
• Demonstrate proficiency in addressing complications associated with peripheral and central lines (such as infiltrations, clots, displacements, and others) by prompt identification of the problem, initiation of indicated therapy, and consultation with appropriate subspecialists as indicated.

Pediatric hospitalists should be able to:

• Exemplify effective communication with patients and the family/caregivers regarding the indications for, and risks, benefits, and steps of the procedure.
• Role model and advocate for safety during procedures, by strict adherence to infection control practices and use of the “time-out for safety” verification process.
• Acknowledge the importance of revising the IV access plan as appropriate given patient and system limitations.
• Recognize the importance of limiting attempts at IV access in young children, with a need for an alternative plan when indicated.

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

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based procedures and policies for IV access, adhering to national guidelines for infection control.
• Collaborate with hospital administration and clinical leaders to ensure adherence to modern procedural sedation and pain control guidelines, including limiting IV access attempts when an alternative plan is clinically feasible.
• Lead, coordinate, or participate in the development and implementation of a system for review of the efficacy, efficiency, and outcomes of intravenous access procedures.
• Lead, coordinate, or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction related to venous access procedures.

Introduction

Intravenous (IV) line placement is the most common procedure performed on hospitalized children. Common indications include fluid resuscitation, parenteral medication, or nutrition delivery. Pediatric hospitalists should be knowledgeable about obtaining peripheral IV access in all pediatric patients and IV or intraosseous (IO) access in critically ill patients. Although not a requirement, many pediatric hospitalists may also obtain skills in the placement of central venous catheters and peripherally inserted central catheters (PICC). Pediatric hospitalists may also be called upon to obtain venous and arterial blood samples from pediatric patients. Preparation and counseling of the patient and family/caregivers, along with the appropriate use of pharmacologic and nonpharmacologic anxiolysis and pain control, can create the environment needed for a successful procedure.

Pediatric hospitalists should be able to:

• List the indications for IV access, such as rehydration, resuscitation, parenteral administration of medications or nutrition, and others.
• Compare and contrast the risks and benefits of using peripheral versus central sites for IV access, including indications and complications for each.
• Describe the indications, risks, benefits, and alternatives for PICC placement, including prolonged medication and/or nutrition needs.
• Compare and contrast risks and benefits of PICC versus midline central catheters and appropriate indications for each.
• Describe common complications of both peripheral and central IV access, including infiltration, bleeding, infection, and venous thrombosis.
• State the indications and contraindications for IO access.
• Discuss how factors such as age, disease process, and individual patient anatomy influence the choice of IV site.
• Summarize current literature and national best practices regarding avoidance of catheter-related bloodstream infections.
• Discuss strategies to minimize the number of IV attempts and common complications from multiple IV attempts.
• Describe use of modalities, such as vein-finding illuminators and ultrasound guidance, which can lead to higher rates of procedural success.
• Review the common radiographic modalities used to assess proper PICC placement and function.
• Review the options for procedural pain and sedation management by age and developmental stage, including pharmacologic and nonpharmacologic interventions.
• Review the indications for subspecialty consultation for IV access or blood sampling.
• Describe the contraindications for use of certain venous sites for IV access or phlebotomy (such as hemodialysis catheters, limb with neurovascular compromise, jugular vein with a neighboring ventriculo-peritoneal shunt, and others.)
• List the indications for arterial blood sampling.
• Describe the proper method for and common complications of obtaining venous and arterial blood samples.

Pediatric hospitalists should be able to:

• Perform a pre-procedural evaluation to determine risks and benefits of IV placement.
• Assess the need for and order appropriate pain and sedation medication and nonmedication interventions.
• Demonstrate the ability to obtain IV access on children of all ages via accessing appropriate personnel or safe performance of the procedure, according to local practice parameters.
• Obtain venous and arterial blood sampling (phlebotomy), with and without IV access, via accessing appropriate personnel or safe performance of the procedure, according to local practice parameters.
• Identify proper techniques for holding and calming patients before, during, and after access attempts and educate other healthcare providers in those techniques.
• Adhere to infection control practices.
• Utilize available modalities where available, such as vein-finding illuminators and ultrasound guidance, to achieve higher rates of procedural success.
• Demonstrate proficiency with intraosseous needle placement as evidenced by successful insertion of the IO needle in a simulated mock code situation.
• Identify barriers to efficient, effective IV access and engage subspecialists, including interventional radiology, anesthesiology, and surgery, to assist as appropriate.
• Identify common complications of IVs and blood sampling and respond with appropriate actions.
• Identify and initiate actions to limit unnecessary intravenous access or sampling by using strategies such as batching of lab tests, transition to oral medication, enteral rehydration, discouraging routine daily lab draws, and daily documentation of need for intravenous access.
• Obtain central venous access and PICCs when indicated via accessing appropriate consultants or safe performance of the procedure, according to local practice parameters.
• Demonstrate proficiency in addressing complications associated with peripheral and central lines (such as infiltrations, clots, displacements, and others) by prompt identification of the problem, initiation of indicated therapy, and consultation with appropriate subspecialists as indicated.

Pediatric hospitalists should be able to:

• Exemplify effective communication with patients and the family/caregivers regarding the indications for, and risks, benefits, and steps of the procedure.
• Role model and advocate for safety during procedures, by strict adherence to infection control practices and use of the “time-out for safety” verification process.
• Acknowledge the importance of revising the IV access plan as appropriate given patient and system limitations.
• Recognize the importance of limiting attempts at IV access in young children, with a need for an alternative plan when indicated.

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

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based procedures and policies for IV access, adhering to national guidelines for infection control.
• Collaborate with hospital administration and clinical leaders to ensure adherence to modern procedural sedation and pain control guidelines, including limiting IV access attempts when an alternative plan is clinically feasible.
• Lead, coordinate, or participate in the development and implementation of a system for review of the efficacy, efficiency, and outcomes of intravenous access procedures.
• Lead, coordinate, or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction related to venous access procedures.

Introduction

Feeding tubes are used in pediatric patients to deliver enteral nutrition, hydration, and medications. Common indications for tube feedings include the inability to meet metabolic demands through oral intake alone and oromotor dyscoordination with risk for aspiration. The need for gastric or transpyloric feeds, the anticipated duration of need, and preferences of patients and the family/caregivers are important factors in the selection of the type of feeding tube placed. Orogastric (OG), nasogastric (NG), and nasojejunal (NJ) tubes are commonly used for short-term needs, typically up to 12 weeks duration. Long-term options include gastric (G), gastrojejunal (GJ), and jejunal (J) tubes. Pediatric hospitalists often encounter children with or in need of feeding tubes and should understand the indications, limitations, and complications associated with their use.

Pediatric hospitalists should be able to:

• Describe basic gastrointestinal anatomy and physiology and how this relates to commonly used feeding tubes.
• Compare and contrast the indications, limitations, and complications of various types of feeding tubes, including OG, NG, NJ, G, GJ, and J tubes.
• Discuss the risks and benefits of short-term enteral feeding compared to intravenous fluid or parenteral nutrition use.
• Compare and contrast the risks and benefits of surgical, endoscopic, and percutaneous techniques for placement of feeding tubes.
• Describe the correct procedure to replace each type of feeding tube, including the associated potential complications.
• Review commonly encountered nonemergent complications of feeding tubes, such as leakage, local irritation, granulation tissue, cellulitis, dislodgement, and clogging.
• Describe potential emergent complications associated with enteral feeding tubes, such as accidental nasal tube placement into the lungs, tube migration, bowel obstruction, visceral puncture, peritonitis, and intussusception.
• List the indications, risks, benefits, and alternatives for surgical gastrostomy with Nissen fundoplication.
• Anticipate discharge needs for patients with feeding tubes, including replacement supplies, education/teaching for care providers, and contingency plans for tube issues, including dislodgment.
• Discuss the role of primary care providers, home health care, subspecialists, registered dieticians, and the family/caregivers in the home management of feeding tubes.

Pediatric hospitalists should be able to:

• Identify patients requiring alternative feeding modalities and prescribe appropriate short or long-term enteral tube placement, as determined clinically.
• Articulate the risks and benefits of combining Nissen fundoplication with G tube placement vs. GJ tube placement to patients and the family/caregivers.
• Prescribe enteral formula choice as well as feeding and advancing regimens (including bolus, continuous, and combination feeds), in collaboration with appropriate subspecialists and registered dieticians.
• Collaborate with subspecialists and registered dieticians to manage tube feeding regimes for patients with feeding intolerance.
• Collaborate with wound care specialists to preserve feeding tube site skin health.
• Monitor nutritional outcomes, such as linear growth and nutritional laboratory values, in children who receive tube feeding.
• Assess the necessity of existing feeding tubes in patients during each inpatient encounter, regardless of the reason for hospitalization.
• Initiate appropriate treatment for common complications associated with feeding tubes, in collaboration with appropriate subspecialists.
• Identify serious complications of tube feedings and prescribe appropriate evidence-based interventions, including ordering appropriate radiological studies and obtaining expeditious subspecialty consultation.
• Demonstrate basic proficiency in the interpretation of radiographic studies commonly performed to assess correct tube placement.
• Collaborate with occupational therapists and/or speech and language pathologists to determine appropriate timing for introduction and/or advancement of oral feeding regimes in children with feeding tubes.
• Educate patients and the family/caregivers about the use and care of feeding tubes, including replacement of dislodged tubes if appropriate, prior to discharge home.

