Implementation of a Checklist Tool to Improve Understanding of Rapid Response Team Protocols.

Rapid response teams (RRT) are multidisciplinary teams activated to assess patients outside of the Intensive Care Unit (ICU) and require a shared framework for approaching a deteriorating patient. In this project, we aimed to improve the understanding of RRT protocols through the development and implementation of the RRT Huddle Checklist. This quality improvement project took place from 2019 to 2022.

Frequency of and Risk Factors for Increased Healthcare Utilization After Pediatric Sepsis Hospitalization.

Objectives: To determine the frequency of and risk factors for increased post-sepsis healthcare utilization compared with pre-sepsis healthcare utilization.

Design: Retrospective observational cohort study.

Setting: Years 2016-2019 MarketScan Commercial and Medicaid Database.

Optimizing Pediatric Rapid Response Teams: Stakeholder Focus Groups.

Objectives: Rapid response teams (RRTs) can improve outcomes in both adult and pediatric hospitals. Most pediatric hospitals have RRT-type systems; however, little is known about stakeholders' perspectives regarding how to optimize RRT quality and efficiency. We aimed to better understand multidisciplinary stakeholder perspectives on how to improve the RRT process.

Barriers and facilitators to effective electronic health record-based sepsis screening in the pediatric intensive care unit.

Introduction: The Pediatric Surviving Sepsis Campaign supports the implementation of automated tools for early sepsis recognition. In 2019 the C.S.

Association of Childbirth With Medical Debt.

We evaluated the association between childbirth and having medical debt in collections and examined differences by neighborhood socioeconomic status. Among a statewide cohort of commercially insured pregnant (n=14,560) and postpartum (n=12,157) adults, having medical debt in collections was more likely among postpartum individuals compared with pregnant individuals (adjusted odds ratio [aOR] 1.36, 95% CI 1.

A Tale of 8 Cities: Pediatric Critical Care Redeployment to Adult Care During Wave 1 of COVID-19.

Background: Pediatric hospital resources including critical care faculty (intensivists) redeployed to provide care to adults in adult ICUs or repurposed PICUs during wave 1 of the coronavirus disease 2019 (COVID-19) pandemic.

Objectives: To determine the magnitude of pediatric hospital resource redeployment and the experience of pediatric intensivists who redeployed to provide critical care to adults with COVID-19.

Methods: A mixed methods study was conducted at 9 hospitals in 8 United States cities where pediatric resources were redeployed to provide care to critically ill adults with COVID-19.

Frequency of and Risk Factors Associated With Hospital Readmission After Sepsis.

Objectives: Although children who survive sepsis are at risk for readmission, identification of patient-level variables associated with readmission has been limited by administrative datasets. We determined frequency and cause of readmission within 90 days of discharge and identified patient-level variables associated with readmission using a large, electronic health record-based registry.

Methods: This retrospective observational study included 3464 patients treated for sepsis or septic shock between January 2011 and December 2018 who survived to discharge at a single academic children's hospital.

Financial outcomes after pediatric critical illness among commercially insured families.

Critical illness results in subjective financial distress for families, but little is known about objective caregiver finances after a child's pediatric intensive care unit (PICU) hospitalization. Using statewide commercial insurance claims linked to cross-sectional commercial credit data, we identified caregivers of children with PICU hospitalizations in January-June 2020 and January-June 2021. Credit data included delinquent debt, debt in collections (medical and non-medical), low credit score (< 660), and a composite of any debt or poor credit and were measured in January 2021 for all caregivers.

Implementing Pediatric Surviving Sepsis Campaign Guidelines: Improving Compliance With Lactate Measurement in the PICU.

Unlabelled: The 2020 pediatric Surviving Sepsis Campaign (pSSC) recommends measuring lactate during the first hour of resuscitation for severe sepsis/shock. We aimed to improve compliance with this recommendation for patients who develop severe sepsis/shock while admitted to the PICU.

Design: Structured, quality improvement initiative.

Patient adverse financial outcomes before and after COVID-19 infection.

Adverse financial outcomes after COVID-19 infection and hospitalization have not been assessed with appropriate comparators to account for other financial disruptions of 2020-2021. Using credit report data from 132,109 commercially insured COVID-19 survivors, we compared the rates of adverse financial outcomes for two cohorts of individuals with credit outcomes measured before and after COVID-19 infection, using an interaction term between cohort and hospitalization to test whether adverse credit outcomes changed more for hospitalized than nonhospitalized COVID-19 patients. Covariates included age group, gender, and several area-level social determinants of health.

Out-of-Pocket Spending for Non-Birth-Related Hospitalizations of Privately Insured US Children, 2017 to 2019.

Importance: Privately insured US children account for 40% of non-birth-related pediatric hospitalizations. However, there are no national data on the magnitude or correlates of out-of-pocket spending for these hospitalizations.

Objective: To estimate out-of-pocket spending for non-birth-related hospitalizations among privately insured children and identify factors associated with this spending.

Children with severe sepsis: relationship between community level income and morbidity and mortality.

Background: Health disparities surrounding pediatric severe sepsis outcomes remains unclear. We aimed to measure the relationship between indicators of socioeconomic status and mortality, hospital length of stay (LOS), and readmission rates among children hospitalized with severe sepsis.

Methods: Children 0-18 years old, hospitalized with severe sepsis in the Nationwide Readmissions Database (2016-2018) were included.

Development and Retention of Early-Career Clinician-Scientists through a Novel Peer Mentorship Program: Multidisciplinary Intensive Care Research Workgroup.

Background: Early-career clinician-scientists often leave academic medicine, but strong mentorship can help facilitate retention. Beyond the traditional dyadic mentor-mentee relationship, formal peer mentoring provides a rich means to augment career development and foster independence.

Objective: To describe a model for early-career peer mentorship and the retention of participating early-career clinician-scientists in academic medicine.

New and Progressive Medical Conditions After Pediatric Sepsis Hospitalization Requiring Critical Care.

Importance: Children commonly experience physical, cognitive, or emotional sequelae after sepsis. However, little is known about the development or progression of medical conditions after pediatric sepsis.

Objective: To quantify the development and progression of 4 common conditions in the 6 months after sepsis and to assess whether they differed after hospitalization for sepsis vs nonsepsis among critically ill children.

Oxygenation Severity Categories and Long-Term Quality of Life among Children who Survive Septic Shock.

 This study aimed to test whether early oxygenation failure severity categories (absent/mild/moderate/severe) were associated with health-related quality of life (HRQL) deterioration among children who survived sepsis-related acute respiratory failure.  We performed a secondary analysis of a study of community-acquired pediatric septic shock, Life After Pediatric Sepsis Evaluation. The primary outcome was an adjusted decline in HRQL ≥ 25% below baseline as assessed 3 months following admission.