Use of central venous access devices outside of the pediatric intensive care units.

BACKGROUND: Central venous access devices (CVAD) are associated with central line associated bloodstream infection (CLABSI) and venous thromboembolism (VTE). We identified trends in non-intensive care unit (ICU) CVAD utilization, described complication rates, and compared resources between low and high CVAD sites. METHODS: We combined data from the Pediatric Health Information System (PHIS) database and surveys from included hospitals. We analyzed 10-year trends in CVAD encounters for non-ICU children between 01/2012-12/2021 and described variation and complication rates between 01/2017-12/2021. Using Fisher's exact test, we compared resources between low and high CVAD users. RESULTS: CVAD use decreased from 6.3% to 3.8% of hospitalizations over 10 years. From 2017-2021, 67,830 encounters with CVAD were identified. Median age was 7 (IQR 2-13) years; 46% were female. Significant variation in CVAD utilization exists (range 1.4-16.9%). Rates of CLABSI and VTE were 4.0% and 3.4%, respectively. Survey responses from 33/41 (80%) hospitals showed 91% had vascular access teams, 30% used vascular access selection guides, and 70% used midline/long peripheral catheters. Low CVAD users were more likely to have a team guiding device selection (100% vs 43%, p = 0.026). CONCLUSIONS: CVAD utilization decreased over time. Significant variation in CVAD use remains and may be associated with hospital resources. IMPACT: Central venous access device (CVAD) use outside of the ICU is trending down; however, significant variation exists between institutions. Children with CVADs hospitalized on the acute care units had a CLABSI rate of 4% and VTE rate of 3.4%. 91% of surveyed institutions have a vascular access team; however, the services provided vary between institutions. Even though 70% of the surveyed institutions have the ability to place midline/long peripheral catheters, the majority use these catheters less than a few times per month. Institutions with low CVAD use are more likely to have a vascular access team that guides device selection.

Outcomes of a dexamethasone-prednisone combination treatment course for status asthmaticus.

OBJECTIVES: Dexamethasone has become the standard of care for pediatric patients with status asthmaticus in the emergency department (ED) setting. Inpatient providers often must decide between continuing the second dose of dexamethasone or transitioning to prednisone. The effectiveness of receiving dexamethasone followed by prednisone (combination therapy) compared to only prednisone or dexamethasone remains unclear. This study compares patient characteristics and ED reutilization/hospital readmission outcomes of dexamethasone, prednisone, and combination therapy for inpatient asthma management. METHODS: A retrospective study was conducted at our tertiary children's hospital of children aged 2 to 18 years hospitalized between March 2016 and December 2018 with a primary discharge diagnosis of asthma, reactive airway disease, or bronchospasm. The differences between steroid groups were compared using Fisher's exact or Chi-square tests for categorical variables, and a Kruskal-Wallis test for continuous variables. A multivariable logistic regression was performed to analyze ED reutilization and hospital readmission rates. RESULTS: 1697 subjects met inclusion criteria. 115 (6.8%) patients received dexamethasone, 597 (35.2%) received prednisone, and 985 (58.0%) received combination therapy. Patients prescribed combination therapy had a lower exacerbation severity than patients prescribed prednisone, but higher severity than patients prescribed dexamethasone (p < .001, p = .001, respectively). Dexamethasone and combination therapy were not associated with increased 30-day ED reutilization/hospital readmissions compared to prednisone (p > .05). CONCLUSIONS: In our study, most patients hospitalized for status asthmaticus received combination therapy. Despite the differences in severity between steroid groups, outcomes of combination therapy and dexamethasone monotherapy, as measured by frequency of ED reutilizations/hospital readmissions, are comparable to prednisone monotherapy.

Adolescent Drug Ingestions Requiring ICU Stay: Single-Center Retrospective Cohort Study.