Introduction

Feeding tubes are used in pediatric patients to deliver enteral nutrition, hydration, and medications. Common indications for tube feedings include the inability to meet metabolic demands through oral intake alone and oromotor dyscoordination with risk for aspiration. The need for gastric or transpyloric feeds, the anticipated duration of need, and preferences of patients and the family/caregivers are important factors in the selection of the type of feeding tube placed. Orogastric (OG), nasogastric (NG), and nasojejunal (NJ) tubes are commonly used for short-term needs, typically up to 12 weeks duration. Long-term options include gastric (G), gastrojejunal (GJ), and jejunal (J) tubes. Pediatric hospitalists often encounter children with or in need of feeding tubes and should understand the indications, limitations, and complications associated with their use.

Pediatric hospitalists should be able to:

• Describe basic gastrointestinal anatomy and physiology and how this relates to commonly used feeding tubes.
• Compare and contrast the indications, limitations, and complications of various types of feeding tubes, including OG, NG, NJ, G, GJ, and J tubes.
• Discuss the risks and benefits of short-term enteral feeding compared to intravenous fluid or parenteral nutrition use.
• Compare and contrast the risks and benefits of surgical, endoscopic, and percutaneous techniques for placement of feeding tubes.
• Describe the correct procedure to replace each type of feeding tube, including the associated potential complications.
• Review commonly encountered nonemergent complications of feeding tubes, such as leakage, local irritation, granulation tissue, cellulitis, dislodgement, and clogging.
• Describe potential emergent complications associated with enteral feeding tubes, such as accidental nasal tube placement into the lungs, tube migration, bowel obstruction, visceral puncture, peritonitis, and intussusception.
• List the indications, risks, benefits, and alternatives for surgical gastrostomy with Nissen fundoplication.
• Anticipate discharge needs for patients with feeding tubes, including replacement supplies, education/teaching for care providers, and contingency plans for tube issues, including dislodgment.
• Discuss the role of primary care providers, home health care, subspecialists, registered dieticians, and the family/caregivers in the home management of feeding tubes.

Pediatric hospitalists should be able to:

• Identify patients requiring alternative feeding modalities and prescribe appropriate short or long-term enteral tube placement, as determined clinically.
• Articulate the risks and benefits of combining Nissen fundoplication with G tube placement vs. GJ tube placement to patients and the family/caregivers.
• Prescribe enteral formula choice as well as feeding and advancing regimens (including bolus, continuous, and combination feeds), in collaboration with appropriate subspecialists and registered dieticians.
• Collaborate with subspecialists and registered dieticians to manage tube feeding regimes for patients with feeding intolerance.
• Collaborate with wound care specialists to preserve feeding tube site skin health.
• Monitor nutritional outcomes, such as linear growth and nutritional laboratory values, in children who receive tube feeding.
• Assess the necessity of existing feeding tubes in patients during each inpatient encounter, regardless of the reason for hospitalization.
• Initiate appropriate treatment for common complications associated with feeding tubes, in collaboration with appropriate subspecialists.
• Identify serious complications of tube feedings and prescribe appropriate evidence-based interventions, including ordering appropriate radiological studies and obtaining expeditious subspecialty consultation.
• Demonstrate basic proficiency in the interpretation of radiographic studies commonly performed to assess correct tube placement.
• Collaborate with occupational therapists and/or speech and language pathologists to determine appropriate timing for introduction and/or advancement of oral feeding regimes in children with feeding tubes.
• Educate patients and the family/caregivers about the use and care of feeding tubes, including replacement of dislodged tubes if appropriate, prior to discharge home.

Introduction

Feeding tubes are used in pediatric patients to deliver enteral nutrition, hydration, and medications. Common indications for tube feedings include the inability to meet metabolic demands through oral intake alone and oromotor dyscoordination with risk for aspiration. The need for gastric or transpyloric feeds, the anticipated duration of need, and preferences of patients and the family/caregivers are important factors in the selection of the type of feeding tube placed. Orogastric (OG), nasogastric (NG), and nasojejunal (NJ) tubes are commonly used for short-term needs, typically up to 12 weeks duration. Long-term options include gastric (G), gastrojejunal (GJ), and jejunal (J) tubes. Pediatric hospitalists often encounter children with or in need of feeding tubes and should understand the indications, limitations, and complications associated with their use.

Pediatric hospitalists should be able to:

• Describe basic gastrointestinal anatomy and physiology and how this relates to commonly used feeding tubes.
• Compare and contrast the indications, limitations, and complications of various types of feeding tubes, including OG, NG, NJ, G, GJ, and J tubes.
• Discuss the risks and benefits of short-term enteral feeding compared to intravenous fluid or parenteral nutrition use.
• Compare and contrast the risks and benefits of surgical, endoscopic, and percutaneous techniques for placement of feeding tubes.
• Describe the correct procedure to replace each type of feeding tube, including the associated potential complications.
• Review commonly encountered nonemergent complications of feeding tubes, such as leakage, local irritation, granulation tissue, cellulitis, dislodgement, and clogging.
• Describe potential emergent complications associated with enteral feeding tubes, such as accidental nasal tube placement into the lungs, tube migration, bowel obstruction, visceral puncture, peritonitis, and intussusception.
• List the indications, risks, benefits, and alternatives for surgical gastrostomy with Nissen fundoplication.
• Anticipate discharge needs for patients with feeding tubes, including replacement supplies, education/teaching for care providers, and contingency plans for tube issues, including dislodgment.
• Discuss the role of primary care providers, home health care, subspecialists, registered dieticians, and the family/caregivers in the home management of feeding tubes.

Pediatric hospitalists should be able to:

• Identify patients requiring alternative feeding modalities and prescribe appropriate short or long-term enteral tube placement, as determined clinically.
• Articulate the risks and benefits of combining Nissen fundoplication with G tube placement vs. GJ tube placement to patients and the family/caregivers.
• Prescribe enteral formula choice as well as feeding and advancing regimens (including bolus, continuous, and combination feeds), in collaboration with appropriate subspecialists and registered dieticians.
• Collaborate with subspecialists and registered dieticians to manage tube feeding regimes for patients with feeding intolerance.
• Collaborate with wound care specialists to preserve feeding tube site skin health.
• Monitor nutritional outcomes, such as linear growth and nutritional laboratory values, in children who receive tube feeding.
• Assess the necessity of existing feeding tubes in patients during each inpatient encounter, regardless of the reason for hospitalization.
• Initiate appropriate treatment for common complications associated with feeding tubes, in collaboration with appropriate subspecialists.
• Identify serious complications of tube feedings and prescribe appropriate evidence-based interventions, including ordering appropriate radiological studies and obtaining expeditious subspecialty consultation.
• Demonstrate basic proficiency in the interpretation of radiographic studies commonly performed to assess correct tube placement.
• Collaborate with occupational therapists and/or speech and language pathologists to determine appropriate timing for introduction and/or advancement of oral feeding regimes in children with feeding tubes.
• Educate patients and the family/caregivers about the use and care of feeding tubes, including replacement of dislodged tubes if appropriate, prior to discharge home.

Introduction

Electrocardiograms (ECGs) are often obtained in the pediatric inpatient setting to screen for and diagnose a wide range of cardiac diseases and conditions, including structural defects and arrhythmias. Pediatric hospitalists frequently consider cardiac diseases and conditions in their differential diagnosis and should be able to recognize these disorders, in order to provide initial and potentially life-saving treatment. Therefore, pediatric hospitalists must be skilled at obtaining and interpreting ECGs.

Pediatric hospitalists should be able to:

• Describe the normal electrical cardiac cycle and the corresponding waveforms on an ECG tracing.
• Give examples of common indications for obtaining an ECG, including elements from the past or current history, exam, treatments in use or anticipated, and others.
• Review the steps in performing an ECG, including lead placement and other technical aspects of the procedure.
• Summarize a systematic approach to the interpretation of pediatric ECGs, including evaluation of heart rate; rhythm; P, QRS, and T wave axis; and waveform durations and intervals.
• Compare and contrast the features of ECGs across the age spectrum.
• Describe the common ECG changes associated with specific electrolyte disturbances.
• List medications commonly associated with potentially serious arrhythmias.
• Summarize findings on the ECG indicative of disease-specific patterns, including obstructive sleep apnea, hypertension, idiopathic chamber hypertrophy, and ischemia.
• Review the differential diagnosis of specific arrhythmias and conduction disturbances, including arrhythmias of sinus, atrial, and ventricular origin, atrioventricular blocks, bundle branch blocks, wide and narrow complex tachycardias, atrial or ventricular fibrillation, long QT syndrome, and pacemaker rhythms.
• Describe the appropriate treatment for commonly encountered specific cardiac arrhythmias, including medications, electrical cardioversion, and defibrillation.
• List the ECG findings that should prompt consultation with a cardiologist, intensivist, pulmonologist, or others, including life-threatening or unstable cardiac arrhythmias.

Pediatric hospitalists should be able to:

• Obtain an ECG using the standard number and placement of leads, recording speed, and sensitivity.
• Determine the heart rate from the ECG, considering both the atrial and ventricular rates if different.
• Determine the PR and QT intervals, P and QRS durations, and the P, QRS, and T wave axes.
• Calculate the corrected QT interval (QTc) and correctly diagnose prolonged QTc.
• Identify regular versus irregular rhythms and determine if rhythms are sinus in origin.
• Correctly identify irregular rhythms that have evidence of underlying patterns (such as 2^nd degree AV block and others) or have irregularly irregular rhythms (such as atrial fibrillation and others).
• Evaluate for chamber hypertrophy and screen for ischemia using standard methodologies for ECG interpretation by age.
• Identify patterns that are pathognomonic for certain diagnoses (such as delta waves in Wolff-Parkinson-White syndrome and others).
• Correctly identify abnormal cardiac rhythms and respond with appropriate actions and interventions where indicated, including cardiac monitoring, medications, electrical cardioversion, and defibrillation.
• Order appropriate monitoring for patients with or at risk for cardiac instability and correctly interpret monitor data.
• Engage consultants (such as pediatric cardiologists, intensivists, and others) and initiate intra- or interfacility transfers of care efficiently and appropriately when indicated.

