Outpatient Management of Fever and Neutropenia in Low-risk Children with Solid Tumors: A Quality Improvement Initiative.

Background: Management of febrile neutropenia in pediatric oncology usually requires inpatient parenteral antibiotics after initial evaluation, but some patients at lower risk of sepsis could be safely managed outpatient. We describe a quality improvement project to increase outpatient management of fever and neutropenia.

Methods: We designed a standardized algorithm for children with a solid tumor diagnosis and low risk for bacteremia.

Reducing Falls in Hospitalized Children and Adolescents with Cancer and Blood Disorders: A Quality Improvement Journey.

Background: Falls in hospitalized pediatric patients represent a serious patient safety concern. Children and adolescents with cancer and blood disorders have inherent risk factors that increase the likelihood of injury from falls. The Hematology/Oncology (HO) and Stem Cell Transplant (SCT) inpatient units at Boston Children's Hospital embarked on a multiyear quality improvement journey to reduce inpatient falls in this population.

Sustained increase in annual transcranial Doppler screening rates in children with sickle cell disease: A quality improvement project.

Introduction: Individuals with sickle cell disease (SCD) at increased risk for stroke should undergo annual stroke risk assessment using transcranial Doppler (TCD) screening between the ages of 2 and 16. Though this screening can significantly reduce morbidity associated with SCD, screening rates at Boston Children's Hospital (and nationwide) remain below the recommended 100% screening adherence rates.

Methods: Three plan-do-study-act (PDSA) cycles were designed and implemented.

Reducing ambulatory central line-associated bloodstream infections: A family-centered approach.

Background: Ambulatory central line-associated bloodstream infections (CLABSIs) cause significant morbidity and mortality, especially in pediatric oncology. Few studies have had interventions directed toward caregivers managing central lines (CL) at home to reduce ambulatory CLABSI rates. We aimed to reduce and sustain our ambulatory CLABSI rate by 25% within 3 years of the start of a quality improvement intervention.

Increasing COVID-19 Vaccination Rates for Children With Sickle Cell Disease.

Background: The COVID-19 vaccine is important for children with sickle cell disease (SCD). This quality improvement project's objective was to increase the proportion of children with SCD receiving ≥2 COVID-19 vaccine doses to ≥70% by June 2022.

Methods: We used the Model for Improvement framework.

Use of the osmolal gap in diagnosing mixed physiology hyponatremia in a child with B-cell acute lymphoblastic leukemia.

Hyponatremia is common among children undergoing treatment for hematologic malignancies and may be attributed to multiple underlying causes. In cases of hyponatremia due to mixed physiology, the osmolal gap, can identify pseudohyponatremia that may be masked by other causes.

Health Literacy and Clinical Outcomes Following Hematopoietic Stem-Cell Transplantation.

Purpose: To test associations between health literacy and clinical outcomes in patients undergoing hematopoietic stem-cell transplantation (HSCT).

Methods: English- and Spanish-speaking patients age ≥ 18 years were recruited while admitted for first allogeneic HSCT. Associations between low health literacy (Newest Vital Sign ≤ 3 or Short Test of Functional Health Literacy in Adults ≤ 22) and HSCT outcomes were evaluated.

Missing Voices: Lessons Learned from Nonparticipating Caregivers in Palliative Care Research.

Our previous study to understand end-of-life care of adolescents and young adults (AYAs) had a suboptimal survey response rate by bereaved caregivers. To identify sociodemographic factors associated with caregiver nonparticipation. analysis of a retrospective multicenter cohort study of caregivers of deceased AYAs from 2013 to 2016.

The relationship between household income and patient-reported symptom distress and quality of life in children with advanced cancer: A report from the PediQUEST study.

Background: Children with advanced cancer experience high symptom distress, which negatively impacts their health-related quality of life (HRQOL). To the authors' knowledge, the relationship between income and symptom distress and HRQOL is not well described.

Methods: The Pediatric Quality of Life and Symptoms Technology (PediQUEST) multisite clinical trial evaluated an electronic patient-reported outcome system to describe symptom distress and HRQOL in children with advanced cancer via repeated surveys.

Disparities in prognosis communication among parents of children with cancer: The impact of race and ethnicity.

Background: Most parents of children with cancer say they want detailed information about their child's prognosis. However, prior work has been conducted in populations of limited diversity. The authors sought to evaluate the impact of parental race/ethnicity on prognosis communication experiences among parents of children with cancer.

Difficult relationships between parents and physicians of children with cancer: A qualitative study of parent and physician perspectives.

Background: Previous work on difficult relationships between patients and physicians has largely focused on the adult primary care setting and has typically held patients responsible for challenges. Little is known about experiences in pediatrics and more serious illness; therefore, we examined difficult relationships between parents and physicians of children with cancer.

Methods: This was a cross-sectional, semistructured interview study of parents and physicians of children with cancer at the Dana-Farber Cancer Institute and Boston Children's Hospital (Boston, Mass) in longitudinal primary oncology relationships in which the parent, physician, or both considered the relationship difficult.