OBJECTIVES: Ingestions are a prevalent form of self-harm in teenagers and are unfortunately an increasingly common reason for admission to both acute care and critical care services. The goal of this study was to identify characteristics associated with requiring PICU stay among adolescents hospitalized for ingestions. DESIGN: Retrospective cohort study comparing patients admitted to hospital medicine service and critical care service from January 2019 to December 2019. SETTING: Freestanding children's hospital in the midwestern United States. PATIENTS: Adolescents 12-18 years old hospitalized for ingestion. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Out of 209 patients included in the study cohort, 95 required PICU admission. High-risk behaviors (having had sex or usage of alcohol, drugs, tobacco, or vaping) were endorsed by 190 of 209 patients (91%). We compared patient characteristics, ingestion history, workup, and pharmacological and PICU-specific interventions between patients hospitalized on the hospital medicine service and the PICU. We failed to identify an association between reason for ingestion, substance ingested, and previously identified suicide risk factors including previous suicide attempt, previous self-harm, and psychiatric comorbidity and admission to PICU, as opposed to non-PICU admission. PICU stay was associated with longer peak corrected QT interval value, receiving a pharmacological intervention, and longer duration of hospital stay. Fifteen of 95 patients (16% [95% CI, 9-25%]) in the PICU received a PICU-specific intervention. CONCLUSIONS: We failed to identify specific patient demographics or mental behavioral health characteristics associated with PICU stay after ingestion. Therefore, we believe that all adolescents hospitalized due to ingestion-irrespective of disposition-should receive standardized high-risk behavior screening due to the pervasive nature of these behaviors among this patient population. PICU-specific care, beyond observation, could be needed in as high as one-in-four PICU admissions. Further research is needed to inform optimal disposition and resource allocation for this patient population.

The impact of global health opportunities on residency selection.

BACKGROUND: An increasing number of medical trainees across specialties desire and expect Global Health (GH) experiences during training. It is useful for residency programs to know the impact that offering GH opportunities has on resident recruitment. The study objectives were to explore the importance of GH opportunities in residency selection among fourth-year medical students, examine the relationship between interest in GH and career plans, and describe students' perspectives on prior GH experiences. METHODS: The authors administered an electronic survey to all fourth-year medical students attending 12 different US institutions in February 2020. Data from the ten schools who were able to comply with the survey distribution methodology and with response rates above 25% were analyzed using descriptive statistics and Pearson's correlation. RESULTS: A total of 707 fourth-year medical students from the included schools completed the survey out of 1554 possible students (46% response rate). One third of respondents ranked the presence of GH experiences in residency as moderately or very important and 26% felt that the presence of a formal GH curriculum was at least moderately important, with variation noted among specialties. After training, 65% of students envision practicing internationally in some capacity. A desire to care for underserved patients in their careers was significantly correlated with an interest in GH experiences during residency. CONCLUSIONS: The opportunity to be involved in GH experiences during training can be an important factor for many medical students when considering residency choice, and the availability of these opportunities may be a valuable recruitment tool. Students valuing GH opportunities during residency are more interested in working with underserved populations in their future careers.

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.

Impact of COVID-19 on Acute Care Hospitalizations for Suicidality.