Pediatric hospitalists should be able to:

• Realize the responsibility for obtaining an ECG and provide an accurate interpretation, working collaboratively with pediatric cardiology for assistance as indicated.
• Appreciate the importance of collaboration with subspecialists, including cardiologists and intensivists, to initiate patient transfer when ECG findings and clinical picture suggest a condition requiring a higher level of care.
• Role model effective communication with patients, the family/caregiver, and other healthcare providers regarding the need to obtain an ECG, findings, and subsequent care plan.
• Recognize the importance of collaborating with the primary care provider and subspecialists to ensure coordinated longitudinal care for children with cardiac pathology.

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 policies regarding indications for obtaining an ECG.
• Engage pediatric cardiologists, hospital staff and leadership to ensure timely, reliable, and accurate ECG interpretation, with an effective, closed-loop communication system for reporting results.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and tertiary referral centers for hospitalized patients requiring specialized pediatric cardiology services.
• Lead, coordinate, or participate in efforts directed at educating healthcare providers about risk factors for cardiac arrhythmia, early identification of abnormal rhythms, and implementation of appropriate resuscitative efforts.

Introduction

Electrocardiograms (ECGs) are often obtained in the pediatric inpatient setting to screen for and diagnose a wide range of cardiac diseases and conditions, including structural defects and arrhythmias. Pediatric hospitalists frequently consider cardiac diseases and conditions in their differential diagnosis and should be able to recognize these disorders, in order to provide initial and potentially life-saving treatment. Therefore, pediatric hospitalists must be skilled at obtaining and interpreting ECGs.

Pediatric hospitalists should be able to:

• Describe the normal electrical cardiac cycle and the corresponding waveforms on an ECG tracing.
• Give examples of common indications for obtaining an ECG, including elements from the past or current history, exam, treatments in use or anticipated, and others.
• Review the steps in performing an ECG, including lead placement and other technical aspects of the procedure.
• Summarize a systematic approach to the interpretation of pediatric ECGs, including evaluation of heart rate; rhythm; P, QRS, and T wave axis; and waveform durations and intervals.
• Compare and contrast the features of ECGs across the age spectrum.
• Describe the common ECG changes associated with specific electrolyte disturbances.
• List medications commonly associated with potentially serious arrhythmias.
• Summarize findings on the ECG indicative of disease-specific patterns, including obstructive sleep apnea, hypertension, idiopathic chamber hypertrophy, and ischemia.
• Review the differential diagnosis of specific arrhythmias and conduction disturbances, including arrhythmias of sinus, atrial, and ventricular origin, atrioventricular blocks, bundle branch blocks, wide and narrow complex tachycardias, atrial or ventricular fibrillation, long QT syndrome, and pacemaker rhythms.
• Describe the appropriate treatment for commonly encountered specific cardiac arrhythmias, including medications, electrical cardioversion, and defibrillation.
• List the ECG findings that should prompt consultation with a cardiologist, intensivist, pulmonologist, or others, including life-threatening or unstable cardiac arrhythmias.

Pediatric hospitalists should be able to:

• Obtain an ECG using the standard number and placement of leads, recording speed, and sensitivity.
• Determine the heart rate from the ECG, considering both the atrial and ventricular rates if different.
• Determine the PR and QT intervals, P and QRS durations, and the P, QRS, and T wave axes.
• Calculate the corrected QT interval (QTc) and correctly diagnose prolonged QTc.
• Identify regular versus irregular rhythms and determine if rhythms are sinus in origin.
• Correctly identify irregular rhythms that have evidence of underlying patterns (such as 2^nd degree AV block and others) or have irregularly irregular rhythms (such as atrial fibrillation and others).
• Evaluate for chamber hypertrophy and screen for ischemia using standard methodologies for ECG interpretation by age.
• Identify patterns that are pathognomonic for certain diagnoses (such as delta waves in Wolff-Parkinson-White syndrome and others).
• Correctly identify abnormal cardiac rhythms and respond with appropriate actions and interventions where indicated, including cardiac monitoring, medications, electrical cardioversion, and defibrillation.
• Order appropriate monitoring for patients with or at risk for cardiac instability and correctly interpret monitor data.
• Engage consultants (such as pediatric cardiologists, intensivists, and others) and initiate intra- or interfacility transfers of care efficiently and appropriately when indicated.

Pediatric hospitalists should be able to:

• Realize the responsibility for obtaining an ECG and provide an accurate interpretation, working collaboratively with pediatric cardiology for assistance as indicated.
• Appreciate the importance of collaboration with subspecialists, including cardiologists and intensivists, to initiate patient transfer when ECG findings and clinical picture suggest a condition requiring a higher level of care.
• Role model effective communication with patients, the family/caregiver, and other healthcare providers regarding the need to obtain an ECG, findings, and subsequent care plan.
• Recognize the importance of collaborating with the primary care provider and subspecialists to ensure coordinated longitudinal care for children with cardiac pathology.

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 policies regarding indications for obtaining an ECG.
• Engage pediatric cardiologists, hospital staff and leadership to ensure timely, reliable, and accurate ECG interpretation, with an effective, closed-loop communication system for reporting results.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and tertiary referral centers for hospitalized patients requiring specialized pediatric cardiology services.
• Lead, coordinate, or participate in efforts directed at educating healthcare providers about risk factors for cardiac arrhythmia, early identification of abnormal rhythms, and implementation of appropriate resuscitative efforts.

Introduction

Electrocardiograms (ECGs) are often obtained in the pediatric inpatient setting to screen for and diagnose a wide range of cardiac diseases and conditions, including structural defects and arrhythmias. Pediatric hospitalists frequently consider cardiac diseases and conditions in their differential diagnosis and should be able to recognize these disorders, in order to provide initial and potentially life-saving treatment. Therefore, pediatric hospitalists must be skilled at obtaining and interpreting ECGs.

Pediatric hospitalists should be able to:

• Describe the normal electrical cardiac cycle and the corresponding waveforms on an ECG tracing.
• Give examples of common indications for obtaining an ECG, including elements from the past or current history, exam, treatments in use or anticipated, and others.
• Review the steps in performing an ECG, including lead placement and other technical aspects of the procedure.
• Summarize a systematic approach to the interpretation of pediatric ECGs, including evaluation of heart rate; rhythm; P, QRS, and T wave axis; and waveform durations and intervals.
• Compare and contrast the features of ECGs across the age spectrum.
• Describe the common ECG changes associated with specific electrolyte disturbances.
• List medications commonly associated with potentially serious arrhythmias.
• Summarize findings on the ECG indicative of disease-specific patterns, including obstructive sleep apnea, hypertension, idiopathic chamber hypertrophy, and ischemia.
• Review the differential diagnosis of specific arrhythmias and conduction disturbances, including arrhythmias of sinus, atrial, and ventricular origin, atrioventricular blocks, bundle branch blocks, wide and narrow complex tachycardias, atrial or ventricular fibrillation, long QT syndrome, and pacemaker rhythms.
• Describe the appropriate treatment for commonly encountered specific cardiac arrhythmias, including medications, electrical cardioversion, and defibrillation.
• List the ECG findings that should prompt consultation with a cardiologist, intensivist, pulmonologist, or others, including life-threatening or unstable cardiac arrhythmias.

Pediatric hospitalists should be able to:

• Obtain an ECG using the standard number and placement of leads, recording speed, and sensitivity.
• Determine the heart rate from the ECG, considering both the atrial and ventricular rates if different.
• Determine the PR and QT intervals, P and QRS durations, and the P, QRS, and T wave axes.
• Calculate the corrected QT interval (QTc) and correctly diagnose prolonged QTc.
• Identify regular versus irregular rhythms and determine if rhythms are sinus in origin.
• Correctly identify irregular rhythms that have evidence of underlying patterns (such as 2^nd degree AV block and others) or have irregularly irregular rhythms (such as atrial fibrillation and others).
• Evaluate for chamber hypertrophy and screen for ischemia using standard methodologies for ECG interpretation by age.
• Identify patterns that are pathognomonic for certain diagnoses (such as delta waves in Wolff-Parkinson-White syndrome and others).
• Correctly identify abnormal cardiac rhythms and respond with appropriate actions and interventions where indicated, including cardiac monitoring, medications, electrical cardioversion, and defibrillation.
• Order appropriate monitoring for patients with or at risk for cardiac instability and correctly interpret monitor data.
• Engage consultants (such as pediatric cardiologists, intensivists, and others) and initiate intra- or interfacility transfers of care efficiently and appropriately when indicated.

Pediatric hospitalists should be able to:

• Realize the responsibility for obtaining an ECG and provide an accurate interpretation, working collaboratively with pediatric cardiology for assistance as indicated.
• Appreciate the importance of collaboration with subspecialists, including cardiologists and intensivists, to initiate patient transfer when ECG findings and clinical picture suggest a condition requiring a higher level of care.
• Role model effective communication with patients, the family/caregiver, and other healthcare providers regarding the need to obtain an ECG, findings, and subsequent care plan.
• Recognize the importance of collaborating with the primary care provider and subspecialists to ensure coordinated longitudinal care for children with cardiac pathology.

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 policies regarding indications for obtaining an ECG.
• Engage pediatric cardiologists, hospital staff and leadership to ensure timely, reliable, and accurate ECG interpretation, with an effective, closed-loop communication system for reporting results.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and tertiary referral centers for hospitalized patients requiring specialized pediatric cardiology services.
• Lead, coordinate, or participate in efforts directed at educating healthcare providers about risk factors for cardiac arrhythmia, early identification of abnormal rhythms, and implementation of appropriate resuscitative efforts.

