Drowning and aquatic injuries dictionary.

BACKGROUND: Drowning is a significant public health issue with more than 320,000 deaths globally every year. These numbers are greatly underestimated, however, due to factors such as inadequate data collection, inconsistent categorization and failure to report in certain regions and cultures.The objective of this study was to develop a standardised drowning dictionary using a consensus-based approach. Through creation of this resource, improved clarity amongst stakeholders will be achieved and, as a result, so will our understanding of the drowning issue. METHODOLOGY: A list of terms and their definitions were created and sent to 16 drowning experts with a broad range of backgrounds across four continents and six languages. A review was conducted using a modified Delphi process over five rounds. A sixth round was done by an external panel evaluating the terms' content validity. RESULTS: The drowning dictionary included more than 350 terms. Of these, less than 10% had been previously published in peer review literature. On average, the external expert validity endorsing the dictionary shows a Scale Content Validity Index (S-CVI/Ave) of 0.91, exceeding the scientific recommended value. Ninety one percent of the items present an I-CVI (Level Content Validity Index) value considered acceptable (>0.78). The endorsement was not a universal agreement (S-CVI/UA: 0.44). CONCLUSION: The drowning dictionary provides a common language, and the authors envisage that its use will facilitate collaboration and comparison across prevention sectors, education, research, policy and treatment. The dictionary will be open to readers for discussion and further review at www.idra.world.

Multifaceted quality improvement initiative to decrease pediatric asthma readmissions.

BACKGROUND: Asthma is the most common chronic disease of childhood and a leading cause of hospitalization in children. A primary goal of asthma control is prevention of hospitalizations. A hospital admission is the single strongest predictor of future hospital admissions for asthma. The 30-day asthma readmission rate at our institution was significantly higher than that of other hospitals in the Children's Hospital Association. As a result, a multifaceted quality improvement project was undertaken with the goal of reducing the 30-day inpatient asthma readmission rate by 50% within two years. METHODS: Analysis of our institution's readmission patterns, value stream mapping of asthma admission, discharge, and follow-up processes, literature review, and examination of comparable successful programs around the United States were all utilized to identify potential targets for intervention. Interventions were implemented in a stepwise manner, and included increasing inhaler availability after discharge, modifying asthma education strategies, and providing in-home post-discharge follow-up. The primary outcome was a running 12-month average 30-day inpatient readmission rate. Secondary outcomes included process measures for individual interventions. RESULTS: From a peak of 7.98% in January 2013, a steady decline to 1.65% was observed by July 2014, which represented a 79.3% reduction in 30-day readmissions. CONCLUSION: A significant decrease in hospital readmissions for pediatric asthma is possible, through comprehensive, multidisciplinary quality improvement that spans the continuum of care.

The 4Rs of Aquatic Rescue: educating the public about safety and risks of bystander rescue.

From 1980 to 2014, 87 persons drowned in New Zealand while attempting to rescue others; all incidents occurred in open water and most (80%) fatalities were male. While bystander rescue has been promoted as a way of preventing drowning, little is known about the knowledge base that informs potential rescuers. This study utilized a family water safety programme to promote a resource entitled the 4Rs of Aquatic Rescue. Participants (n = 174) completed a pre-intervention survey and were then provided with information and access to electronic resources on safe bystander rescue techniques. Most respondents (71%) had never been taught rescue techniques, and males were more confident of their rescue ability. Upon completion of the programme, significant differences were evident in respondents' understanding of rescue safety, but this did not translate to greater confidence or disposition towards performing a rescue. Ways of promoting bystander safety around water are discussed and recommendations for future studies are made.

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children.

OBJECTIVE: To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges. METHODS: This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children's hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan-do-study-act cycles were conducted on patient populations selected by each site. Data on discharge-related care failures, family readiness for discharge, and 72-hour and 30-day readmissions were reported monthly by each site. Surveys of each site were also conducted to evaluate the use of various change strategies. RESULTS: Most sites addressed discharge planning, quality of discharge instructions, and providing postdischarge support by phone. There was a significant decrease in discharge-related care failures, from 34% in the first project quarter to 21% at the end of the collaborative (P < .05). There was also a significant improvement in family perception of readiness for discharge, from 85% of families reporting the highest rating to 91% (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and slight worsening of the 30-day readmission rate (4.5% vs 6.3%, P = .05). CONCLUSIONS: Institutions that participated in the collaborative had lower rates of discharge-related care failures and improved family readiness for discharge. There was no significant improvement in unplanned readmissions. More studies are needed to evaluate which interventions are most effective and to assess feasibility in non-children's hospital settings.

Toddler parents training, understanding, and perceptions of CPR.

BACKGROUND: Little is known about parent CPR skills and their perceptions of its use, especially in the context of drowning incidents among young children where parents are often the first responder. The primary objective of the study was to examine parental understanding of child and adult CPR, extent of CPR training, and parental confidence to perform CPR. METHOD: Survey research using a self-complete questionnaire was used to gather data from parents (n = 1716) whose 2-4-year-old toddlers were either attending early childhood centres (n = 781) or enrolled in swim schools (n = 935). Differences in parental CPR training, knowledge, levels of confidence in ability to perform CPR, and perceptions were measured by frequency, with regression tests used to discern differences by institution, gender, ethnicity, length of residency, and recency of CPR training. RESULTS: Almost two-thirds (64%) of parents reported that they had received formal CPR training in the past, yet few correctly reported the current ratios for either adult CPR (19%) or child CPR (12%). Most parents correctly agreed that, in child CPR, you must always give initial breaths before starting compressions (74%), but the majority incorrectly believed you should seek help before starting CPR (61%) and continue CPR for 5 min before stopping (59%). Most parents (56%) felt anxious about their ability to perform CPR on an adult, and even more (62%) felt anxious about their ability to perform child CPR. CONCLUSION: Our findings highlight the need for education interventions to address the substantial gaps in knowledge of CPR for all parents of young children.

Can the ministry collaborate to form the "next generation" of sponsors?

In looking to the future of sponsored ministry of Catholic institutions, the formation of future sponsors--both religious and lay alike--is an important issue. As this ministry continues to evolve, and sponsoring groups determine how best to prepare new sponsors, might it not be time to think about how to pool the ministry's collective wisdom on formation? Sponsors act not only in the name of the health care institution (or other ministry) but on behalf of the faith community engaged in continuing the compassionate healing ministry of Jesus. In Catholic ministry, and particularly health care ministry, sponsors carry out their responsibilities through a multiplicity of organizational relationships. Just as structures differ, so too do criteria that guide who will be called to join a sponsoring group. There are several core elements that are incorporated in the majority of sponsor competency sets. Elements identified by a committee of ministry members, and reviewed by hundreds of sponsors and other ministry leaders are: mission oriented, animated, theologically grounded, collaborative, church related, and accountable. If one is looking at the potential for convening dialogues about possible areas of collaboration in formation, these core elements, with examples of how they are lived out, may offer an outline of areas new sponsors might need to learn more about for their personal and professional development. Our Catholic health ministry depends on leaders who can create and steward organizational cultures that incarnate Jesus' healing. The possibilities for collaboration in the formation of future sponsors are endless, but there are challenges. If you are a member of a sponsor body/council/corporate member in Catholic health care, and are interested in nominating potential persons to take part in a representative group that would discuss possibilities for collaboration in sponsor formation, please go to www.chausa.org/sponsorformation and complete all sections of the nomination form.