Food Insecurity Screening of Hospitalized Patients: A Descriptive Analysis.

OBJECTIVES: The purpose of this study is to describe an advocacy effort to implement a food insecurity (FI) screening during hospital admission and describe characteristics of hospitalized patients with household FI. METHODS: This is a descriptive study after the implementation of FI screening at a quaternary-care children's hospital in the Southeastern United States between August 2020 and April 2021. The Hunger Vital Sign, a 2-question screening tool for FI, was added to the intake questionnaire performed on inpatient admissions. A positive screen triggered a social work consult to connect patients with resources. Chart review and statistical analyses were performed on patients with household FI. RESULTS: There were 7751 hospital admissions during the study period, of which 4777 (61.6%) had an FI screen completed. Among those with a completed screen, 233 patients (4.9%) were positive for household FI. Patients with household FI were more likely to be Black (P <.001) and have Medicaid (P <.001). Social work documented care specific to FI in 125 of the 233 (56%) FI patients, of which 39 (31%) were not enrolled in the Women, Infants, and Children Program/Supplemental Nutrition Assistance Program. CONCLUSIONS: This initiative highlights hospitalization as an opportunity to screen for FI using a multidisciplinary approach. Our findings underscore the importance of identifying FI with the goal of reducing FI and mitigating the adverse effects of FI on child health outcomes.

Predictors of Potentially Unnecessary Transfers to Pediatric Emergency Departments.

OBJECTIVES: With soaring US health care costs, identifying areas for reducing cost is prudent. Our objective was to identify the burden of potentially unnecessary pediatric emergency department (ED) transfers and factors associated with these transfers. METHODS: We performed a retrospective analysis of Pediatric Hospital Information Systems data. We performed a secondary analysis of all patients ≤19 years transferred to 46 Pediatric Hospital Information Systems-participating hospital EDs (January 1, 2013, to December 31, 2014). The primary outcome was the proportion of potentially unnecessary transfers from any ED to a participating ED. Necessary ED-to-ED transfers were defined a priori as transfers with the disposition of death or admission >24 hours or for patients who received sedation, advanced imaging, operating room, or critical care charges. RESULTS: Of 1 819 804 encounters, 1 698 882 were included. A total of 1 490 213 (87.7%) encounters met our definition for potentially unnecessary transfer. In multivariate analysis, age 1 to 4 years (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.34-1.39), female sex (OR, 1.08; 95% CI, 1.07-1.09), African American race (OR, 1.51; 95% CI, 1.49-1.53), urban residence (OR, 1.75; 95% CI, 1.71-1.78), and weekend transfer (OR, 1.06; 95% CI, 1.05-1.07) were positively associated with potentially unnecessary transfer. Non-Hispanic ethnicity (OR, 0.756; 95% CI, 0.76-0.78), nonminor severity (OR, 0.23; 95% CI, 0.23-0.24), and commercial insurance (OR, 0.86; 95% CI, 0.84-0.87) were negatively associated. CONCLUSIONS: There are disparities among pediatric ED-to-ED transfers; further research is needed to investigate the cause. Additional research is needed to evaluate how this knowledge could mitigate potentially unnecessary transfers, decrease resource consumption, and limit the burden of these transfers on patients and families.

What Defines an Honors Student? Survey of Pediatric and Internal Medicine Faculty Perspectives.

OBJECTIVE: Although considerable emphasis is placed on the attainment of honors in core medical school clerkships, little is known about what student characteristics are used by attending physicians to earn this designation. The purpose of this study was to evaluate what values and characteristics that attending physicians consider important in the evaluation of Pediatrics and Internal Medicine clerkship students for clinical honors designation. METHODS: This cross-sectional survey study was framed around Accreditation Council for Graduate Medical Education (ACGME) competencies. It was administered at three tertiary care hospitals associated with one large medical school in an urban setting. Teaching ward attendings in Pediatrics and Internal Medicine who evaluated third-year medical students between 2013 and 2016 were surveyed. RESULTS: Overall, Pediatric and Internal Medicine faculty demonstrated close agreement in which competencies were most important in designating clinical honors. Both groups believed that professionalism was the most important factor and that systems-based practice and patient care were among the least important factors. The only competency with a significant difference between the two groups was systems-based practice, with Internal Medicine placing more emphasis on the coordination of patient care and understanding social determinants of health. CONCLUSIONS: Professionalism, communication skills, and medical knowledge are the most important characteristics when determining clinical honors on Pediatrics and Internal Medicine clerkships.