Introduction

Radiographic studies have become fully integrated into the daily practice of Pediatric Hospital Medicine, as the interpretation of a given image often plays a pivotal role in the management of a hospitalized child. With the explosion of imaging technology in the past three decades, clinicians are now faced with a myriad of possible studies from which to choose. The choices vary by setting, as availability and expertise with different imaging modalities can differ by institution and practice setting. More recently, there has been a greater appreciation of the potential impact of ionizing radiation when applied to young children. Judicious use of radiographic studies requires a collaborative, team-based approach, working closely with radiology and subspecialty colleagues to best utilize these powerful clinical tools. Knowledge of the studies locally available, selection of the optimal imaging modality, and interpretation of the most common radiographic studies remain critically important for pediatric hospitalists in any setting.

Pediatric hospitalists should be able to:

• Describe relevant human anatomy and relate this to interpretation of common plain radiographs of areas such as the chest, abdomen, airway, and long bones.
• Describe the indications and limitations of different radiographic modalities, including plain radiography, fluoroscopy, ultrasound, computed tomography, magnetic resonance imaging, and nuclear medicine.
• List the risks of ionizing radiation in children and review the concept of ALARA (as low as reasonably achievable) in limiting radiation exposure.
• Review the indications for, and benefits and risks of, oral and intravenous contrast.
• Review the indications for anxiolytics, sedation, and anesthesia relevant to age, developmental stage, and the procedure being performed.
• List the appropriate imaging study for common clinical presentations, such as acute respiratory distress, altered mental status, stridor, abdominal pain, and others.
• Compare and contrast the utility, risks, and costs of different imaging modalities for presentations of complicated pneumonia and acute abdominal pain.
• Discuss the impact of practice setting on the availability of pediatric radiological services.

Pediatric hospitalists should be able to:

• Choose the optimal study to answer a specific clinical question in a safe, cost-effective manner.
• Order radiologic studies, noting indications for the study, the clinical question to answer, sedation/anesthesia need, and other relevant information within the order.
• Perform initial interpretation of the most common radiographic studies in daily practice, such as plain radiographs of the chest and abdomen for children 0-18 years of age.
• Interpret radiographic studies to diagnose time-sensitive conditions, such as a pneumothorax, prior to review and interpretation by a radiologist.
• Integrate the results of radiographic studies into ongoing clinical care plans.
• Engage the radiologist and subspecialists as consultants in imaging decisions.
• Communicate effectively with nurses, trainees, radiologists, and sedation experts, to ensure safe and effective performance of radiographic studies.
• Communicate effectively with patients and the family/caregivers in order to address concerns regarding radiation exposure and risk.
• Communicate effectively with patient and the family/caregivers in order to provide basic teaching and understanding of results of radiographic images and the impact on the overall care plan.

Pediatric hospitalists should be able to:

• Recognize the radiologist as a consultant with whom to collaborate in decision-making.
• Appreciate the importance of collaborating with hospital staff, radiologists, and sedation and anesthesia experts, to ensure coordinated timing, planning, and performance of radiologic studies.
• Realize the value of effective communication with patients and the family/caregivers regarding the indications for, risks, benefits, alternatives, and steps involved in the radiologic procedure.
• Recognize the importance of obtaining results of all studies and reviewing images in a timely manner.

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

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based standards for radiology services for children, ensuring that standards and protocols for minimizing ionizing radiation to children are in place.
• Lead, coordinate, or participate in development and implementation of a system to review the accuracy of readings for pediatric patients.
• Work with hospital administration to ensure that clinicians have appropriate and necessary access to key imaging modalities to practice at the standard of care.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and tertiary referral centers, so as to allow review of pediatric images between centers to benefit patient care.
• Work with hospital administration, subspecialists, and others to review acquisition of new technologies which are cost effective and positively impact patient care.

Introduction

Radiographic studies have become fully integrated into the daily practice of Pediatric Hospital Medicine, as the interpretation of a given image often plays a pivotal role in the management of a hospitalized child. With the explosion of imaging technology in the past three decades, clinicians are now faced with a myriad of possible studies from which to choose. The choices vary by setting, as availability and expertise with different imaging modalities can differ by institution and practice setting. More recently, there has been a greater appreciation of the potential impact of ionizing radiation when applied to young children. Judicious use of radiographic studies requires a collaborative, team-based approach, working closely with radiology and subspecialty colleagues to best utilize these powerful clinical tools. Knowledge of the studies locally available, selection of the optimal imaging modality, and interpretation of the most common radiographic studies remain critically important for pediatric hospitalists in any setting.

Pediatric hospitalists should be able to:

• Describe relevant human anatomy and relate this to interpretation of common plain radiographs of areas such as the chest, abdomen, airway, and long bones.
• Describe the indications and limitations of different radiographic modalities, including plain radiography, fluoroscopy, ultrasound, computed tomography, magnetic resonance imaging, and nuclear medicine.
• List the risks of ionizing radiation in children and review the concept of ALARA (as low as reasonably achievable) in limiting radiation exposure.
• Review the indications for, and benefits and risks of, oral and intravenous contrast.
• Review the indications for anxiolytics, sedation, and anesthesia relevant to age, developmental stage, and the procedure being performed.
• List the appropriate imaging study for common clinical presentations, such as acute respiratory distress, altered mental status, stridor, abdominal pain, and others.
• Compare and contrast the utility, risks, and costs of different imaging modalities for presentations of complicated pneumonia and acute abdominal pain.
• Discuss the impact of practice setting on the availability of pediatric radiological services.

Pediatric hospitalists should be able to:

• Choose the optimal study to answer a specific clinical question in a safe, cost-effective manner.
• Order radiologic studies, noting indications for the study, the clinical question to answer, sedation/anesthesia need, and other relevant information within the order.
• Perform initial interpretation of the most common radiographic studies in daily practice, such as plain radiographs of the chest and abdomen for children 0-18 years of age.
• Interpret radiographic studies to diagnose time-sensitive conditions, such as a pneumothorax, prior to review and interpretation by a radiologist.
• Integrate the results of radiographic studies into ongoing clinical care plans.
• Engage the radiologist and subspecialists as consultants in imaging decisions.
• Communicate effectively with nurses, trainees, radiologists, and sedation experts, to ensure safe and effective performance of radiographic studies.
• Communicate effectively with patients and the family/caregivers in order to address concerns regarding radiation exposure and risk.
• Communicate effectively with patient and the family/caregivers in order to provide basic teaching and understanding of results of radiographic images and the impact on the overall care plan.

Pediatric hospitalists should be able to:

• Recognize the radiologist as a consultant with whom to collaborate in decision-making.
• Appreciate the importance of collaborating with hospital staff, radiologists, and sedation and anesthesia experts, to ensure coordinated timing, planning, and performance of radiologic studies.
• Realize the value of effective communication with patients and the family/caregivers regarding the indications for, risks, benefits, alternatives, and steps involved in the radiologic procedure.
• Recognize the importance of obtaining results of all studies and reviewing images in a timely manner.

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

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based standards for radiology services for children, ensuring that standards and protocols for minimizing ionizing radiation to children are in place.
• Lead, coordinate, or participate in development and implementation of a system to review the accuracy of readings for pediatric patients.
• Work with hospital administration to ensure that clinicians have appropriate and necessary access to key imaging modalities to practice at the standard of care.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and tertiary referral centers, so as to allow review of pediatric images between centers to benefit patient care.
• Work with hospital administration, subspecialists, and others to review acquisition of new technologies which are cost effective and positively impact patient care.

Introduction

Radiographic studies have become fully integrated into the daily practice of Pediatric Hospital Medicine, as the interpretation of a given image often plays a pivotal role in the management of a hospitalized child. With the explosion of imaging technology in the past three decades, clinicians are now faced with a myriad of possible studies from which to choose. The choices vary by setting, as availability and expertise with different imaging modalities can differ by institution and practice setting. More recently, there has been a greater appreciation of the potential impact of ionizing radiation when applied to young children. Judicious use of radiographic studies requires a collaborative, team-based approach, working closely with radiology and subspecialty colleagues to best utilize these powerful clinical tools. Knowledge of the studies locally available, selection of the optimal imaging modality, and interpretation of the most common radiographic studies remain critically important for pediatric hospitalists in any setting.

Pediatric hospitalists should be able to:

• Describe relevant human anatomy and relate this to interpretation of common plain radiographs of areas such as the chest, abdomen, airway, and long bones.
• Describe the indications and limitations of different radiographic modalities, including plain radiography, fluoroscopy, ultrasound, computed tomography, magnetic resonance imaging, and nuclear medicine.
• List the risks of ionizing radiation in children and review the concept of ALARA (as low as reasonably achievable) in limiting radiation exposure.
• Review the indications for, and benefits and risks of, oral and intravenous contrast.
• Review the indications for anxiolytics, sedation, and anesthesia relevant to age, developmental stage, and the procedure being performed.
• List the appropriate imaging study for common clinical presentations, such as acute respiratory distress, altered mental status, stridor, abdominal pain, and others.
• Compare and contrast the utility, risks, and costs of different imaging modalities for presentations of complicated pneumonia and acute abdominal pain.
• Discuss the impact of practice setting on the availability of pediatric radiological services.

