Use of Peer Comparison, Provider Education, and Electronic Medical Record Triggers to Increase Influenza Vaccination Rates in Hospitalized Children.

BACKGROUND: The American Academy of Pediatrics recommends annual influenza vaccination for all children 6 months and older, yet only 59% of children nationally received the vaccine during the 2014-2016 influenza seasons. Of these, only 4% received the vaccine in a hospital setting. The goal of this quality improvement (QI) initiative was to increase influenza vaccination status at discharge at least twofold in children admitted to our hospital during the 2017-2018 influenza season compared with the 2016-2017 season. METHODS: The QI initiative was conducted in the inpatient units at a tertiary care children's hospital. Interventions included electronic medical record triggers, provider education, and peer comparison. The primary outcome measure was the percentage of children discharged from the hospital with at least 1 dose of the influenza vaccine received either at the hospital or before admission. Queries about the influenza vaccination status of children were used as a process measure. Length of stay was used as a balancing measure. RESULTS: The percentage of hospitalized children discharged with at least 1 dose of the vaccine increased 4.7-fold during the QI initiative (46%) compared with baseline (10%). There was a fourfold increase in parental query about the influenza vaccination status of their children (68%) during the QI initiative compared with the baseline period (16%). No significant difference occurred in the median length of stay among patients admitted during the QI initiative versus the baseline period. CONCLUSIONS: We increased influenza vaccination status among children admitted to our hospital using electronic medical record triggers, provider education, and peer comparison.

Impact of Contaminated Blood Cultures on Children, Families, and the Health Care System.

BACKGROUND: Contaminated blood cultures pose a significant burden. We sought to determine the impact of contaminated peripheral blood cultures on patients, families, and the health care system. METHODS: In this retrospective case-control study from January 1, 2014, to December 31, 2017, we compared the hospital course, return visits and/or admissions, charges, and length of stay of patients with contaminated peripheral blood cultures (case patients) with those of patients with negative cultures (controls). Patients were categorized into those evaluated and discharged from the emergency department (ED) (ED patients) and those who were hospitalized (inpatients). RESULTS: A total of 104 ED case patients were matched with 208 ED control patients. A total of 343 case inpatients were matched with 686 inpatient controls. There was no significant difference between case and control patient demographics, ED, or hospital course at presentation. Fifty-five percent of discharged ED patients returned to the hospital for evaluation and/or admission versus 4% of controls. There was a significant (P < .0001) increase in repeat blood cultures (43% vs 1%), consultations obtained (21% vs 2%), cerebrospinal fluid studies (10% vs 0%), and antibiotic administration (27% vs 1%) in ED patients compared with controls. Each ED patient requiring revisit to the hospital incurred, on average, $4660 in additional charges. There was a significant (P < .04) increase in repeat blood cultures (57% vs 7%), consultations obtained (35% vs 28%), broadening of antibiotic coverage (18% vs 11%), median length of stay (75 vs 64 hours), and median laboratory charges ($3723 vs $3296) in case inpatients compared with controls. CONCLUSIONS: Contaminated blood cultures result in increased readmissions, testing and/or procedures, length of stay, and hospital charges in children.