Author: Nancy Fliesler

Managing anxiety in primary care pediatrics

managing anxiety in children

Anxiety is common in children and adolescents, but at what point does it cross the line and become a mental health concern? Notes posed this question to clinical psychologist Keneisha Sinclair-McBride, PhD, and child psychiatrist Olivia Carrick, MD, both in the Department of Psychiatry at Boston Children’s, and asked their management advice. …Read More

Quick Note: Improving nighttime communications in the hospital

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It’s now well known that breakdowns in communications are a leading cause of hospital medical errors, contributing to more than 60 percent of serious adverse events. Efforts such as I-PASS, which standardize communications during patient “handoffs,” have cut harmful medical errors by 30 percent.

But nighttime care, which evidence suggests is particularly error-prone, has been somewhat overlooked. Researchers at Boston Children’s Hospital, led by Alisa Khan, MD, MPH and Christopher Landrigan, MD, MPH, also wanted to incorporate parents’ experience, which had been missing in nighttime communications when families were asleep. In this study in Academic Pediatrics, Khan, Landrigan and colleagues prospectively evaluated a family-centered, multidisciplinary nighttime communication intervention.

The intervention was developed with input from parents, nurses and medical residents, as well as the hospital’s Family Advisory Council, residency program and nursing leadership. It consisted of a short, early-evening nurse–physician briefing session at about 7:30 p.m.; a bedside, family-centered huddle in I-PASS format between 8 and 9 p.m.; and, for selected patients, a nightly family update sheet.

The team prospectively followed patients, parents and nighttime providers on two pediatric inpatient units at Boston Children’s. They surveyed parents and providers both pre-intervention (May-October 2013) and post-intervention (May-October 2014) and compared their answers.

The intervention wasn’t fully adopted by staff, but it did improve some aspects of communication. Providers’ experience improved in several domains. Parents reported more of a sense of shared understanding with nurses and a better experience communicating with nighttime doctors.

But several communication parameters did not improve, highlighting the importance of continued family involvement in research and design of the interventions. The ongoing multicenter Patient and Family Centered I-PASS Study is now testing several enhancements.

Valuing family-provided medical care for children with special health care needs

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About half of U.S. children with special health care needs — approximately 5.6 million — receive medical care from uncompensated family members. According to a recent study led by Boston Children’s Hospital and the University of Southern California (USC), the impact of in-home care is costing families billions. …Read More

Quick Note: Developmental pediatricians offer long-range perspective on Zika

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The ongoing Zika virus outbreak has shined a spotlight on microcephaly. But Boston Children’s Hospital’s developmental/behavioral experts Marie Reilly, MD, and Leonard Rappaport, MD, note that Zika isn’t the first virus to cause birth defects.

In an article published in the Journal of Developmental & Behavioral Pediatrics, they offer a long-range perspective on challenges children infected with Zika prenatally may face.  …Read More