Academic Half Day Improves Resident Perception of Education Without Compromising Patient Safety.

BACKGROUND: Residency programs are required to offer a didactic curriculum and protect resident time for education. Our institution implemented an academic half day (AHD) in the 2021-2022 academic year to address issues related to the standard noon conference series. OBJECTIVE: Determine the impact of AHD implementation on education, patient safety, and workflow. METHODS: This was a prospective, single-site educational intervention study. Pre- and post-implementation surveys and Accreditation Council for Graduate Medical Education (ACGME) surveys assessed changes in trainee and faculty attitudes and behaviors. Patient safety and workflow were evaluated by comparing the number of safety event reports, rapid response team activations, time to admission from the ED, and time of discharge on AHD days compared to other weekdays. RESULTS: Survey response rates were: residents 68%/48%, fellows 42%/35%, and faculty 59%/29%. AHD was associated with a significant, positive change in resident attitudes and experiences and on ACGME survey items. On AHDs compared with other weekdays, there were no significant differences in safety event report rates (P = .98), nor in rapid response team activation rates (P = .99). There was not a clinically meaningful difference in median admission time from the ED on AHD weekdays (125 minutes) compared to other weekdays (130 minutes, P = .04). There was no significant difference in median discharge time on AHD vs other weekdays (P = .13). CONCLUSIONS: This study suggests that there is no significant difference in patient safety or workflow with the implementation of AHD. This study supports prior studies that residents strongly prefer AHD. AHD may be a useful framework for resident education without compromising patient care.

Admission practices following pediatric tonsillectomy: A survey of ASPO members.

OBJECTIVES: Although evidence-based Clinical Practice Guidelines (CPGs) have specified postoperative admission criteria for pediatric tonsillectomy, there is substantial variation in guideline implementation and adherence among otolaryngologists in practice. We aimed to assess pediatric otolaryngologists' post-tonsillectomy admission practices and to examine patient and surgeon factors associated with differences in admission practices. METHODS: An electronic cross-sectional survey was distributed to members of the American Society of Pediatric Otolaryngology (ASPO) to determine current practices regarding admission practices following pediatric tonsillectomy. Chi-square and Fisher's exact tests were performed to compare differences in adherence to tonsillectomy CPGs by respondent characteristics. RESULTS: The survey was sent to 644 pediatric otolaryngologists with a response rate of 19.1%. 37% of respondents reported "always" and 60% "often" using the Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) CPG to guide decision for admission. Years in practice was the factor most strongly associated with admission practices, with 10 or fewer years in practice significantly correlated with stricter adherence to the AAO-HNS CPG of overnight observation when Apnea-Hypopnea Index (AHI) ≥10, age <3 years, or O2 nadir <80%) (OR 4.2, p <0.001), as well as specific individual criteria such as an AHI ≥10 (OR 4.1, p = 0.03). Respondents in an academic practice setting were more likely to admit children <3 years of age than those in private practice (OR 5.0, p = 0.01). CONCLUSION: Admission practices varied among pediatric otolaryngologist survey respondents, and strict AAO-HNS CPG adherence was associated with fewer years in practice and academic practice setting. These results suggest that further study investigating factors influencing guideline adherence and post-tonsillectomy admission practices is warranted.

SARS-CoV-2 Gastrointestinal Shedding in Hospitalized Children.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory virus that can cause gastrointestinal (GI) symptoms, with studies demonstrating detection of stool viral RNA weeks after respiratory tract clearance. It is unknown if children who test negative for SARS-CoV-2 on a nasopharyngeal (NP) swab may be shedding the virus in their stool. OBJECTIVE: To measure the prevalence of SARS-CoV-2 stool shedding in children with positive and negative SARS-CoV-2 NP polymerase chain reactions (PCR) tests, and to determine clinical factors associated with GI shedding. METHODS: In this cross-sectional study, we enrolled hospitalized patients 0 to 21 years old with a positive or a negative SARS-CoV-2 NP PCR test who had respiratory and/or GI symptoms. Participants were surveyed, and stool samples were sent for viral PCR testing. Fisher's exact test was used to evaluate bivariate associations of stool PCR test positivity with categorical variables. RESULTS: Sixty-seven patients were consented; 34 patients did not provide stool samples so 33 patients were included: 17 NP-positive and 16 NP-negative for SARS-CoV-2. Eight of the 17 NP-positive patients had a positive stool PCR test for SARS-CoV-2, while none of the 16 SARS-CoV-2 NP-negative patients had a positive result (P < .01). For the 17 SARS-CoV-2 NP-positive patients, GI symptoms were associated with a positive stool PCR test (P = .05) for SARS-CoV-2, but this association was not found for all 33 patients (P = .11). No associations were found with patients in an immunocompromised state or those with a comorbid condition, fever and/or chills, respiratory symptoms, headache and/or myalgias, or anosmia and/or ageusia. CONCLUSIONS: SARS-CoV-2 GI shedding is common and associated with GI symptoms in NP-positive children, with 47% having positive stool PCRs for SARS-CoV-2. GI shedding was not demonstrated in SARS-CoV-2 NP-negative children.

Improving the Pediatric Floor Discharge Process Following Tonsillectomy.