Pediatric hospitalists should be able to:

• Choose the optimal study to answer a specific clinical question in a safe, cost-effective manner.
• Order radiologic studies, noting indications for the study, the clinical question to answer, sedation/anesthesia need, and other relevant information within the order.
• Perform initial interpretation of the most common radiographic studies in daily practice, such as plain radiographs of the chest and abdomen for children 0-18 years of age.
• Interpret radiographic studies to diagnose time-sensitive conditions, such as a pneumothorax, prior to review and interpretation by a radiologist.
• Integrate the results of radiographic studies into ongoing clinical care plans.
• Engage the radiologist and subspecialists as consultants in imaging decisions.
• Communicate effectively with nurses, trainees, radiologists, and sedation experts, to ensure safe and effective performance of radiographic studies.
• Communicate effectively with patients and the family/caregivers in order to address concerns regarding radiation exposure and risk.
• Communicate effectively with patient and the family/caregivers in order to provide basic teaching and understanding of results of radiographic images and the impact on the overall care plan.

Pediatric hospitalists should be able to:

• Recognize the radiologist as a consultant with whom to collaborate in decision-making.
• Appreciate the importance of collaborating with hospital staff, radiologists, and sedation and anesthesia experts, to ensure coordinated timing, planning, and performance of radiologic studies.
• Realize the value of effective communication with patients and the family/caregivers regarding the indications for, risks, benefits, alternatives, and steps involved in the radiologic procedure.
• Recognize the importance of obtaining results of all studies and reviewing images in a timely manner.

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

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based standards for radiology services for children, ensuring that standards and protocols for minimizing ionizing radiation to children are in place.
• Lead, coordinate, or participate in development and implementation of a system to review the accuracy of readings for pediatric patients.
• Work with hospital administration to ensure that clinicians have appropriate and necessary access to key imaging modalities to practice at the standard of care.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and tertiary referral centers, so as to allow review of pediatric images between centers to benefit patient care.
• Work with hospital administration, subspecialists, and others to review acquisition of new technologies which are cost effective and positively impact patient care.

Introduction

The ability to communicate effectively is a core skill for all physicians. It is of particular importance for pediatric hospitalists, who may have more limited longitudinal relationships with patients. This skill is pivotal to clinical practice, as it helps to establish rapport and a therapeutic alliance with patients and the family/caregivers. Communication is delivered both verbally and nonverbally, and can be learned and improved with practice, as with any other technical or clinical proficiency. Pediatric hospitalists must demonstrate effective communication in a variety of settings, including direct patient care, interactions with colleagues, and trainee education. The most critical setting for effective communication is at the bedside, where a pediatric hospitalist must communicate key information clearly and efficiently to patients, the family/caregivers, and to the entire healthcare team.

Pediatric hospitalists should be able to:

• Define the components of effective expressive and receptive communication, such as introduction of team members and their roles, avoiding medical jargon, using calm tone, appropriate word choice and body language, and allowing adequate time for patient and family input.
• Identify personal values, biases, and relationships that may influence communication.
• Discuss the benefits of including the family/caregivers and others who are important to the patient in daily decision-making and long-term plan development.
• Describe the importance of listening carefully, followed by effective use of information obtained to form conclusions and guide interventions.
• List examples of common nonlistening behaviors to avoid, such as allowing distractions, asking unrelated questions, jumping to conclusions, interrupting the speaker, and failing to notice the speaker’s nonverbal language.
• Understand the inherent vulnerability patients and the family/caregivers may feel when hospitalized and how this can affect bedside communication with the care team.
• Describe the importance of considering the cultural factors and spiritual beliefs of patients and the family/caregivers when establishing a therapeutic relationship.
• Explain how vulnerabilities, life situations, limitations in activities of daily living, education, language, and other factors should each be considered and addressed when communicating with patients and the family/caregivers.
• Discuss methods to achieve a more favorable interchange when faced with agitated communicators, such as asking for behavior change, paraphrasing to diffuse emotion, pausing the interaction until all parties are able to participate productively, and others.
• Describe practices essential for effective communication of difficult information, including sitting down, expressing empathy, giving patients and the family/caregivers time to ask questions, maintaining a calm demeanor, and choosing a quiet, private location for the discussion.
• Describe components of effective written communication, including timing of clinical documentation, legibility, grammar, accuracy, disagreements in approaches to care, and documentation of clinical changes.
• Explain why effective communication is central to patient safety during handoffs and list evidence-based handoff tools for use within hospitalist groups and with other healthcare providers.

Pediatric hospitalists should be able to:

• Demonstrate command of a comprehensive array of expressive and receptive communication skills.
• Develop and implement effective plan for daily communication that is family-centered and models best practices in communication, such as sitting down, avoiding jargon, and addressing key patient/family concerns.
• Engage patients and the family/caregivers in shared decision-making regarding the child’s plan of care.
• Coordinate discussions with all clinical care team members (such as nurses, consultants, and others) to ensure a single clear message is given to patients, the family, and all caregivers for the child.
• Demonstrate closed-loop communication to improve patient safety and decrease communication errors.
• Participate in conflict resolution, both within the health care team and between team members and the family/caregivers when indicated.
• Identify when the use of interpreters for patients and the family/caregivers with limited English language proficiency is necessary and effectively integrate interpreters into the communication plan.
• Lead and facilitate a multidisciplinary care conference when applicable.
• Record concise, complete written documents that accurately and succinctly relay key patient information, while meeting expectations of external reviewing agencies and malpractice carriers.
• Develop clear and concise discharge instructions for patients and the family/caregivers.
• Communicate in a timely manner with a child’s primary care provider, incorporating information on the admission reason, hospital course, discharge diagnosis, discharge plan, and follow-up needs and recommendations.

Pediatric hospitalists should be able to:

• Acknowledge the importance of respecting the skills and contributions of all clinical and nonclinical providers involved in the care of patients.
• Realize the responsibility for promoting equitable interactions with patients and the family/caregivers, free from bias related to background, age, language, education level, race, or ethnicity.
• Exemplify professionalism in all communication.
• Seek opportunities to enhance communication skills.

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

• Collaborate with hospital administrators to improve medical record documentation systems by technical means.
• Lead, support, or assist in the development of hospital and system-wide educational programs to enhance communication skills and decrease communication-related errors.
• Work with hospital administration to establish or evaluate existing patient and family experience metrics to ultimately improve communication at the bedside.
• Lead, coordinate, or participate in activities to support effective communication methods for patients and the family/caregivers with limited English language proficiency.

Introduction

The ability to communicate effectively is a core skill for all physicians. It is of particular importance for pediatric hospitalists, who may have more limited longitudinal relationships with patients. This skill is pivotal to clinical practice, as it helps to establish rapport and a therapeutic alliance with patients and the family/caregivers. Communication is delivered both verbally and nonverbally, and can be learned and improved with practice, as with any other technical or clinical proficiency. Pediatric hospitalists must demonstrate effective communication in a variety of settings, including direct patient care, interactions with colleagues, and trainee education. The most critical setting for effective communication is at the bedside, where a pediatric hospitalist must communicate key information clearly and efficiently to patients, the family/caregivers, and to the entire healthcare team.

Pediatric hospitalists should be able to:

• Define the components of effective expressive and receptive communication, such as introduction of team members and their roles, avoiding medical jargon, using calm tone, appropriate word choice and body language, and allowing adequate time for patient and family input.
• Identify personal values, biases, and relationships that may influence communication.
• Discuss the benefits of including the family/caregivers and others who are important to the patient in daily decision-making and long-term plan development.
• Describe the importance of listening carefully, followed by effective use of information obtained to form conclusions and guide interventions.
• List examples of common nonlistening behaviors to avoid, such as allowing distractions, asking unrelated questions, jumping to conclusions, interrupting the speaker, and failing to notice the speaker’s nonverbal language.
• Understand the inherent vulnerability patients and the family/caregivers may feel when hospitalized and how this can affect bedside communication with the care team.
• Describe the importance of considering the cultural factors and spiritual beliefs of patients and the family/caregivers when establishing a therapeutic relationship.
• Explain how vulnerabilities, life situations, limitations in activities of daily living, education, language, and other factors should each be considered and addressed when communicating with patients and the family/caregivers.
• Discuss methods to achieve a more favorable interchange when faced with agitated communicators, such as asking for behavior change, paraphrasing to diffuse emotion, pausing the interaction until all parties are able to participate productively, and others.
• Describe practices essential for effective communication of difficult information, including sitting down, expressing empathy, giving patients and the family/caregivers time to ask questions, maintaining a calm demeanor, and choosing a quiet, private location for the discussion.
• Describe components of effective written communication, including timing of clinical documentation, legibility, grammar, accuracy, disagreements in approaches to care, and documentation of clinical changes.
• Explain why effective communication is central to patient safety during handoffs and list evidence-based handoff tools for use within hospitalist groups and with other healthcare providers.

Pediatric hospitalists should be able to:

• Demonstrate command of a comprehensive array of expressive and receptive communication skills.
• Develop and implement effective plan for daily communication that is family-centered and models best practices in communication, such as sitting down, avoiding jargon, and addressing key patient/family concerns.
• Engage patients and the family/caregivers in shared decision-making regarding the child’s plan of care.
• Coordinate discussions with all clinical care team members (such as nurses, consultants, and others) to ensure a single clear message is given to patients, the family, and all caregivers for the child.
• Demonstrate closed-loop communication to improve patient safety and decrease communication errors.
• Participate in conflict resolution, both within the health care team and between team members and the family/caregivers when indicated.
• Identify when the use of interpreters for patients and the family/caregivers with limited English language proficiency is necessary and effectively integrate interpreters into the communication plan.
• Lead and facilitate a multidisciplinary care conference when applicable.
• Record concise, complete written documents that accurately and succinctly relay key patient information, while meeting expectations of external reviewing agencies and malpractice carriers.
• Develop clear and concise discharge instructions for patients and the family/caregivers.
• Communicate in a timely manner with a child’s primary care provider, incorporating information on the admission reason, hospital course, discharge diagnosis, discharge plan, and follow-up needs and recommendations.

