Intravenous antibiotics for urinary tract infections in children with neurologic impairment.

Background: Children with high-intensity neurologic impairment (HINI) have an increased risk of urinary tract infection (UTI) and prolonged intravenous (IV) antibiotic exposure.

Objective: To determine the association between short (≤3 days) and long (>3 days) IV antibiotic courses and UTI treatment failure in hospitalized children with HINI.

Methods: We performed a retrospective cohort study examining UTI hospitalizations at 49 hospitals in the Pediatric Health Information System from 2016 to 2021 for children (1-18 years) with HINI.

Health Literacy-Informed Communication to Reduce Discharge Medication Errors in Hospitalized Children: A Randomized Clinical Trial.

Importance: Inadequate communication between caregivers and clinicians at hospital discharge contributes to medication dosing errors in children. Health literacy-informed communication strategies during medication counseling can reduce dosing errors but have not been tested in the pediatric hospital setting.

Objective: To test a health literacy-informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children.

Disparities in Pharmacologic Restraint for Children Hospitalized in Mental Health Crisis.

Background And Objectives: Children hospitalized with a mental health crisis often receive pharmacologic restraint for management of acute agitation. We examined associations between pharmacologic restraint use and race and ethnicity among children admitted for mental health conditions to acute care nonpsychiatric children's hospitals.

Methods: We performed a retrospective cohort study of children (aged 5-≤18 years) admitted for a primary mental health condition from 2018 to 2022 at 41 US children's hospitals.

Association of neighborhood opportunity and pediatric hospitalization rates in the United States.

We examined associations between a validated, multidimensional measure of social determinants of health and population-based hospitalization rates among children <18 years across 18 states from the 2017 Healthcare Cost and Utilization Project State Inpatient Databases and the US Census. The exposure was ZIP code-level Child Opportunity Index (COI), a composite measure of neighborhood resources and conditions that matter for children's health. The cohort included 614,823 hospitalizations among a population of 29,244,065 children (21.

Caregiver and Clinician Perspectives on Discharge Medication Counseling: A Qualitative Study.

Objectives: Children are at increased risk for medication errors and the transition from hospital-to-home is a vulnerable time for errors to occur. This study aimed to explore the perspectives of multidisciplinary clinicians and caregivers regarding discharge medication counseling and to develop a conceptual model to inform intervention efforts to reduce discharge medication dosing errors.

Methods: We conducted semistructured interviews with clinicians and caregivers of children <4 years old discharged from the hospital on a liquid medication.

Parental Perceptions of Penicillin Allergy Risk Stratification and Delabeling.

Background: Penicillin (PCN) allergy labels are widely recognized to be highly inaccurate. Little is known about parental perceptions of the PCN allergy evaluation and removal process, especially in the hospital setting.

Methods: Focus groups were held with parents of children and adolescents with a PCN allergy label discharged from a large academic children's hospital between January 1, 2019, and April 15, 2020.

Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals.

Background: Children in mental health crises are increasingly admitted to children's hospitals awaiting inpatient psychiatric placement. During hospitalization, patients may exhibit acute agitation prompting pharmacologic restraint use.

Objective: To determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals.

Designing and Conducting Scholarly Quality Improvement: A Practical Guide for Improvers Everywhere.

Successful publication of quality improvement (QI) work is predicated on the use of established QI frameworks and rigorous analytical methods that allow teams to understand the impact of interventions over time. This article is meant to help QI teams disseminate their work more broadly through publication by providing tangible methods that many journals desire in QI articles with specific examples of published works referenced throughout the article. We introduce improvement frameworks that teams should identify early and use as a foundation throughout their projects.

Child Opportunity Index 2.0 and acute care utilization among children with medical complexity.

Background: Disproportionately high acute care utilization among children with medical complexity (CMC) is influenced by patient-level social complexity.

Objective: The objective of this study was to determine associations between ZIP code-level opportunity and acute care utilization among CMC.

Design, Setting, And Participants: This cross-sectional, multicenter study used the Pediatric Health Information Systems database, identifying encounters between 2016-2019.

Decreasing pre-procedural fasting times in hospitalized children.

Objective: Prolonged pre-procedural fasting in children is associated with decreased patient and family satisfaction and increased patient hemodynamic instability. Practice guidelines recommend clear liquid fasting times of 2 h. We aimed to decrease pre-procedural clear liquid fasting time from 10 h 13 min to 5 h for pediatric hospital medicine (PHM) patients.

Association of Race/Ethnicity and Social Determinants with Rehospitalization for Mental Health Conditions at Acute Care Children's Hospitals.

Objective: To evaluate associations of race/ethnicity and social determinants with 90-day rehospitalization for mental health conditions to acute care nonpsychiatric children's hospitals.

Study Design: We conducted a retrospective cohort analysis of mental health hospitalizations for children aged 5-18 years from 2016 to 2018 at 32 freestanding US children's hospitals using the Children's Hospital Association's Pediatric Health Information System database to assess the association of race/ethnicity and social determinants (insurance payer, neighborhood median household income, and rurality of patient home location) with 90-day rehospitalization. Risk factors for rehospitalization were modeled using mixed-effects multivariable logistic regression.

Know It When You See It: Identifying and Using Special Cause Variation for Quality Improvement.

In this month’s , Liao et al share their team’s journey to improve the accuracy of their institution’s electronic health record (EHR) problem list. They presented their results as statistical process control (SPC) charts, which are a mainstay for visualization and analysis for improvers to understand processes, test hypotheses, and quickly learn their interventions’ effectiveness. Although many readers might understand that 8 consecutive points above or below the mean signifies special cause variation resulting in a centerline “shift,” there are many more special cause variation rules revealed in these charts that likely provided valuable real-time information to the improvement team.