Stories about: Quick Note

Quick Note: Odds of hospital readmission increase for children as they become adults

Busy garage as hospital readmission rates increase

As accountable care organizations continue to evolve, primary care pediatricians may increasingly share financial risks with hospitals on quality of care measures, including hospital readmissions.

In an article published in The BMJ, Boston Children’s Hospital readmission experts Jay Berry, MD, MPH, and Emily Bucholz, MD, MPH, PhD, show that the odds of hospital readmission increase substantially for children as they become adolescents and enter adulthood. In fact, their odds of readmission are just as high or higher than elderly, Medicare beneficiaries.

Berry and Bucholz discuss the reasons for those findings and how better systems of care are needed for children — especially those with chronic conditions — as they transition to adulthood.

Read the paper published in The BMJ.

Quick Note: Improving nighttime communications in the hospital

hospital communications

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.

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

QuickNote: Does Tylenol really make asthma symptoms worse?

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New research on Tylenol and asthma may surprise you

You may have heard that acetaminophen (Tylenol) can exacerbate asthma in children, and that alternative medications should be given to children with asthma when they experience pain or fever. A new study refutes this widely-held belief, and finds no correlation between Tylenol and increased asthma symptoms in children.

The study, published last week in The New England Journal of Medicine, followed 300 children 1 – 5 years old with mild persistent asthma from 18 health care institutions. The patients were randomly divided into two groups: one was told to use acetaminophen as indicated for pain or fever, and the other was told to use ibuprofen. The study was conducted over a 48-week period.

During the nearly seven week follow-up period, researchers found no statistically significant difference in asthma rates or severity between the two groups.

Read the full text in The New England Journal of Medicine.