I am sure many colleague primary care providers are familiar with the soaring feeling of frustration when at the end of a visit, hand on the doorknob and ready to move on to the next patient, you are unexpectedly halted by your patient’s one last question. Often the one last question — aka the “doorknob” question — is in fact so important to your patient’s health and one you wish you’d been asked earlier in the encounter. …Read More
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.
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.
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