Outcomes of a Clinical Pathway to Standardize Use of Maintenance Intravenous Fluids.

Objectives: Improper use of maintenance intravenous fluids (IVFs) may cause serious hospital-acquired harm. We created an evidence-based clinical pathway to guide providers on the indications for IVF, its preferred composition, and appropriate clinical monitoring.

Methods: Pathway implementation was supported by the creation of an electronic order set (PowerPlan) and hospital-wide education.

Reliable Pregnancy Testing Before Intravenous Cyclophosphamide: A Quality Improvement Study.

Background And Objective: Cyclophosphamide is a teratogenic medication used in the treatment of adolescents with autoimmune disorders. This adolescent population is sexually active, does not receive adequate contraceptive care, and is at risk for unintended pregnancy. We undertook a quality improvement initiative to improve rates of pregnancy screening before intravenous cyclophosphamide administration in our adolescent girl patients.

Stratification of children by medical complexity.

Objective: To stratify children using available software, Clinical Risk Groups (CRGs), in a tertiary children's hospital, Seattle Children's Hospital (SCH), and a state's Medicaid claims data, Washington State (WSM), into 3 condition groups: complex chronic disease (C-CD); noncomplex chronic disease (NC-CD), and nonchronic disease (NC).

Methods: A panel of pediatricians developed consensus definitions for children with C-CD, NC-CD, and NC. Using electronic medical record review and expert consensus, a gold standard population of 700 children was identified and placed into 1 the 3 groups: 350 C-CD, 100 NC-CD, and 250 NC.

Predictive Analytics In Healthcare: Medications as a Predictor of Medical Complexity.

Children with special healthcare needs (CSHCN) require health and related services that exceed those required by most hospitalized children. A small but growing and important subset of the CSHCN group includes medically complex children (MCCs). MCCs typically have comorbidities and disproportionately consume healthcare resources.

Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study.

Objective: To compare inpatient resource use trends for healthy children and children with chronic health conditions of varying degrees of medical complexity.

Design: Retrospective cohort analysis.

Setting: Twenty-eight US children's hospitals.

Identifying children with lifelong chronic conditions for care coordination by using hospital discharge data.

Background: Children with lifelong chronic conditions (LLCC) are costly, of low prevalence, and a high proportion of patients at children's hospitals. Few methods identify these patients.

Objectives: We sought to identify children with LLCC in hospital discharge data for care coordination by using clinical risk groups (CRGs), to evaluate the accuracy of this methodology compared with a chart review and to investigate accuracy according to condition groups.