Implementing an evidence-based acute gastroenteritis guideline at a children's hospital.

Background: Guidelines for preventing and treating acute gastroenteritis (AGE) have generally not been incorporated into medical practice. An evidence-based clinical practice guideline was adapted from national guidelines to meet the practice styles characterizing care in southwestern Ohio and implemented at the Children's Hospital Medical Center (Cincinnati). Its efficacy was assessed in terms of emergency department (ED) encounters and admissions, mean and total hospital costs, and mean length of hospitalization.

Sustaining the implementation of an evidence-based guideline for bronchiolitis.

Objective: To describe the changes occurring over a 3-year period after implementation of an evidence-based clinical practice guideline for the care of infants with bronchiolitis.

Design: Before and after study.

Setting: Children's Hospital Medical Center, Cincinnati, Ohio.

Differential markers for regionalization.

Objective: To examine the site of delivery for very low birth weight (VLBW) infants and infants with major congenital malformations (MCM) within an established system of perinatal regionalization.

Study Design: A retrospective study of site of delivery for VLBW infants and infants born with MCM (tracheoesophageal fistula/esophageal atresia, diaphragmatic hernia, or gastroschisis/omphalocele) from 1990 through 1995 in Ohio.

Results: A total of 59.

Prenatal care and infant emergency department use.

Objective: To determine the relationship between mothers' use of prenatal care and pediatric emergency department (ED) use by their infants in the first 3 months of life.

Methods: This is a retrospective, cohort-control study of well, full-term infants who use a children's hospital ED. Using logistic regression, the likelihood of an emergency visit in the first 3 months of life was compared between infants of women with fewer than two prenatal visits and infants of women with two or more prenatal visits.

Evaluation of an evidence-based guideline for bronchiolitis.

Objective: To describe the effect of implementing an evidence-based clinical practice guideline for the inpatient care of infants with bronchiolitis at the Children's Hospital Medical Center in Cincinnati, Ohio.

Methodology: A multidisciplinary team generated the guideline for infants < or = 1 year old who were admitted to the hospital with a first-time episode of typical bronchiolitis. The guideline was implemented January 15, 1997, and data on all patients admitted with bronchiolitis from that date through March 27, 1997, were compared with data on similar patients admitted in the same periods in the years 1993 through 1996.

Safety of early discharge for Medicaid newborns.

Context: Neonates are being discharged from the hospital more rapidly, but the risks associated with this practice, especially for low-income populations, are unclear.

Objective: To determine the impact of decreasing postnatal length of stay on rehospitalization rates in the immediate postdischarge period for Medicaid neonates.

Design And Setting: Retrospective, population-based cohort study using Ohio Medicaid claims data linked to vital statistics files from July 1, 1991, to June 15, 1995.

Physician variations and the ancillary costs of neonatal intensive care.

Objective: To determine to what degree attending physicians contribute to cost variations in the care of ventilator-dependent newborns.

Data Sources: Clinical data were merged with hospital financial data describing daily ancillary care costs during the first two weeks of life for 132 extremely low-birthweight newborns. In addition, each patient's chart was reviewed and illness severity graded using both SNAP and CRIB scores.

Use of hospital-based services in the first three months of life: impact of an early discharge program.

Objective: To assess the effect of an early discharge program on the use of hospital-based health care services in the first 3 months of life.

Design: Retrospective cohort study.

Setting: Metropolitan university hospital and a children's hospital.

The influence of day of life in predicting the inpatient costs for providing care to very low birth weight infants.

The purpose of this study was to test, refine, and extend a statistical model that adjusts neonatal intensive care costs for a very low birth weight infant's day of life and birth weight category. Subjects were 62 infants with birth weights below 1,501 g who were born and cared for in a university hospital until discharged home alive. Subjects were stratified into 250-g birth weight categories.

Use of health care services by inner-city infants in an early discharge program.

Objective: To assess the use of health care services by inner-city infants enrolled in an early discharge program who received care in tertiary care children's hospital primary care clinic.

Design: Retrospective cohort study.

Setting: Large, metropolitan university hospital and a children's hospital.

Description and evaluation of a program for the early discharge of infants from a neonatal intensive care unit.

The effect of a cost-containment program focused on decreasing the lengths of hospital stay of high-risk neonates was assessed by comparison of discharge weights and lengths of stay for 257 study infants, discharged from a neonatal intensive care unit (NICU) after an early-discharge program began, with those of 477 control infants discharged during a prior 1-year period. Demographic data and costs, as well as data on emergency department use and hospital readmissions, were included in the comparisons. There was a significant decrease in mean discharge weight and length of stay for infants in the study group.

Acuity scores as predictors of cost-related outcomes of neonatal intensive care.

Objective: The Medicus Patient Classification System (PCS) and the lameter Acuity Index Method (AIM) are two proprietary scoring systems in common use for stratifying patient populations before making comparisons of the medical care they receive. In this study the validities of these scores were tested when the scores were used to evaluate cost-related elements of high-risk neonatal intensive care.

Methods: A total of 687 surviving inborn infants cared for in a university hospital newborn intensive care unit provided data for these analyses.

Local skin hyperthermia due to transcutaneous electrode heat.

The hypothesis that a transcutaneous monitor electrode can heat skin beyond the electrode edge was tested. This heating would cause a skin thermistor probe, if placed too close to the transcutaneous electrode, to transduce an artifactually high skin temperature. In a skin servo control system, this might result in a cooler environment than desired.

A computer-generated blood gas display in a newborn intensive care unit.

A computer was programmed to collect, store, analyze, and display blood gas data in a newborn intensive care unit. Data were displayed if they were (1) markedly abnormal or (2) represented a worsening trend. A controlled study demonstrated that, with the display, the markedly abnormal blood gas values were followed by normal values in a shorter period, and fewer worsening trends progressed.

Tuberculosis in pregnancy with fatal congenital infection.

An unusual case of miliary tuberculosis which presented as fever and a tubo-ovarian abscess in a postpartum patient is described. Fatal congenital tuberculosis was also diagnosed in the mother's premature infant. The difficulties encountered in diagnosing the tuberculosis in these patients are summarized, and the need for early recognition and therapy is emphasized.

Neonatal hotline telephone network.

By simplifying the process by which telephone contacts are made, improved communications were established between a university-affiliated newborn intensive care center and some of the community hospital nurseries that it serves as a regional resource. Initiation of the improved system of communications was associated with a significant improvement in the survival of infants transferred from the community hospitals to the regional care facility.

Errors in drug computations during newborn intensive care.

Medical personnel in a pediatric center were tested for their ability to correctly compute drug doses for sick newborns. One of every 12 doses computed by 95 registered nurses contained an error that would result in the administration of an amount that was ten times higher or lower than the dose ordered. The error rate was no different for experienced or inexperienced nurses.

Computer-assisted newborn intensive care.

A minicomputer has been programmed to aid in the intensive care of high-risk newborn babies. The computer provides 24-hour on-line access to physiologic and environmental data and controls the heating of infant incubators. The control algorithm limits fluctuations in the incubator chamber and protects the infant against escape from neutral thermal conditions.

Use of pertussis vaccine in an epidemic involving hospital staff.

An epidemic of pertussis occurred among hospital staff caring for paediatric patients. Eight physicians and five nurses were affected. Pertussis developed in six newborn infants exposed to infected hospital staff in the nursery.