OBJECTIVES/HYPOTHESIS: Over 300,000 tonsillectomies are performed nationwide every year. In 2017, half of children undergoing tonsillectomy at our institution were admitted to the pediatric floor, with only 10.4% being discharged before 11 AM on postoperative day 1 (POD1). Our primary objective was to increase the percentage of patients discharged before 11 AM on POD1 to at least 50% within 1 year. STUDY DESIGN: Prospective observational (quality improvement). METHODS: A multidisciplinary quality improvement (QI) team was assembled. The primary outcome was "timely discharges," defined as percentage of patients discharged before 11 AM on POD1; secondary outcomes were percentage of patients discharged before 1 PM and mean length of stay (hours). Seven-day readmission rate served as our balancing measure. Prior year data served as baseline. A process map, Ishikawa diagram, and Pareto chart were utilized to identify specific target areas for improvement. Key interventions included announcement of our initiative, an electronic health record-based handoff text prompt, discharge checklist, automated discharge instructions, encouragement to place discharge orders by 9 AM and implementation of early POD1 rounds. Data were collected on a biweekly basis and the primary and secondary outcomes were plotted on control charts and analyzed using rules for special cause variation. RESULTS: Within 12 months, POD1 discharges before 11 AM and before 1 PM increased to 44.9% and 83.8%, respectively, with sustained improvement for the first 6 months of the subsequent year. Mean length of stay decreased, and 7-day readmission rates were unchanged. CONCLUSIONS: By understanding the factors influencing timely POD1 discharges after tonsillectomy, key interventions were implemented to achieve an increase in timely discharges. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:225-233, 2022.

Responses of three urban U.S. Children's Hospitals to COVID-19: Seattle, New York and New Orleans.

Since January 2020, there has been a worldwide pandemic of COVID-19, caused by a novel coronavirus-severe acute respiratory syndrome coronavirus 2. The United States has been particularly affected, with the largest number of confirmed cases in a single country in the world. Healthcare systems for adults as well as children have dealt with challenges. This article will reflect on the experiences of selected children's hospitals in Seattle, New York City, and New Orleans, three of the "hotspots" in the US and share common aspects and lessons learned from these experiences. This article discusses testing and cohorting of patients, personal protective equipment utilization, limiting workplace exposure, and information sharing.

Understanding Parental Preferences for Participants in Medical Decision-making for Their Hospitalized Children.

OBJECTIVES: Family-centered care promotes parental engagement in medical decision-making for hospitalized children. Little is understood about parental preferences and factors influencing the desire to involve extended family in decision-making. We explored parent and family member interest in participation in medical decision-making. METHODS: Parents of hospitalized children ≤7 years old admitted to the inpatient service were interviewed regarding preferences for self-, other parent, and extended family involvement in decision-making. Scores were calculated for each potential participant on a scale of 1 to 5 (5 indicating that parents strongly agreed with participation). Associations of decision-making preferences with parental age, education, language, and health; the involvement of a child with chronic illness; and the level of clinical acuity were assessed with χ2 tests, Wilcoxon rank tests, and the Spearman correlation. RESULTS: There were 116 participants. Parents' median level of interest in participation in decision-making was as follows: self (4.3; interquartile range [IQR]: 4-4.6); other parent (3.6; IQR: 2.7-4), and family (2.0; IQR: 1.7-2.7). Parents with better physical health (P < .001) and those in a relationship with the other parent (P < .001) were more likely to desire involvement of the other parent in medical decision-making. This was also true for those who faced higher acuity scenarios. Parents <35 years old (P < .01) and those who were interviewed in Spanish (P = .03) were more likely to desire participation of extended family members. CONCLUSIONS: Parents of hospitalized children want to participate in medical decision-making. Desire for the involvement of other family members is complex; therefore, discussions regarding parental preferences are necessary.

Family-centered rounds in theory and practice: an ethnographic case study.

BACKGROUND: Family-centered rounds (FCR) seek to incorporate principles of family-centered care-including clear and open information sharing, respect, participation and collaboration-into inpatient settings. Although potential models designed to translate these principles into everyday clinical practice have been reported, few studies explore how FCR practices align with principles of family-centered care. METHODS: We conducted an ethnographic study, observing over 200 hours of FCR on a general pediatrics inpatient service from January to August 2010 (185 distinct rounding events). To complement observation, we conducted interviews with 6 family members. Qualitative analysis entailed applying codes to data from observation and interviews and deriving themes using the principles of family-centered care as an interpretive lens. RESULTS: Four themes emerged that suggested incomplete alignment between FCR practices and principles of family-centered care. 1) FCR provided a forum for information sharing; nonetheless, medical jargon sometimes limited communication. 2) Medical teams approached families with practices intended to demonstrated respect, but contextual factors served to undermine this intent. 3) FCR gave family members the opportunity to participate in care but did not guarantee their involvement. 4) FCR were a starting point for collaboration around plan making, but did not guarantee that collaboration occurred. CONCLUSIONS: Although FCR practices may set the stage for family-centered care, they do not necessarily ensure that the principles of family-centered care are upheld. Efforts to more effectively deliver FCR should consider physical, organizational, and cultural factors that influence both patient/family and medical team behavior.