DeSante J, Degrazia D, Danis M. Parents of adults with diminished self-governance. Camb Q Healthcare Ethics. 2016 Jan;25(1):93-107.
Pushing the chick towards the edge of the nest. While there are multiple philosophical theories on parenthood and the duties of a parent, all of them based on the assumption that the child will grow up to be an independent and autonomous adult. There is a dearth of guidance for the parents of medically complex children who will remain dependent on their parents for the remainder of their lives. Based on common characteristics of these parent-child relationships and several philosophical accounts of parental obligations, the team extrapolated the duties of parents to parents of semiautonomous adult children. Parents of these children have an obligation to promote autonomy and independence in their children from a young age, above and beyond the obligation of most parents.
Li Q, Kirkendall ES, Hall ES, Ni Y, Lingren T, Kaiser M, Lingren N, Zhai H, Solti I, Melton K. Automated detection of medication administration errors in neonatal intensive care. J Biomed Inform. 2015 Oct;57:124-33.
Stop that medication. The traditional reporting mechanism for medication errors is paper-based, voluntary incident reporting. However, electronic medical records provide opportunities for efficient, automated, and scalable ways to detect and alert prescribers to these errors. Using a computerized algorithm, identification of medication administration errors for patients in the neonatal intensive care unit was far more sensitive (82%) than traditional incident reporting (5%). In addition, the computerized algorithms also had increased precision (70%) over traditional incident reporting (50%). These algorithms are an important addition to existing safety systems that allow the identification of medical errors in real-time.
Auger KA, Mueller EL, Weinberg SH, Forster CS, Shah A, Wolski C, Mussman G, Ipsaro AJ, Davis MM. A validated method for identifying unplanned pediatric readmission. J Pediatr. 2016 Mar;170:105-12.
Towards more reliable measurement of quality of care. Some State Medicaid agencies view readmissions as a measure of quality of care and penalize hospitals with higher than expected readmission rates. In determining readmission rates, hospitals must distinguish planned or scheduled medical (e.g., initiation of a ketogenic diet) and surgical (e.g., gastrostomy tube placement) from unplanned readmissions. However, there is no widely accepted and validated method to distinguish unplanned from scheduled admissions. This study identified and validated a new method to easily and reliably identify unplanned readmissions by examining hospital registration time and patient arrival time. Widespread use of this metric permit meaningful comparison of readmissions across hospitals, offering a reliable metric for policy makers.
Parker MW, Shah SS, Hall M, Fieldston M, Fieldston ES, Coley BD, Morse RB. Computed tomography and shifts to alternate imaging modalities in hospitalized children. Pediatrics. 2015 Sep;136(3):e573-81.
Reducing risks and costs of medical care. Computed tomography or CT scans, special x-rays that allow doctors to see organs, bones, and blood vessels, can improve the diagnosis of certain conditions. However, they also expose the patient to ionizing radiation, which likely increases the risk of future cancer. This study examined trends in CT use at 33 children’s hospitals over a nine year period. The authors found that CT use decreased by as much as 40% for some conditions such as appendicitis and concussions. They attribute this decrease to several factors. First, there is a greater awareness of the potential harms of even relatively small amounts of ionizing radiation. A notion supported by their finding that much of this decrease was attributable to shifts to imaging modalities such as MRI or ultrasound that do not expose patients to ionizing radiation. Second, there is recognition through national campaigns such as “Image Gently,” by the Alliance for Radiation Safety in Pediatric Imaging, and “Choosing Wisely,” a cause championed by the Society for Hospital Medicine, that more testing does not necessarily improve patient outcomes.
Thomson J, Hall M, Ambroggio L, Stone B, Srivastava R, Shah SS, Berry JG. Aspiration and Non-Aspiration Pneumonia in Hospitalized Children With Neurologic Impairment. Pediatrics. 2016 Feb;137(2):e20151612.
Pneumonia in children with medical complexity. Children with neurologic impairment are commonly hospitalized with pneumonia. This study of >27,000 children from >40 U.S. hospitals found that neurologically impaired children with pneumonia caused by aspiration of stomach contents (i.e., aspiration pneumonia) have more complications, and greater hospital utilization, than children with other causes of pneumonia. Specifically, children with aspiration pneumonia were 20% more likely to have complications, such as respiratory failure, and 40% more likely to require intensive care unit transfer than children diagnosed with other causes of pneumonia. These findings highlight the need for more research into treatment and prevention of aspiration pneumonia in neurologically impaired children.