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic contributed to the public health crisis for pediatric mental health. We characterized our local patient population presenting with suicidality or suicide attempts before and after the pandemic by examining: 1. frequencies of hospitalizations for suicidality to determine whether they differed by age, legal sex, race and ethnicity, or socioeconomic status; 2. average length of stay and discharge disposition; 3. 7-, 30-, and 365-day reutilization rates; and 4. admission trends during COVID-19 surges. METHODS: Retrospective data between March 2018 and March 2022 was analyzed, including patients ages 10 to 17 years hospitalized for either suicidality or a suicide attempt at 1 freestanding tertiary care pediatric medical hospital in the Midwest. Encounters were divided into 2 categories on the basis of the COVID-19 pandemic: "Prelockdown" (March 1, 2018-March 12, 2020) and "postlockdown" (March 13, 2020-March 31, 2022). Patients were limited to 1 presentation pre- and postlockdown. We analyzed frequencies using means and SDs, categorical data using χ2 and Fisher's exact tests, and continuous data with t tests. RESULTS: A total of 1017 encounters were included, stratified into pre- and postlockdown groups for analysis (909 encounters, 889 unique patients). There was a significant difference in 365-day reutilization pre- and postlockdown when analyzing re-presentation to the emergency department (P = .025) and hospital readmission (P = .006). Admissions incrementally increased after the COVID-19 alpha variants in September 2020 and again after the delta variant in August 2021. CONCLUSIONS: The COVID-19 pandemic further intensified the already critical issue of pediatric mental health, demonstrating increased reutilization in the year after their initial presentation and an increase in admissions after the alpha variant.

Hospitalized Adolescents' Perspectives on Sexual and Reproductive Health Discussions.

OBJECTIVES: Experts recommend that providers discuss adolescent patients' sexual and reproductive health (SRH) at any health care encounter, including hospitalizations. The purpose of this qualitative study was to gain insight into hospitalized adolescents' experiences and perspectives on SRH discussions (SHDs) to better inform patient-centered care. METHODS: Private semistructured interviews were conducted with hospitalized adolescents aged 13 to 17 years. Interviews were coded and analyzed using thematic analysis. Themes were developed through an iterative process with focus on the primary research aim. RESULTS: Twenty participants were interviewed with a median age of 15.4 years. Adolescents expressed a range of preferences related to SHDs with providers. Themes included (1) experiences discussing SRH with providers, (2) SHDs during hospitalization, (3) communication preferences, and (4) perceptions of why providers initiate SHDs. Viewpoints about SHDs during hospitalizations varied, including that they addressed unmet needs, as well as that they seemed irrelevant to some participants. Aspects that facilitate SHDs include brevity with relevant depth, nonjudgmental provider demeanor, and reassurance of privacy. Some participants believed providers could judge the depth of discussion needed on the basis of the adolescent's age or personality. CONCLUSIONS: This study highlights variation in adolescents' preferences around SHDs with health care providers. Providers should initiate SHDs with statements of purpose and confidentiality. Given the variation in adolescents' perspectives, tools to privately collect self-reported behaviors before an SHD may help providers frame the conversation to the adolescent's specific SRH needs and communication style preferences.

The Rounds Efficiency Index: A Novel Physics-Based Construct for Patient- and Family-Centered Rounds.

BACKGROUND AND OBJECTIVES: Efficiently conducting patient- and family-centered rounds (PFCR) is challenging, particularly without a measure of efficiency. In physics, efficiency is the ratio of work output to work input. We sought to evaluate PFCR efficiency via a novel construct rooted in physics. Our objectives were to (1) Establish baseline work output for clinical work (CW), educational effectiveness (EE), and family experience (FE); (2) establish baseline work input for rounds length (RL); and (3) begin preliminary construction of a rounds efficiency index (REI) as a measure of PFCR efficiency. METHODS: Four components of rounds efficiency were collected on 5 inpatient acute care teams during a baseline period. CW consisted of the percentage of daily orders placed on rounds. EE was assessed via survey for trainees and FE by families. RL was recorded in minutes per patient. During an 8-week intensive period, the REI (reported as %) was calculated as a ratio of work output/work input using aggregate mean/median ratings for CW, EE, FE, and RL. RESULTS: Baseline data included 809 orders, 28 EE ratings, 21 FE ratings, and RL mean of 11.4 minutes per patient. During the intensive period, the median team-specific weekly REI for the end versus beginning of the academic year was 58% and 52.5% (P = .17), respectively. The median REI during the start and end of the block was 49% and 57% (P = .15), respectively. CONCLUSIONS: The study assessed 4 components of efficiency (CW, EE, FE, RL) and calculated REI allowing for a preliminary tool to measure rounding efficiency. With this, targeted interventions can improve PFCR efficiency.

