Publications by authors named "Paula Soung"
Objectives: Dexamethasone has become the standard of care for pediatric patients with status asthmaticus in the emergency department (ED) setting. Inpatient providers often must decide between continuing the second dose of dexamethasone or transitioning to prednisone. The effectiveness of receiving dexamethasone followed by prednisone (combination therapy) compared to only prednisone or dexamethasone remains unclear.
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- Osteoarticular infections (OAIs) in children can be risky if not treated properly, prompting the introduction of a clinical practice guideline (CPG) aimed at reducing broad-spectrum and IV antibiotic use while increasing the use of narrow-spectrum oral antibiotics.
- Over 96 months, the study analyzed data from 330 patients, achieving significant improvements: broad cephalosporin use dropped from 47% to 10%, IV antibiotic discharge rates decreased from 75% to 11%, and discharge on narrow-spectrum oral antibiotics rose from 24% to 84%.
- The CPG implementation resulted in fewer adverse drug reactions (down from 31% to 10%), while other factors like complication rates and readmissions remained stable
Article Synopsis
- The study evaluates pediatric hospital providers' preferences for prescribing dexamethasone versus prednisone for hospitalized asthma patients, noting that while dexamethasone is often favored for those with oral tolerance issues, prednisone remains the go-to for more severe cases.
- Surveys were conducted in 2019 and 2021, revealing a rising acceptance of dexamethasone, yet significant disagreement among providers regarding its use.
- Despite some shifts in prescribing practices, the length of dexamethasone therapy did not appear to impact the choice of steroid among providers.
Wheezing is a common finding across patients of all age groups presenting to the emergency department and being hospitalized for respiratory distress, with most patients responding to standard therapeutics and having readily apparent diagnoses of asthma or bronchiolitis. We describe several clinical entities that may present with wheezing and respiratory distress, calling attention to the broad differential that may masquerade as asthma or bronchiolitis, and potentially lead to misdiagnosis, delayed diagnosis, or inappropriate treatment.
View Article and Find Full Text PDFObjectives: The health care system faces ongoing challenges due to low-value care. Building on the first pediatric hospital medicine contribution to the American Board of Internal Medicine Foundation Choosing Wisely Campaign, a working group was convened to identify additional priorities for improving health care value for hospitalized children.
Methods: A study team composed of nominees from national pediatric medical professional societies was convened, including pediatric hospitalists with expertise in clinical care, hospital leadership, and research.
Background And Objectives: Factorial design of a natural experiment was used to quantify the benefit of individual and combined bundle elements from a 4-element discharge transition bundle (checklist, teach-back, handoff to outpatient providers, and postdischarge phone call) on 30-day readmission rates (RRs).
Methods: A 2 factorial design matrix of 4 bundle element combinations was developed by using patient data ( = 7725) collected from January 2014 to December 2017 from 4 hospitals. Patients were classified into 3 clinical risk groups (CRGs): no chronic disease (CRG1), single chronic condition (CRG2), and complex chronic condition (CRG3).
Background: Our internal infant sepsis evaluation clinical practice guideline recommends infants with negative culture results who are undergoing sepsis evaluation receive antibiotics until culture results are negative for a maximum of 36 hours. The aims of our project were to decrease the percentage of patients who received >30 hours of administered antibiotic doses (recognizing effective concentrations last until hour 36) and increase 36-hour phrase documentation by using clinical decision support tools.
Methods: We used quality improvement methodology to study infants aged ≤60 days with negative culture results.
Background And Objectives: Paging is a primary mode of communication in hospitals, but message quality varies. With this project, we aimed to standardize paging, thus improving end user (EU) satisfaction, patient safety, and efficiency. Objectives were to increase the percent of pages containing 6 critical elements (CEs) (ie, the sender's first and last name, a 7-digit callback number, patient name, room number, and urgency indicator [information only, call, or come] to 90%); improve EU satisfaction to 80% rating paging communication as good or excellent; and decrease the frequency of safety events related to paging.
View Article and Find Full Text PDFBackground And Objectives: To improve hospital to home transitions, a 4-element pediatric patient-centered transition bundle was developed, including: a transition readiness checklist; predischarge teach-back education; timely and complete written handoff to the primary care provider; and a postdischarge phone call. The objective of this study was to demonstrate the feasibility of bundle implementation and report initial outcomes at 4 pilot sites. Outcome measures included postdischarge caregiver ability to teach-back key home management information and 30-day reuse rates.
View Article and Find Full Text PDFObjective: The primary objective of this study was to establish the validity and reliability of 2 respiratory scores, the Respiratory Distress Assessment Instrument (RDAI) and the Children's Hospital of Wisconsin Respiratory Score (CHWRS), in bronchiolitis. A secondary objective was to identify the respiratory score components that most determine overall respiratory status.
Methods: This was a prospective cohort study in infants aged < 1 year seen at Children's Hospital of Wisconsin for bronchiolitis.