Pediatric hospitalists should be able to:

• Acknowledge the importance of respecting the skills and contributions of all clinical and nonclinical providers involved in the care of patients.
• Realize the responsibility for promoting equitable interactions with patients and the family/caregivers, free from bias related to background, age, language, education level, race, or ethnicity.
• Exemplify professionalism in all communication.
• Seek opportunities to enhance communication skills.

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

• Collaborate with hospital administrators to improve medical record documentation systems by technical means.
• Lead, support, or assist in the development of hospital and system-wide educational programs to enhance communication skills and decrease communication-related errors.
• Work with hospital administration to establish or evaluate existing patient and family experience metrics to ultimately improve communication at the bedside.
• Lead, coordinate, or participate in activities to support effective communication methods for patients and the family/caregivers with limited English language proficiency.

Introduction

The ability to communicate effectively is a core skill for all physicians. It is of particular importance for pediatric hospitalists, who may have more limited longitudinal relationships with patients. This skill is pivotal to clinical practice, as it helps to establish rapport and a therapeutic alliance with patients and the family/caregivers. Communication is delivered both verbally and nonverbally, and can be learned and improved with practice, as with any other technical or clinical proficiency. Pediatric hospitalists must demonstrate effective communication in a variety of settings, including direct patient care, interactions with colleagues, and trainee education. The most critical setting for effective communication is at the bedside, where a pediatric hospitalist must communicate key information clearly and efficiently to patients, the family/caregivers, and to the entire healthcare team.

Pediatric hospitalists should be able to:

• Define the components of effective expressive and receptive communication, such as introduction of team members and their roles, avoiding medical jargon, using calm tone, appropriate word choice and body language, and allowing adequate time for patient and family input.
• Identify personal values, biases, and relationships that may influence communication.
• Discuss the benefits of including the family/caregivers and others who are important to the patient in daily decision-making and long-term plan development.
• Describe the importance of listening carefully, followed by effective use of information obtained to form conclusions and guide interventions.
• List examples of common nonlistening behaviors to avoid, such as allowing distractions, asking unrelated questions, jumping to conclusions, interrupting the speaker, and failing to notice the speaker’s nonverbal language.
• Understand the inherent vulnerability patients and the family/caregivers may feel when hospitalized and how this can affect bedside communication with the care team.
• Describe the importance of considering the cultural factors and spiritual beliefs of patients and the family/caregivers when establishing a therapeutic relationship.
• Explain how vulnerabilities, life situations, limitations in activities of daily living, education, language, and other factors should each be considered and addressed when communicating with patients and the family/caregivers.
• Discuss methods to achieve a more favorable interchange when faced with agitated communicators, such as asking for behavior change, paraphrasing to diffuse emotion, pausing the interaction until all parties are able to participate productively, and others.
• Describe practices essential for effective communication of difficult information, including sitting down, expressing empathy, giving patients and the family/caregivers time to ask questions, maintaining a calm demeanor, and choosing a quiet, private location for the discussion.
• Describe components of effective written communication, including timing of clinical documentation, legibility, grammar, accuracy, disagreements in approaches to care, and documentation of clinical changes.
• Explain why effective communication is central to patient safety during handoffs and list evidence-based handoff tools for use within hospitalist groups and with other healthcare providers.

Pediatric hospitalists should be able to:

• Demonstrate command of a comprehensive array of expressive and receptive communication skills.
• Develop and implement effective plan for daily communication that is family-centered and models best practices in communication, such as sitting down, avoiding jargon, and addressing key patient/family concerns.
• Engage patients and the family/caregivers in shared decision-making regarding the child’s plan of care.
• Coordinate discussions with all clinical care team members (such as nurses, consultants, and others) to ensure a single clear message is given to patients, the family, and all caregivers for the child.
• Demonstrate closed-loop communication to improve patient safety and decrease communication errors.
• Participate in conflict resolution, both within the health care team and between team members and the family/caregivers when indicated.
• Identify when the use of interpreters for patients and the family/caregivers with limited English language proficiency is necessary and effectively integrate interpreters into the communication plan.
• Lead and facilitate a multidisciplinary care conference when applicable.
• Record concise, complete written documents that accurately and succinctly relay key patient information, while meeting expectations of external reviewing agencies and malpractice carriers.
• Develop clear and concise discharge instructions for patients and the family/caregivers.
• Communicate in a timely manner with a child’s primary care provider, incorporating information on the admission reason, hospital course, discharge diagnosis, discharge plan, and follow-up needs and recommendations.

Pediatric hospitalists should be able to:

• Acknowledge the importance of respecting the skills and contributions of all clinical and nonclinical providers involved in the care of patients.
• Realize the responsibility for promoting equitable interactions with patients and the family/caregivers, free from bias related to background, age, language, education level, race, or ethnicity.
• Exemplify professionalism in all communication.
• Seek opportunities to enhance communication skills.

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

• Collaborate with hospital administrators to improve medical record documentation systems by technical means.
• Lead, support, or assist in the development of hospital and system-wide educational programs to enhance communication skills and decrease communication-related errors.
• Work with hospital administration to establish or evaluate existing patient and family experience metrics to ultimately improve communication at the bedside.
• Lead, coordinate, or participate in activities to support effective communication methods for patients and the family/caregivers with limited English language proficiency.

Introduction

Bladder catheterization is a commonly performed procedure, typically used to collect a sterile urine sample for analysis and culture when urinary tract infection (UTI) is suspected. Bladder catheterization is also used to relieve urinary retention or obstruction, particularly in cases of anatomic abnormalities or neurogenic bladder, or to monitor urine output and overall fluid status. Pediatric hospitalists frequently encounter patients requiring bladder catheterization, and in many practice settings, may need to be adept at performing this procedure in infants, children, and adolescents. While not all pediatric hospitalists will regularly perform bladder catheterization, all will be required to interpret urinalysis (UA) in routine practice. A UA is most commonly used to diagnose UTI but can also be used to detect a wide range of pediatric conditions, including primary renal disease, trauma, diabetes, and metabolic disease. The ability to effectively interpret a urinalysis in the inpatient setting remains a core skill for the pediatric hospitalist.

Pediatric hospitalists should be able to:

• Review the basic anatomy of the male and female genitourinary tract.
• Discuss the indications and contraindications for bladder catheterization.
• Describe how the method used to collect a urine specimen can affect interpretation of urine culture results.
• Explain why bladder catheterization is the preferred method of collection in infants and children who cannot reliably produce a voided specimen or in whom a sterile sample is needed.
• Compare and contrast the implications of using different methods to collect a urine specimen, including the varied ability to correctly interpret the UA and culture.
• Describe the steps in performing bladder catheterization for both male and female patients, attending to aspects such as patient identification, sterile technique, patient positioning, equipment needs, and specimen handling.
• Describe the risks and complications associated with bladder catheterization, including localized trauma, creation of a false passage, and potential stricture formation.
• Discuss the indications for analgesia, sedation, or anxiolysis and the medications that may be used for each.
• Describe the indications and risks of indwelling bladder catheters and the criteria for removal.
• Describe best practices and care bundles that can minimize the risk of catheter associated urinary tract infections (CAUTIs).
• Review the indications for consultation with a urologist for bladder catheterization, including known genitourinary tract abnormality, recent genitourinary surgery, or urethral trauma.
• Define a UTI in terms of minimum bacterial colony counts needed with different methods of obtaining the sample, such as catheterization, clean catch, and clean bag.
• Discuss the importance of appropriate specimen handling and the potential effect on culture results.
• Discuss the different components of a urinalysis, including specific gravity, white and red blood cell counts, protein, casts, and glucose, including how each can be used to detect and manage different pediatric conditions.
• Compare and contrast the sensitivity, specificity, and positive or negative predictive value of the leukocyte esterase and nitrite components of a UA in the diagnosis of UTI.

Pediatric hospitalists should be able to:

• Perform a pre-procedural evaluation to determine risks and benefits of bladder catheterization.
• Demonstrate proficiency in performance of bladder catheterization on infants, children, and adolescents, when required according to local practice.
• Identify the level of pain and anxiety provoked by the procedure and provide appropriate pharmacologic or nonpharmacologic interventions when indicated.
• Employ proper techniques for holding and calming patients before, during, and after bladder catheterization and educate healthcare providers in these practices when indicated.
• Consistently adhere to infection control practices.
• Identify complications and respond with appropriate actions.
• Distinguish the need for and efficiently access appropriate consultants and support services for assistance with analgesia, sedation, anxiolysis, and performance of a bladder catheterization.
• Diagnose pediatric conditions, such as UTI, nephrotic syndrome, glomerulonephritis, diabetes mellitus, and others, through effective interpretation of a UA.

Pediatric hospitalists should be able to:

• Realize the importance of obtaining a sterile urine specimen to correctly diagnose urinary tract infection.
• Realize the importance of effective communication with patients and the family/caregivers regarding the indications for, risks, benefits, and steps of bladder catheterization.
• Appreciate the need for collaboration with nurses, learners and other healthcare providers, to promote the use of evidence-based practices in maintenance of urinary catheters to decrease risk of CAUTIs in the inpatient setting.
• Exemplify appropriate adherence to and advocate for strict infection control practices.

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

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based procedures and policies for performance of bladder catheterization in children.
• Lead, coordinate, or participate in the development and implementation of educational initiatives designed to teach the proper technique for bladder catheterization as well as safe catheter maintenance when prolonged catheterization is required.