Educational Podcast Impact on Student Study Habits and Exam Performance.

BACKGROUND: Emerging technologies, trainees' proficiency with digital resources, and the COVID-19 pandemic have increased the role of mobile and asynchronous learning methods in medical education. Educational podcasts have gained popularity in both formal curricula and independent learning, but their impact on educational outcomes has not been well studied. METHODS: We conducted a prospective cohort study of third-year medical students during pediatrics clerkship. An educational podcast series titled "Peds Soup" was introduced to students as a voluntary study resource. We surveyed students at the end of the rotation to assess study habits and perceptions of the podcast. We compared survey responses from podcast users and nonusers, and used standardized pediatrics subject examination scores to measure knowledge differences between groups. RESULTS: Eighty-three students participated in the study. Peds Soup listeners (n=43) reported spending significantly more time studying during clerkship (M=16.5, SD=9.0 vs M=12.4, SD=9.2 hours/week, P=.009) than nonlisteners. Users expressed positive views toward the podcast's impact on introducing, reinforcing, and helping apply knowledge, and endorsed that Peds Soup made it easier to find time to study. Examination scores did not differ between the two groups. DISCUSSION: The podcast demonstrated a reaction-level impact, with users reporting positive attitudes toward the podcast's impact and spending more time studying during pediatrics clerkship. Podcasts have strong potential as a supplement to existing curricula, where they can fill a need for interested learners. Future research should focus on the relationship between time spent and knowledge gain or utilize alternative measures of knowledge.

After "The Talk": Adolescents' Perspectives Reveal Need for Improvement in Hospital Sexual Health Care Delivery.

OBJECTIVES: To fill access gaps for adolescents, addressing sexual and reproductive health (SRH) is recommended in nontraditional settings. In previous improvement work, we increased documentation of sexual history to >80% of adolescents hospitalized on our pediatric hospital medicine (PHM) service. This study assessed adolescents' perception of SRH conversations with hospital providers and the extent to which they were helpful. METHODS: Postdischarge survey of patients 13 to 17 years discharged from the PHM service at an academic children's hospital between August 2019 and March 2020. Survey items included demographics; whether confidential discussion of sexual health topics such as contraception, sexually transmitted infection (STI), and sexual orientation occurred; perceptions of these discussions, and sexual history. RESULTS: Eighty-three patients enrolled and 44 (53%) completed the survey after discharge. A total of 68% of respondents were female and median age was 15 years (interquartile range 14-16). A total of 77% reported discussing SRH privately with a PHM provider. A total of 18% recalled discussing condoms, and 63% rated the discussion helpful. A total of 27% of females reported discussing birth control, and 40% rated it helpful. A total of 57% recalled discussing sexual orientation, and 40% rated it helpful. None reported discussions of STI testing with PHM. Of the 23% who were sexually active, none reported being given condoms. CONCLUSIONS: Analysis of adolescent patient experiences identified opportunities for continued improvement in the content and quality of SRH discussions, specifically regarding offering STI testing, condom distribution, and sexual orientation conversations. Our work highlights the importance of incorporating patient-reported data into improvement work to ensure providers are addressing targeted gaps in adolescent care.

Underprepared: influences of U.S. medical students' self-assessed confidence in immigrant and refugee health care.

