Updates in Pediatric Hospital Medicine: Six Practical Ways to Improve the Care of Hospitalized Children
BACKGROUND: As pediatric hospital medicine continues to grow, it is important to keep abreast of the current literature. This article provides a summary of six of the most impactful articles published in 2018.
METHODS: The authors reviewed articles published between January 2018 and December 2018 for the 2019 Society of Hospital Medicine national conference presentation of Top Articles in Pediatric Hospital Medicine, where the top 10 articles of 2018 were presented. Six of the 10 articles are highlighted in this review based on article quality and their applicability to change practices in the hospital setting or prompt further research.
RESULTS: Key findings from the articles include: multiple interventions aimed at providers can improve compliance with bronchiolitis guidelines; a developed calculator can improve testing for urinary tract infections in children aged 2-24 months; nonmedical costs of hospitalizations are underappreciated and disproportionately affect those with a lower socioeconomic status; a progress note template in an electronic health record can lead to higher quality and shorter notes; for febrile infants aged 60 days and younger, most blood and cerebrospinal fluid culture pathogens can be identified within 24 hours and nearly all by 36 hours; and the development of a high-value care tool can help to bring concepts of high-value care into family-centered rounds.
CONCLUSION: The six selected articles highlight findings pertinent to pediatric hospital medicine.
© 2019 Society of Hospital Medicine
The field of pediatric hospital medicine has seen tremendous growth in scholarship in the past decade. To obtain a wide view of advancements in the field from the current literature, the authors selected 18 English-language journals (Table 1) across four domains believed to be relevant to the practice of pediatric hospital medicine, including hospital medicine, pediatrics, emergency care, and medical education. The median Hirsch index (h-index) of the selected journals was 131. A goal of 10, a number that could maximally benefit consumers of the finished product, was set as the final number of articles to be selected.
Guiding principles for the initial selection included novelty of hypotheses, study design, significance of results, and likelihood to change pediatric hospital medicine practice from both the community and academic hospital perspectives. Journals were assigned randomly to each author for review and assignments were switched after six months to limit potential bias in coverage. A three-stage review process was employed. The authors initially independently reviewed titles and abstracts from 13,296 articles published between January 2018 and December 2018 and rated them according to their likelihood to be included in the final set of 10 articles and their broad applicability to pediatric hospital medicine. This resulted in 99 studies that were selected for further review. Next, the authors were assigned a subset of the 99 articles for further review; each author rated the articles independently based on their likelihood of inclusion in the final 10-article set. At this stage, 75 articles were excluded. Finally, all remaining 24 articles were reviewed independently and in depth by both authors.
Ten articles were selected by consensus formation, and the authors presented their findings at the 2019 Society for Hospital Medicine annual meeting. From these 10 articles, six were determined to be most impactful to current practice; these articles are presented below. After discussing the study background, an overview, key results, limitations of the study, important findings (Table 2), and implications for practice and future research are presented.
SELECTED PUBLICATIONS
Interventions to Reduce Over-Utilized Tests and Treatments in Bronchiolitis. Tyler A, et al. Pediatrics. 2018;141(6):e20170485. 1
Background
The American Academy of Pediatrics (AAP) published clinical practice guidelines (CPG) for bronchiolitis in 2014.2 However, unnecessary tests and interventions continue to be ordered and used on children with bronchiolitis that are not recommended by the guidelines. In this quality improvement project, the authors sought to increase compliance with the AAP CPG for bronchiolitis by reducing chest x-rays (CXR) to <20%, respiratory viral testing (RVT) to <15%, and use of bronchodilators to <20%.
