Ensuring No Death Is Ignored: Development of a Hospital Mortality Review and Notification System.

BACKGROUND AND OBJECTIVES: Standardized review of mortalities may identify potential system improvements. We designed a hospitalwide identification, review, and notification system for inpatient pediatric mortalities. METHODS: Key stakeholders constructed a future state process map for identification and review of deaths. An online mortality review form was modified through a series of Plan-Do-Study-Act cycles and spread to all pediatric services in January 2019. Mortalities occurring within 30 days of discharge were added in December 2019. Our primary outcome was percentage of mortalities reviewed, and the process measure was time to review completion. Additional Plan-Do-Study-Act cycles were used to refine 2 mechanisms for monthly notification of deaths. We surveyed monthly mortality notification e-mail recipients to elicit feedback to further improve notifications. RESULTS: After the pilot, 284 of 328 (86.6%) of mortalities were reviewed. Average time to review completion decreased by 49% compared with baseline after an increase during the first year of the pandemic. Qualitative analysis of a subset of these mortalities showed that 154 of 229 (67.2%) underwent further review. We added a summary of mortalities by unit to a monthly hospitalwide safety report and developed monthly mortality notification e-mails. The survey showed that 89% of respondents (70 of 79) learned about a death they did not know about, 58% (46 of 79) sought additional information through discussion with a colleague, and 76% (65 of 86) agreed that the notifications helped process grief. CONCLUSIONS: We describe an effective and well-received approach to the identification, review, and notification of mortalities at an academic pediatric hospital, which may be useful at other institutions.

A simulation procedure curriculum to increase pediatric resident exposure to procedures rarely performed in clinical practice.

BACKGROUND: Pediatrics residents are expected by the Accreditation Council for Graduate Medical Education to competently perform 13 procedures. However, residents are graduating with poor self-perceived competency for these procedures. OBJECTIVE: We developed a curriculum using simulation training at the beginning of internship and 'refresher' workshops throughout the year in order to increase procedure exposure and improve self-perceived competency. DESIGN: Procedural workshops were taught during intern orientation and to all pediatrics residents throughout the academic year. Residents provided a quantitative competency self-assessment before and after each workshop; interns provided an additional self-assessment at the end of the intern year. RESULTS: The curriculum was well-liked and led to more procedural experience. Mean competency self-assessment scores improved immediately after almost every procedure workshop. Mean scores were retained at the end of intern year for most procedures. However, end-of-year mean competency self-assessment and procedural experience on actual patients were similar to interns from a previous year that had not participated in the curriculum. CONCLUSIONS: A pre-internship procedure workshop coupled with longitudinal workshops is a feasible way to improve intern exposure to pediatric procedural training. However, it was not sufficient to improve mean competency self-assessments compared to a traditional model of bedside procedural training.

Sleep-disordered breathing is common among term and near term infants in the NICU.

OBJECTIVE: Among older infants and children, sleep-disordered breathing (SDB) has negative neurocognitive consequences. We evaluated the frequency and potential impact of SDB among newborns who require intensive care. STUDY DESIGN: Term and near-term newborns at risk for seizures underwent 12-h attended polysomnography in the neonatal intensive care unit (NICU). Bayley Scales of Infant Development, third edition (Bayley-III) were administered at 18-22 months. RESULT: The 48 newborns (EGA 39.3 ± 1.6) had a median pediatric apnea-hypopnea index (AHI) of 10.1 (3.3-18.5) and most events were central (vs obstructive). Maternal and prenatal factors were not associated with AHI. Moreover, neonatal PSG results were not associated with Bayley-III scores (P > 0.05). CONCLUSION: SDB is common among term and near-term newborns at risk for seizures. Follow-up at ages when more nuanced testing can be performed may be necessary to establish whether neonatal SDB is associated with long-term neurodevelopmental disability.