BACKGROUND: United States (U.S.) census data from 2017 indicates that the percentage of persons born outside of the U.S. is increasing. However, no studies describe the amount of class time focused on immigrant and refugee health during medical school in the U.S. nor on incoming residents' confidence in providing culturally sensitive care. The objective of this study is to characterize final-year medical students' exposure to immigrant and refugee health and their confidence in caring for these populations. METHODS: A voluntary, cross-sectional survey was sent electronically to fourth-year medical students at twelve U.S. medical schools in 2020, with 707 respondents (46% response rate). Questions addressed respondents' curricular exposure to immigrant and refugee health care during medical school and their confidence in providing culturally sensitive care. Chi-square tests were used to assess relationships between categorical variables, and odds ratios were calculated for dichotomized variables. RESULTS: Most students (70.6%) described insufficient class time dedicated to culturally sensitive care, and many (64.5%) reported insufficient clinical exposure in caring for immigrants/refugees. The odds that incoming residents felt 'usually' or 'always' confident in their ability to provide culturally sensitive care to immigrants and refugees were higher in those with more class time on culturally sensitive care (OR 5.2 [3.6-7.4]), those with more clinical opportunities to care for immigrants and refugees (OR 7.2 [5.1-10.2]), and those who participated in a domestic low-resource or international elective (OR 1.4 [1.02-1.9]). More than half (55.3%) of respondents reported feeling 'not at all' or only 'sometimes' confident in their ability to provide culturally sensitive care to immigrants/refugees. CONCLUSIONS: Most fourth-year U.S. medical students entering residency feel unprepared to deliver culturally sensitive care to immigrants and refugees. This may be mediated by increased exposure to didactic curricula class time and/or experiential clinical activities, as those factors are associated with improved student confidence.

The Effect of a Mock Medical Visit on Refugee Health Self-Efficacy and Medical Trainee Communication Apprehension.

INTRODUCTION: As refugees adjust to a new country, their health care can take a toll. Refugees may have difficulty navigating a new health care system and experience low health self-efficacy. Another potential contributor is inadequate medical trainee curriculum addressing refugee health. METHODS: We devised simulated clinic experiences called mock medical visits. Surveys were utilized before and after the mock medical visits to assess the Health Self-Efficacy Scale for refugees and the Personal Report of Intercultural Communication Apprehension for trainees. RESULTS: Health Self-Efficacy Scale scores increased from 13.67 to 15.47 (P = 0.08, n = 15). Personal Report of Intercultural Communication Apprehension scores decreased from 27.1 to 25.4 (P = 0.40, n = 10). DISCUSSION: While our study did not reach statistical significance, the overall trends suggest mock medical visits can be a valuable tool to increase health self-efficacy in refugee community members and decrease intercultural communication apprehension in medical trainees.

Current Practice and Rationale of Prescribing Dexamethasone for Pediatric Patients Hospitalized for Asthma.

OBJECTIVE: Dexamethasone use for pediatric asthma exacerbations in the emergency department is supported in literature as a beneficial alternative to prednisone; however, there is limited data in the hospital setting. This study assesses factors that influence pediatric hospital providers' steroid choice for patients hospitalized for status asthmaticus. METHODS: A survey was developed to assess factors influencing steroid prescribing practices. It was completed by our institution's pediatric hospitalists and advance practice providers in June 2019 and April 2021. Responses were summarized using descriptive statistics, interrater agreement was analyzed with Cohen's kappa statistic, and bivariate comparisons were analyzed with chi-square tests. RESULTS: Thirty-six of 39 providers completed the survey in 2019; 31 of 43 completed it in 2021. They reported wide disagreement with the use of dexamethasone in both surveys (2019 vs 2021: 34% vs 55% in favor, 43% vs 35% neutral, 23% vs 9% opposing, P = 0.191). There was a self-reported increase in prescribing frequency of dexamethasone from 2019 to 2021 (P = 0.007). There was moderate agreement with prescribing dexamethasone for patients with poor oral tolerance or medication noncompliance (2019: κ = 0.485, P = 0.002; 2021: κ = 0.281, P = 0.048). There was moderate agreement with prescribing prednisone for patients with higher severity of baseline asthma or current exacerbation (2019: κ = 0.537, P < 0.001; 2021: κ = 0.500, P < 0.001). Length of the dexamethasone course did not influence prescribing practices (P > 0.05). CONCLUSIONS: In our inpatient setting, prednisone is preferred for severe asthma cases, while dexamethasone is preferred for patients with poor oral tolerance or medication noncompliance. The length of the dexamethasone course did not influence providers' steroid choice.

