Descriptive feedback with targeted education to improve telephonic escalation of care: a simulation-based study.

BACKGROUND: Awareness of communication failures in healthcare has necessitated the implementation of standardized, validated handover tools such as Identification, Situation, Background, Assessment, Recommendation (ISBAR). Although educational sessions improve communication, the effectiveness of individualized care escalation communication training is unknown. The primary aim was to conduct a simulation-based study to assess individualized one-on-one communication training for junior medical doctors for improving care escalation in pediatric emergencies. The secondary aim was to assess the evaluation of the training. METHODS: The prospective observational study assessed participants pre- and post-intervention. In Session One, participants presented a written case scenario telephonically to two senior pediatricians. Fifty participants were scored using an 18-item checklist based on the ISBAR tool and "free text" responses. Immediately following case presentations, participants completed individualized one-on-one 30-minute educational sessions regarding self-reflection, didactic teaching, and constructive feedback based on the ISBAR. Session Two included a second case presentation and reassessment. We conducted qualitative analysis of supervisor's feedback on performance and trainee doctor's evaluation of the training. RESULTS: There was significant improvement in 8 of the 18 components of the ISBAR checklist. All elements of care escalation were significantly improved, and overall communication was higher post-intervention (P < 0.001); however, no improvement was noted in participants' explorations of differential diagnoses (P = 0.263). The qualitative analysis identified themes of improved urgency in seeking senior support and conversational clarity from supervisors, and improved intervention quality and self-confidence from participants. CONCLUSIONS: Individualized communication training may improve pediatric emergency care escalation and communication among junior doctors.

Neonatal retrievals from a regional centre: Outcomes, missed opportunities and barriers to back transfer.

AIM: High-risk neonates are retrieved from regional centres to tertiary neonatal units when the required care of the baby exceeds the clinical capabilities of the birthing facility. However, there is limited research on the outcomes of neonatal retrievals from regional special care centres and the barriers to back transfer of neonates from a tertiary centre are not well established. This study aimed to review the outcome of neonatal retrievals >32 weeks gestation from a regional referral centre. The study also aimed to determine missed opportunities for providing care at the regional centre and evaluate patient back transfer delays. METHODS: All neonates transferred to a tertiary neonatal intensive care unit in North Queensland over the 5-year period January 2016 to December 2020 from a regional neonatal centre were retrospectively reviewed from the electronic medical records. RESULTS: Fifty neonates transferred to a tertiary neonatal intensive care unit over the study period were identified. Between 2016 and 2020, the number of neonatal retrievals increased (P = 0.021). Out of the 50 neonatal retrievals, 86% were for medical reasons. Overall, eight neonates were identified as missed opportunities whose care could have been maintained at the regional centre with support from the tertiary neonatal intensive care unit. In total, 16 neonates were affected by a delay in back transfer. CONCLUSIONS: This study shows a significant increase in retrievals to tertiary neonatal intensive care unit over the study period. Increasing bed capacity, utilising telehealth and recruiting regional special care nursery staff could improve outcomes and reduce strain on tertiary neonatal resources.

Safety of stimulant medications for attention deficit hyperactivity disorder in paediatric congenital heart disease.

AIM: To review current literature regarding the safety of stimulant medications for treatment of attention deficit hyperactivity disorder in paediatric congenital heart disease (CHD) patients. METHODS: Embase, MEDLINE complete, CINAHL complete and Psychology and Behavioural Sciences Collection were searched for relevant articles from January 1980 to July 2022. RESULTS: One hundred and three articles were identified during the initial search after removal of duplicates. Thirty-five articles were selected for review and 11 were included as relevant to the clinical question. CONCLUSIONS: Stimulant medications are safe in patients with underlying CHD. In mild congenital cardiac conditions (ventricular septal defect, atrial septal defect and isolated semilunar valve disease), paediatricians can safely initiate stimulant therapy. With complex CHD cases, cardiology opinion is recommended prior to starting stimulants.

Is intravenous magnesium sulphate safe to be administered outside the critical care setting?

AIM: To review current evidence regarding the safety of intravenous bolus magnesium sulphate for the treatment of children with acute severe asthma in the non-critical care setting. METHODS: MEDLINE via Ovid, Embase and the Cochrane Library were searched for relevant articles. RESULTS: Four hundred and eighteen articles were identified during the initial search after removal of duplicates. Eighty full-text articles were selected for review and 16 included as relevant to the clinical question. CONCLUSIONS: Current evidence suggests that bolus intravenous magnesium sulphate is safe to be administered in non-critical care settings provided that line of sight nursing and cardiorespiratory monitoring are available.

A cautionary tale of hyperbilirubinaemia in subhepatic appendicitis.

Subhepatic appendicitis is rare in children and often presents with atypical symptoms and signs, resulting in delayed diagnosis with attendant complications. The presence of hyperbilirubinemia could be a marker of complicated appendicitis and may assist rural physicians to seek specialist assistance early.

Epidemiology and outcomes of gastroschisis in Tasmania.

AIM: To describe the epidemiology and outcomes of gastroschisis in Tasmania. METHODS: A retrospective analysis of all pregnancies complicated by gastroschisis in Tasmania from 1996 to 2015 was undertaken (epidemiology cohort), and the presentation, surgical management and outcomes (surgery cohort) were reviewed for the period between September 1990 and July 2015. RESULTS: Gastroschisis was detected in 58 pregnancies during the 20-year epidemiology cohort period, giving an incidence of 4.4 per 10 000 live births for the 20-year period. Two of the four stillbirths occurred after 36 weeks' gestation. Of the 65 babies with gastroschisis treated at the Royal Hobart Hospital, 51 had a staged surgical repair (silo in 47, stoma formation in 4), and 14 had a primary closure. Staged repair was associated with a significantly longer duration of ventilation and stay in the neonatal intensive care unit. There were six post-natal deaths, all born in the first epoch. Death was significantly associated with the condition of the intestine at delivery (P = 0.02). There were no deaths in babies with simple gastroschisis. Complex gastroschisis was significantly associated with longer duration of total parenteral nutrition (P = 0.0002) and longer stay in hospital (P = 0.03). CONCLUSIONS: The incidence of gastroschisis in Tasmania is similar to that reported in other Australian regions and has not increased over the 20-year period of study. The high risk of stillbirth, and the significant association between mortality and the condition of the intestine at birth necessitates close fetal surveillance. Complex gastroschisis imposes a significant burden on hospital resources.

Congenital Afibrinogenemia presenting as antenatal intracranial bleed: a case report.

Congenital afibrinogenemia is a very rare inherited coagulation disorder, characterized by virtual absence of plasma fibrinogen (factor I). There are only about 250 cases reported in the world literature 1. We describe a case of congenital afibrinogenemia which presented as an antenatally detected intracranial bleed.