Introduction

Bladder catheterization is a commonly performed procedure, typically used to collect a sterile urine sample for analysis and culture when urinary tract infection (UTI) is suspected. Bladder catheterization is also used to relieve urinary retention or obstruction, particularly in cases of anatomic abnormalities or neurogenic bladder, or to monitor urine output and overall fluid status. Pediatric hospitalists frequently encounter patients requiring bladder catheterization, and in many practice settings, may need to be adept at performing this procedure in infants, children, and adolescents. While not all pediatric hospitalists will regularly perform bladder catheterization, all will be required to interpret urinalysis (UA) in routine practice. A UA is most commonly used to diagnose UTI but can also be used to detect a wide range of pediatric conditions, including primary renal disease, trauma, diabetes, and metabolic disease. The ability to effectively interpret a urinalysis in the inpatient setting remains a core skill for the pediatric hospitalist.

Pediatric hospitalists should be able to:

• Review the basic anatomy of the male and female genitourinary tract.
• Discuss the indications and contraindications for bladder catheterization.
• Describe how the method used to collect a urine specimen can affect interpretation of urine culture results.
• Explain why bladder catheterization is the preferred method of collection in infants and children who cannot reliably produce a voided specimen or in whom a sterile sample is needed.
• Compare and contrast the implications of using different methods to collect a urine specimen, including the varied ability to correctly interpret the UA and culture.
• Describe the steps in performing bladder catheterization for both male and female patients, attending to aspects such as patient identification, sterile technique, patient positioning, equipment needs, and specimen handling.
• Describe the risks and complications associated with bladder catheterization, including localized trauma, creation of a false passage, and potential stricture formation.
• Discuss the indications for analgesia, sedation, or anxiolysis and the medications that may be used for each.
• Describe the indications and risks of indwelling bladder catheters and the criteria for removal.
• Describe best practices and care bundles that can minimize the risk of catheter associated urinary tract infections (CAUTIs).
• Review the indications for consultation with a urologist for bladder catheterization, including known genitourinary tract abnormality, recent genitourinary surgery, or urethral trauma.
• Define a UTI in terms of minimum bacterial colony counts needed with different methods of obtaining the sample, such as catheterization, clean catch, and clean bag.
• Discuss the importance of appropriate specimen handling and the potential effect on culture results.
• Discuss the different components of a urinalysis, including specific gravity, white and red blood cell counts, protein, casts, and glucose, including how each can be used to detect and manage different pediatric conditions.
• Compare and contrast the sensitivity, specificity, and positive or negative predictive value of the leukocyte esterase and nitrite components of a UA in the diagnosis of UTI.

Pediatric hospitalists should be able to:

• Perform a pre-procedural evaluation to determine risks and benefits of bladder catheterization.
• Demonstrate proficiency in performance of bladder catheterization on infants, children, and adolescents, when required according to local practice.
• Identify the level of pain and anxiety provoked by the procedure and provide appropriate pharmacologic or nonpharmacologic interventions when indicated.
• Employ proper techniques for holding and calming patients before, during, and after bladder catheterization and educate healthcare providers in these practices when indicated.
• Consistently adhere to infection control practices.
• Identify complications and respond with appropriate actions.
• Distinguish the need for and efficiently access appropriate consultants and support services for assistance with analgesia, sedation, anxiolysis, and performance of a bladder catheterization.
• Diagnose pediatric conditions, such as UTI, nephrotic syndrome, glomerulonephritis, diabetes mellitus, and others, through effective interpretation of a UA.

Pediatric hospitalists should be able to:

• Realize the importance of obtaining a sterile urine specimen to correctly diagnose urinary tract infection.
• Realize the importance of effective communication with patients and the family/caregivers regarding the indications for, risks, benefits, and steps of bladder catheterization.
• Appreciate the need for collaboration with nurses, learners and other healthcare providers, to promote the use of evidence-based practices in maintenance of urinary catheters to decrease risk of CAUTIs in the inpatient setting.
• Exemplify appropriate adherence to and advocate for strict infection control practices.

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

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based procedures and policies for performance of bladder catheterization in children.
• Lead, coordinate, or participate in the development and implementation of educational initiatives designed to teach the proper technique for bladder catheterization as well as safe catheter maintenance when prolonged catheterization is required.

Introduction

Bladder catheterization is a commonly performed procedure, typically used to collect a sterile urine sample for analysis and culture when urinary tract infection (UTI) is suspected. Bladder catheterization is also used to relieve urinary retention or obstruction, particularly in cases of anatomic abnormalities or neurogenic bladder, or to monitor urine output and overall fluid status. Pediatric hospitalists frequently encounter patients requiring bladder catheterization, and in many practice settings, may need to be adept at performing this procedure in infants, children, and adolescents. While not all pediatric hospitalists will regularly perform bladder catheterization, all will be required to interpret urinalysis (UA) in routine practice. A UA is most commonly used to diagnose UTI but can also be used to detect a wide range of pediatric conditions, including primary renal disease, trauma, diabetes, and metabolic disease. The ability to effectively interpret a urinalysis in the inpatient setting remains a core skill for the pediatric hospitalist.

Pediatric hospitalists should be able to:

• Review the basic anatomy of the male and female genitourinary tract.
• Discuss the indications and contraindications for bladder catheterization.
• Describe how the method used to collect a urine specimen can affect interpretation of urine culture results.
• Explain why bladder catheterization is the preferred method of collection in infants and children who cannot reliably produce a voided specimen or in whom a sterile sample is needed.
• Compare and contrast the implications of using different methods to collect a urine specimen, including the varied ability to correctly interpret the UA and culture.
• Describe the steps in performing bladder catheterization for both male and female patients, attending to aspects such as patient identification, sterile technique, patient positioning, equipment needs, and specimen handling.
• Describe the risks and complications associated with bladder catheterization, including localized trauma, creation of a false passage, and potential stricture formation.
• Discuss the indications for analgesia, sedation, or anxiolysis and the medications that may be used for each.
• Describe the indications and risks of indwelling bladder catheters and the criteria for removal.
• Describe best practices and care bundles that can minimize the risk of catheter associated urinary tract infections (CAUTIs).
• Review the indications for consultation with a urologist for bladder catheterization, including known genitourinary tract abnormality, recent genitourinary surgery, or urethral trauma.
• Define a UTI in terms of minimum bacterial colony counts needed with different methods of obtaining the sample, such as catheterization, clean catch, and clean bag.
• Discuss the importance of appropriate specimen handling and the potential effect on culture results.
• Discuss the different components of a urinalysis, including specific gravity, white and red blood cell counts, protein, casts, and glucose, including how each can be used to detect and manage different pediatric conditions.
• Compare and contrast the sensitivity, specificity, and positive or negative predictive value of the leukocyte esterase and nitrite components of a UA in the diagnosis of UTI.

Pediatric hospitalists should be able to:

• Perform a pre-procedural evaluation to determine risks and benefits of bladder catheterization.
• Demonstrate proficiency in performance of bladder catheterization on infants, children, and adolescents, when required according to local practice.
• Identify the level of pain and anxiety provoked by the procedure and provide appropriate pharmacologic or nonpharmacologic interventions when indicated.
• Employ proper techniques for holding and calming patients before, during, and after bladder catheterization and educate healthcare providers in these practices when indicated.
• Consistently adhere to infection control practices.
• Identify complications and respond with appropriate actions.
• Distinguish the need for and efficiently access appropriate consultants and support services for assistance with analgesia, sedation, anxiolysis, and performance of a bladder catheterization.
• Diagnose pediatric conditions, such as UTI, nephrotic syndrome, glomerulonephritis, diabetes mellitus, and others, through effective interpretation of a UA.

Pediatric hospitalists should be able to:

• Realize the importance of obtaining a sterile urine specimen to correctly diagnose urinary tract infection.
• Realize the importance of effective communication with patients and the family/caregivers regarding the indications for, risks, benefits, and steps of bladder catheterization.
• Appreciate the need for collaboration with nurses, learners and other healthcare providers, to promote the use of evidence-based practices in maintenance of urinary catheters to decrease risk of CAUTIs in the inpatient setting.
• Exemplify appropriate adherence to and advocate for strict infection control practices.

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

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based procedures and policies for performance of bladder catheterization in children.
• Lead, coordinate, or participate in the development and implementation of educational initiatives designed to teach the proper technique for bladder catheterization as well as safe catheter maintenance when prolonged catheterization is required.

Introduction

Urinary tract infections (UTI) can involve any structure from the kidney to the urethra and occur in up to 2.8% of all children and 5% of febrile infants. According to the latest estimates from the Agency for Healthcare Research and Quality’s Kid Inpatient Database, more than 40,000 children aged 0-18 years were hospitalized in 2016 because of a UTI. The rate is highest in very young infants who present with unexplained fever and is particularly high in girls and uncircumcised boys. Infants younger than 1 year of age account for more than 30% of UTI hospitalizations. Most UTI can be treated as an outpatient; indications for inpatient treatment include age less than 1-2 months, dehydration, inability to tolerate oral antibiotics, and concern for serious complication (such as renal abscess, obstructive uropathy, urosepsis, and others). Pediatric hospitalists frequently encounter children with UTI and must remain current on strategies for diagnosis, treatment, and follow-up care.