Caring for Refugee Patients: An Interprofessional Course in Resettlement, Medical Intake, and Culture.

INTRODUCTION: Refugees access health care at rates similar to US citizens. Many clinicians, however, do not feel prepared to care for them. This study evaluated whether an interprofessional presentation could improve knowledge of refugee health and cross-cultural comfort. METHODS: The session consisted of a lecture and 3 small-group sessions. Students from various health care programs attended via Zoom. Participants completed pre- and postsurveys to assess cross-cultural comfort and knowledge of refugee health. RESULTS: Of 161 attendees, 63 completed the presurvey (39%) and 49 completed the postsurvey (30%). All 9 knowledge questions demonstrated statistically significant improvements, while only 1 cross-cultural question showed significant improvement. DISCUSSION: The session improved knowledge of refugee health but not cross-cultural comfort, indicating the need for further interventions.

Quality Initiative to Increase Delivery of Adolescent Hospital-Based Reproductive Health Care.

OBJECTIVES: Hospitals are an important nontraditional setting in which to address adolescent reproductive health. However, opportunities for intervention are frequently missed, especially for boys and patients hospitalized for noningestion complaints. Our global aim was to increase delivery of reproductive health care to adolescents hospitalized through our children's hospital Pediatric Hospital Medicine service. METHODS: We performed 2 quality improvement intervention cycles: (1) provider education and monthly reminder e-mails and (2) an automated electronic health record (EHR) adolescent history and physical note template with social history prompts while discontinuing reminder e-mails. The primary outcome measure was sexual history documentation (SHD). Secondary measures were sexually transmitted infection (STI) testing and contraception provision. Statistical process control charts were used to analyze effectiveness of interventions. RESULTS: From July 2018 through June 2019, 528 Primary Hospital Medicine encounters were included in this study and compared with published baseline data on 150 encounters. Control charts revealed a special cause increase in SHD from 60% to 82% overall, along with 37% to 73% for boys and 57% to 80% for noningestion hospitalizations. Increased SHD correlated with cycle 1 and was maintained through cycle 2. Percent STI testing significantly increased but did not shift or trend toward special cause variation. Contraception provision, length of stay, and patient relations consultations were not affected. CONCLUSIONS: The interventions were successful in increasing SHD, including among boys and noningestion hospitalizations. The EHR enhancement maintained these increases after reminder emails were discontinued. Future interventions should specifically address STI testing and provision of contraception.

Use of Peer- and Self-Evaluation to Improve Conversations with Interfacility Referring Clinicians.

INTRODUCTION: Pediatric hospital medicine physicians receive little formal training in communicating with interfacility referring clinicians. We sought to improve pediatric hospital medicine physician confidence and communication scores by 10% during patient triage calls from interfacility referring providers via a continuing professional development initiative. METHODS: We conducted a single-center 10-month quality improvement project. Confidence was assessed via survey before and after the initiative. A novel self- and peer-evaluation tool was used to assess accepting pediatric hospital medicine physician communication on recorded calls. Call assessment scores were measured at baseline, cycle 1, and cycle 2. Interventions included group discussion and development of a scripting flowsheet. RESULTS: Twenty pediatric hospital medicine physicians participated and completed a total of 203 call assessments. From baseline to post-initiative, general confidence communicating with referring clinicians increased by 13% (mean ranks 11.8, 16.8, respectively), and specific confidence communicating when there is a difference of opinion increased significantly by 37% (mean ranks 9.8, 19.2, P < 0.001). Interfacility transfer conversation evaluation scores increased by 11%. DISCUSSION: Our initiative improved accepting physician's confidence and communication evaluation scores using self- and peer-evaluation, group reflection, and a scripting flowsheet. Self- and peer-evaluation of recorded calls can be an effective intervention for building physician confidence in communicating with referring clinicians.

