A 'PEaRL' of Support and Cooperative Learning: A Pilot Study Shifting the Sands of the Dreaded Morbidity and Mortality Conference.

BACKGROUND: When unanticipated and/or poor patient outcomes occur, clinicians frequently experience guilt, anger, psychological distress, and fear, which can be intensified by traditional morbidity and mortality conferences. METHODS: The Pediatric Event Review and Learning (PEaRL) curriculum was developed to discuss unanticipated and/or poor patient outcomes and foster support while highlighting foundational safety concepts. Pre- and post-implementation evaluations of quarterly cased-based sessions were completed. RESULTS: All respondents endorsed that unanticipated and/or poor patient outcomes affected their mood, well-being, and functioning. Post-implementation of the PEaRL curriculum, significantly more respondents endorsed existence of a safe environment and structured format to discuss these outcomes, as well as feeling more supported. DISCUSSION: The PEaRL curriculum provides a valuable opportunity for trainees and experienced clinicians alike to explore and discuss unanticipated and/or poor patient outcomes while addressing key patient safety principles.

Kwashiorkor in an 8-Month-Old Infant Due to Homemade Formula Use.

INTRODUCTION: Kwashiorkor is a malnutrition syndrome most commonly seen in the United States among patients with malabsorptive conditions. While it is rare in otherwise healthy individuals, cases can develop where low nutritional literacy or unorthodox diets are a factor. CASE PRESENTATION: We present an 8-month-old infant who developed kwashiorkor after transitioning to homemade infant formula. DISCUSSION: This patient developed severe malnutrition due to consumption of homemade formula that did not meet nutritional standards. The recipe was promoted by an alternative health organization as a healthy option, and the difficulty in identifying reliable health information online also played a significant role. CONCLUSIONS: Families of young children face many challenges, particularly during the recent infant formula shortage. Maintaining strong relationships and open communication with trusted health care professionals is vital to combating health misinformation and helping patients and families navigate these challenges safely.

A pause in pediatrics: implementation of a pediatric diagnostic time-out.

OBJECTIVES: Diagnostic errors are frequently the product of cognitive biases that arise when heuristic-based approaches fail. The efficiency-thoroughness tradeoff (ETTO) principle states sacrificing thoroughness for efficiency is normal and occurs frequently in medicine. The goal of a diagnostic timeout was to provide an actionable template for when providers transition to an analytical mindset and to help incorporate the ETTO principle during the diagnostic process. METHODS: A diagnostic time-out was adapted for use in pediatric hospital medicine (PHM). In this prospective study, a group of eight PHM providers piloted the time-out in the hospitalized setting. Data was collected over 12 months and descriptive statistics were used for analysis. RESULTS: Cases were most frequently chosen for time-out use due to clinician intuition. In more than half the cases the time-out didn't confirm the initial diagnosis and alternate diagnoses for the wrong diagnosis were pursued. There was only one case of the time-out being burdensome from a time perspective. Learners participated in all cases. As a result of the diagnostic time-out, new actions were taken in all cases. CONCLUSIONS: Implementation of a diagnostic time out provides an actionable template for providers to actively change their mindset to an analytical thinking process to counteract cognitive biases and potentially reduce diagnostic errors in the pediatric inpatient setting.