Pediatric hospitalists should be able to:

• Describe the abnormal anatomic and physiologic aspects of the urogenital system that may predispose children to UTI at varying ages, such as vesicoureteral reflux, posterior urethral valves, constipation, voiding dysfunction (including neurologic causes), and others.
• Describe the range of clinical presentations attending to differences in age.
• Compare and contrast lower (cystitis) versus upper (pyelonephritis) UTI.
• Explain indications for admission of a child with UTI, such as young age, dehydration, sepsis, suspected serious complication, and others.
• List uropathogens that cause UTI in both previously healthy hosts and those with underlying disease.
• Discuss the utility and limitations of commonly obtained laboratory tests, such as urinalysis, urine culture, blood culture, serum chemistries, and others.
• Specify appropriate antimicrobial coverage for common uropathogens, with awareness of antimicrobial resistance patterns within the local community.
• Describe the indications for screening for underlying anatomic abnormalities, especially for children with a first UTI.
• Discuss the utility and limitations of various imaging modalities, including ultrasonography, voiding cystourethrography, and nuclear scintigraphy.
• Describe the typical response to therapy, including common complications to consider if response is atypical.
• Summarize current literature regarding treatment and evaluation for underlying abnormalities.
• List indications for subspecialty consultation or referral.
• Summarize the discharge plan regarding continued antimicrobial therapy, need for antimicrobial prophylaxis, and follow-up.

Pediatric hospitalists should be able to:

• Identify patients at risk for UTI.
• Use the appropriate urine collection method attending to patient’s age, voiding function, and clinical condition.
• Prescribe appropriate initial antimicrobial and supportive therapy.
• Interpret results of diagnostic testing and use results to guide diagnosis and management.
• Identify when consultation is appropriate and efficiently access appropriate support services needed to provide comprehensive care.
• Establish discharge criteria, including medical and social considerations, and identify when they are met.
• Create a discharge plan that includes contingency instructions, medications, and follow-up as appropriate.
• Communicate effectively with patients, the family/caregivers, and the primary care provider regarding the expected course of illness, treatment options, possible sequelae, and the importance of both short-term and longer-term follow-up.

Pediatric hospitalists should be able to:

• Recognize the importance of communicating with the patients, the family/caregivers, and the primary care provider to assure a safe, efficient, and effective discharge and post-discharge care.
• Exemplify collaborative practice with the healthcare team to ensure coordinated hospital care for children with UTI.

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

• Collaborate with referring physicians (primary care, emergency medicine, specialists, and other hospital physicians) to develop and sustain appropriate referral networks for evaluation, admission, or transfer of children with UTI.
• Collaborate with subspecialists when appropriate, to ensure consistent, timely, and up-to-date evaluation and care in the inpatient setting and after discharge.
• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management of hospitalized children with UTI.
• Collaborate with laboratory and radiology directors and staff to ensure the availability of systems for timely evaluation of specimens and performance and interpretation of appropriate evaluation studies.

Introduction

Urinary tract infections (UTI) can involve any structure from the kidney to the urethra and occur in up to 2.8% of all children and 5% of febrile infants. According to the latest estimates from the Agency for Healthcare Research and Quality’s Kid Inpatient Database, more than 40,000 children aged 0-18 years were hospitalized in 2016 because of a UTI. The rate is highest in very young infants who present with unexplained fever and is particularly high in girls and uncircumcised boys. Infants younger than 1 year of age account for more than 30% of UTI hospitalizations. Most UTI can be treated as an outpatient; indications for inpatient treatment include age less than 1-2 months, dehydration, inability to tolerate oral antibiotics, and concern for serious complication (such as renal abscess, obstructive uropathy, urosepsis, and others). Pediatric hospitalists frequently encounter children with UTI and must remain current on strategies for diagnosis, treatment, and follow-up care.

Pediatric hospitalists should be able to:

• Describe the abnormal anatomic and physiologic aspects of the urogenital system that may predispose children to UTI at varying ages, such as vesicoureteral reflux, posterior urethral valves, constipation, voiding dysfunction (including neurologic causes), and others.
• Describe the range of clinical presentations attending to differences in age.
• Compare and contrast lower (cystitis) versus upper (pyelonephritis) UTI.
• Explain indications for admission of a child with UTI, such as young age, dehydration, sepsis, suspected serious complication, and others.
• List uropathogens that cause UTI in both previously healthy hosts and those with underlying disease.
• Discuss the utility and limitations of commonly obtained laboratory tests, such as urinalysis, urine culture, blood culture, serum chemistries, and others.
• Specify appropriate antimicrobial coverage for common uropathogens, with awareness of antimicrobial resistance patterns within the local community.
• Describe the indications for screening for underlying anatomic abnormalities, especially for children with a first UTI.
• Discuss the utility and limitations of various imaging modalities, including ultrasonography, voiding cystourethrography, and nuclear scintigraphy.
• Describe the typical response to therapy, including common complications to consider if response is atypical.
• Summarize current literature regarding treatment and evaluation for underlying abnormalities.
• List indications for subspecialty consultation or referral.
• Summarize the discharge plan regarding continued antimicrobial therapy, need for antimicrobial prophylaxis, and follow-up.

Pediatric hospitalists should be able to:

• Identify patients at risk for UTI.
• Use the appropriate urine collection method attending to patient’s age, voiding function, and clinical condition.
• Prescribe appropriate initial antimicrobial and supportive therapy.
• Interpret results of diagnostic testing and use results to guide diagnosis and management.
• Identify when consultation is appropriate and efficiently access appropriate support services needed to provide comprehensive care.
• Establish discharge criteria, including medical and social considerations, and identify when they are met.
• Create a discharge plan that includes contingency instructions, medications, and follow-up as appropriate.
• Communicate effectively with patients, the family/caregivers, and the primary care provider regarding the expected course of illness, treatment options, possible sequelae, and the importance of both short-term and longer-term follow-up.

Pediatric hospitalists should be able to:

• Recognize the importance of communicating with the patients, the family/caregivers, and the primary care provider to assure a safe, efficient, and effective discharge and post-discharge care.
• Exemplify collaborative practice with the healthcare team to ensure coordinated hospital care for children with UTI.

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

• Collaborate with referring physicians (primary care, emergency medicine, specialists, and other hospital physicians) to develop and sustain appropriate referral networks for evaluation, admission, or transfer of children with UTI.
• Collaborate with subspecialists when appropriate, to ensure consistent, timely, and up-to-date evaluation and care in the inpatient setting and after discharge.
• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management of hospitalized children with UTI.
• Collaborate with laboratory and radiology directors and staff to ensure the availability of systems for timely evaluation of specimens and performance and interpretation of appropriate evaluation studies.

Introduction

Urinary tract infections (UTI) can involve any structure from the kidney to the urethra and occur in up to 2.8% of all children and 5% of febrile infants. According to the latest estimates from the Agency for Healthcare Research and Quality’s Kid Inpatient Database, more than 40,000 children aged 0-18 years were hospitalized in 2016 because of a UTI. The rate is highest in very young infants who present with unexplained fever and is particularly high in girls and uncircumcised boys. Infants younger than 1 year of age account for more than 30% of UTI hospitalizations. Most UTI can be treated as an outpatient; indications for inpatient treatment include age less than 1-2 months, dehydration, inability to tolerate oral antibiotics, and concern for serious complication (such as renal abscess, obstructive uropathy, urosepsis, and others). Pediatric hospitalists frequently encounter children with UTI and must remain current on strategies for diagnosis, treatment, and follow-up care.

Pediatric hospitalists should be able to:

• Describe the abnormal anatomic and physiologic aspects of the urogenital system that may predispose children to UTI at varying ages, such as vesicoureteral reflux, posterior urethral valves, constipation, voiding dysfunction (including neurologic causes), and others.
• Describe the range of clinical presentations attending to differences in age.
• Compare and contrast lower (cystitis) versus upper (pyelonephritis) UTI.
• Explain indications for admission of a child with UTI, such as young age, dehydration, sepsis, suspected serious complication, and others.
• List uropathogens that cause UTI in both previously healthy hosts and those with underlying disease.
• Discuss the utility and limitations of commonly obtained laboratory tests, such as urinalysis, urine culture, blood culture, serum chemistries, and others.
• Specify appropriate antimicrobial coverage for common uropathogens, with awareness of antimicrobial resistance patterns within the local community.
• Describe the indications for screening for underlying anatomic abnormalities, especially for children with a first UTI.
• Discuss the utility and limitations of various imaging modalities, including ultrasonography, voiding cystourethrography, and nuclear scintigraphy.
• Describe the typical response to therapy, including common complications to consider if response is atypical.
• Summarize current literature regarding treatment and evaluation for underlying abnormalities.
• List indications for subspecialty consultation or referral.
• Summarize the discharge plan regarding continued antimicrobial therapy, need for antimicrobial prophylaxis, and follow-up.

Pediatric hospitalists should be able to:

• Identify patients at risk for UTI.
• Use the appropriate urine collection method attending to patient’s age, voiding function, and clinical condition.
• Prescribe appropriate initial antimicrobial and supportive therapy.
• Interpret results of diagnostic testing and use results to guide diagnosis and management.
• Identify when consultation is appropriate and efficiently access appropriate support services needed to provide comprehensive care.
• Establish discharge criteria, including medical and social considerations, and identify when they are met.
• Create a discharge plan that includes contingency instructions, medications, and follow-up as appropriate.
• Communicate effectively with patients, the family/caregivers, and the primary care provider regarding the expected course of illness, treatment options, possible sequelae, and the importance of both short-term and longer-term follow-up.

Pediatric hospitalists should be able to:

• Recognize the importance of communicating with the patients, the family/caregivers, and the primary care provider to assure a safe, efficient, and effective discharge and post-discharge care.
• Exemplify collaborative practice with the healthcare team to ensure coordinated hospital care for children with UTI.

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

• Collaborate with referring physicians (primary care, emergency medicine, specialists, and other hospital physicians) to develop and sustain appropriate referral networks for evaluation, admission, or transfer of children with UTI.
• Collaborate with subspecialists when appropriate, to ensure consistent, timely, and up-to-date evaluation and care in the inpatient setting and after discharge.
• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management of hospitalized children with UTI.
• Collaborate with laboratory and radiology directors and staff to ensure the availability of systems for timely evaluation of specimens and performance and interpretation of appropriate evaluation studies.