Intent, Substance, and Care: Characteristics of Adolescent Ingestion Hospitalizations.

OBJECTIVES: To characterize the patient population of adolescents hospitalized at a tertiary center for ingestions and identify opportunities to improve health care delivered and resources offered to these adolescents. METHODS: Retrospective study of a consecutive sample of adolescent patients (12-18 years old) discharged from the hospitalist service at a large academic pediatric tertiary care center from May 2017 through April 2018. Data were collected regarding patient and hospital encounter characteristics including length of stay, admission service, reason for ingestion, substance(s) ingested, previous suicidal ideation (SI) screening, sexual history documentation, pregnancy testing, disposition at discharge and follow-up with primary care physicians (PCPs). RESULTS: Most hospitalizations for ingestions were reported as intentional suicide attempts (79%). Most commonly, adolescents ingested exclusively prescription medications (45%) or over-the-counter medications (32%). Of adolescents with a reported suicide attempt for whom PCP records were available, 56% did not have SI screening documented in the medical record. One-quarter of adolescents hospitalized for an ingestion did not have a sexual history documented, and 11% of female patients were not tested for pregnancy before discharge. A majority (66%) of the adolescents with PCP records available did not follow-up with their PCP within 2 months after their hospitalization. CONCLUSIONS: On the basis of our study results, opportunities to improve adolescent health include increased screening for SI and mental health symptoms throughout medical environments, comprehensive risk assessment of all adolescents hospitalized for an ingestion and increased guidance for caregivers of adolescents regarding prescription and over-the-counter medication storage in the home.

Did You Get My Snap? Snapchat as a Health Education Tool for Hospitalized Adolescents.

PURPOSE: Given the popularity of Snapchat with teens, we used this tool to disseminate reproductive health information to adolescent patients. METHODS: We developed a unique Snapcode linked to educational materials located on a cloud service and accessible via the Snapchat app. The Snapcode was printed on a business card and distributed to hospitalized adolescents. We tracked card distribution and how often the materials were accessed through our cloud service and through Snapchat. RESULTS: A total of 236 cards were distributed to teens with 117 unique scans and 122 views of the PDF. Of the teens who received the card (N = 236), 49.5% of teens used the Snapcode to access reproductive health education. CONCLUSIONS: Snapchat is a promising way to distribute educational materials to adolescents in a discrete manner on a platform many teens use. This mechanism demonstrates a way for providers to use Snapchat as a tool to provide education to hospitalized adolescents.

One Call Away: Addressing a Safety Gap for Urgent Issues Post Discharge.

OBJECTIVES: The transition period from hospitalization to outpatient care can be high risk for pediatric patients. Our aim was to profile the use of a "safety net" for families through provision of specific inpatient provider contact information for urgent issues post discharge. METHODS: In this prospective study, we implemented an updated after-visit summary that directed families to call the hospital operator and specifically ask for the pediatric hospital medicine attending on call if they were unable to reach their primary care provider (PCP) with an urgent postdischarge concern. Education for nursing staff, operators, and pediatric hospital medicine providers was completed, and contact information was automatically populated into the after-visit summary. Information collected included the number of calls, the topic, time spent, whether the family contacted the PCP first, and the time of day. Descriptive statistics and Fisher's exact test were used to summarize findings. RESULTS: Over a 13-month period, of 5145 discharges, there were 47 postdischarge phone calls, which averaged to 3.6 calls per month. The average length of time spent on a call was 21 minutes. For 30% of calls, families had tried contacting their PCPs first, and 55% of calls occurred at night. Topics of calls included requesting advice about symptoms, time line for reevaluation, and assistance with medications. CONCLUSIONS: This safety net provided families with real-time problem-solving for an urgent need post discharge, which included triaging patient symptoms at home, counseling on medication questions, information about the time line of illness recovery, and provision of additional resources.