Introduction of a rounding sticker improves care and reduces infection rates in the Pediatric Intensive Care Unit (PICU).

As part of our plan to decrease infection rates, we instituted a rounding sticker used during daily rounds. This sticker is a checklist that serves as a reminder of interventions known to improve quality of care in the PICU. It is completed daily and placed in the bedside chart of all patients in the Pediatric Intensive Care Unit (PICU) at Arkansas Children's Hospital. Date was collected on central venous catheter days, foley catheter days, arterial line days, infection rates, GI prophylaxis use, neuromuscular blocker use, and changes in medications before and after institution of the rounding sticker. Following rounding sticker use, there was a 56% reduction in urinary tract infections [4.13/1000 device days vs 1.8/1000 device days; p = 0.027], as well as an increase in GI prophylaxis (1846 vs 2399) and enoxaparin (119 vs 151) use.

Redefining the golden hour in pediatric transport.

OBJECTIVE: To emphasize the urgent need for research efforts and application of goal-directed therapy in the pediatric transport environment. DESIGN: Review of existing literature and commentary on current pediatric transport practices. CONCLUSIONS: Pediatric transport has evolved significantly since its inception >2 decades ago. Advancements in technology and therapeutic interventions now afford an opportunity to extend intensive care into the transport environment. However, misapplication of the concept of the golden hour has led to a focus on speed of transfer to tertiary care facilities, often delaying early, goal-directed therapeutic interventions. If we are to further improve outcomes for critically ill children, we must extend early institution of goal-directed therapy into the pretertiary hospital setting and bring expertise to the child.

Hurricane Katrina: emergent interstate transport of an evacuee on biventricular assist device support.

In many U.S. hospitals, mechanical circulatory support has become routine. However, catastrophes such as Hurricane Katrina test the abilities of a hospital system to sustain patients on such support and transport them in emergent situations. A 15-year-old boy with dilated cardiomyopathy who was receiving biventricular mechanical circulatory support at a New Orleans hospital was successfully transported by Angel One Transport from Arkansas Children's Hospital across state lines to Texas Children's Hospital, where he was stabilized and received an orthotopic heart transplant.