Introduction As SARS-CoV-2 has evolved, so has its effects on the pediatric population.1 While early variants typically resulted in lower respiratory infections, the recently identified Omicron variant may exhibit a predilection for the upper airways.2 The relatively smaller upper respiratory tract in children compared to adults has been thought to predispose them to more severe clinical presentations resembling laryngotracheobronchitis, or croup. Caused by viral-induced subglottic airway inflammation, croup is classically characterized by sudden onset “barking cough”, inspiratory stridor, and respiratory distress. Endemic coronaviruses have been linked to croup, however only sparse case reports have described croup specifically associated with SARS-CoV-2 and it remains unclear if croup cases constitute a causative relationship or result of co-infection with another virus.3–6 To address this knowledge gap, we performed a retrospective analysis of the incidence and clinical characteristics of croup associated with SARS-CoV-2 infection at a large freestanding children’s hospital.
Objective This study evaluates and characterizes the use of a confidential clinic note type as part of the implementation of open notes at a free-standing children’s hospital. We describe how this electronic health record feature which disables patient and family access to selected notes in the patient portal is used across our institution, which clinicians are using this feature, and the type of data our clinicians consider confidential. Materials and Methods Through retrospective chart review, we have evaluated the use of a confidential note type over a 1-year period. Results We identified 402 964 clinic notes created during a 1-year period, of which 9346 (2.3%) were flagged as confidential. Use of this confidential note type was associated with female patient sex and increase in patient age. It was used most frequently by a small subset of providers. 922 (83.8%) of 1100 notes manually reviewed contained sensitive information. Reasons for confidential notes varied, but patient’s mental health was most commonly identified. Discussion Our data demonstrate variability in the use of a confidential note type across specialties, patient ages, and types of confidential information. This note type is frequently utilized by a subset of providers who often manage sensitive patient and parent information. As vendors and institutions enable open notes, thoughtful implementation and provider education surrounding the use of this confidential feature is needed. Conclusion A confidential clinic note feature is an integral aspect of pediatric open notes implementation. This feature supports protection of confidential information pertaining to our patients and their caregivers.
BACKGROUND AND OBJECTIVES: Pediatric health care encounters declined during the coronavirus disease 2019 (COVID-19) pandemic, and pediatric residency programs have adapted trainee schedules to meet the needs of this changing clinical environment. We sought to evaluate the impact of the pandemic on pediatric interns' clinical exposure. METHODS:In this retrospective cohort study, we quantified patient exposure among pediatric interns from a single large pediatric residency program at a freestanding children's hospital. Patient encounters and shifts per pediatric intern in the inpatient and emergency department settings were evaluated during the COVID-19 pandemic, from March to June 2020, as compared with these 3 months in 2019. Patient encounters by diagnosis were also evaluated. RESULTS:The median number of patient encounters per intern per 2-week block declined on the pediatric hospital medicine service (37.5 vs 27.0; P < .001) and intensive care step-down unit (29.0 vs 18.8; P = .004) during the pandemic. No significant difference in emergency department encounters was observed (63.0 vs 40.5; P = .06). The median number of shifts worked per intern per 2-week block also decreased on the pediatric hospital medicine service (10.5 vs 9.5, P < .001). Across all settings, there were more encounters for screening for infectious disease and fewer encounters for respiratory illnesses.CONCLUSIONS: Pediatric interns at the onset of the COVID-19 pandemic were exposed to fewer patients and had reduced clinical schedules. Careful consideration is needed to track and supplement missed clinical experiences during the pandemic.
Background The incidence of venous thrombo‐embolism (VTE) in hospitalized children has increased by 130%–200% over the last two decades. Given this increase, many centers utilize electronic clinical decision support (CDS) to prognosticate VTE risk and recommend prophylaxis. SARS‐CoV‐2 infection (COVID‐19) is a risk factor for VTE; however, CDS developed before the COVID‐19 pandemic may not accurately prognosticate VTE risk in children with COVID‐19. This study's objective was to identify areas to improve thromboprophylaxis recommendations for children with COVID‐19. Methods Inpatients with a positive COVID‐19 test at admission were identified at a quaternary‐care pediatric center between March 1, 2020 and January 20, 2022. The results of the institution's automated CDS thromboprophylaxis recommendations were compared to institutional COVID‐19 thromboprophylaxis guidelines and to the actual thromboprophylaxis received. CDS optimization was performed to improve adherence to COVID‐19 thromboprophylaxis recommendations. Results Of the 329 patients included in this study, 106 (28.2%) were prescribed pharmaco‐prophylaxis, 167 (50.8%) were identified by the institutional COVID‐19 guidelines as requiring pharmaco‐prophylaxis, and 45 (13.2%) were identified by the CDS as needing pharmaco‐prophylaxis. On univariate analysis, only age 12 years or more was associated with recipient of appropriate prophylaxis (OR 1.78, 95% CI: 1.13–2.82, p = .013). Five patients developed VTEs; three had symptoms at presentation, two were identified as high risk for VTE by both the automated and best practice assessments but were not prescribed pharmaco‐prophylaxis. Conclusion Automated thromboprophylaxis recommendations developed prior to the COVID‐19 pandemic may not identify all COVID‐19 patients needing pharmaco‐prophylaxis. Existing CDS tools need to be updated to reflect COVID‐19‐specific risk factors for VTEs.
Chase R. Parsons, DO, MBI were registered in only 0.3% to 10% of cases. This low rate suggests the need for improved institutional workflows and governance surrounding proxy account creation as well as patient and family education at the beginning of and throughout adolescence. The authors highlight that local quality improvement and enhanced communications are beginning because of these findings, but it is likely that many other institutions could benefit from similar initiatives.
Background Patients with limited English proficiency (LEP) are at a higher risk of poor health outcomes and are less likely to use telehealth than English-speaking patients. To date, there is no formal evaluation of inpatient (IP) telehealth user experience of patients and their families by language preference during visits with their clinicians. Objective This study aims to compare the experiences of English- and Spanish-speaking patients and their families using IP telehealth, as well as to evaluate the experience of Spanish interpreters providing services through IP telehealth. Methods We prospectively administered a survey to English- and Spanish-speaking patients and their families who used IP telehealth from October 1, 2020, to March 31, 2021. We performed semistructured phone interviews of hospital-based Spanish interpreters who provided services through IP telehealth. Results A total of 661 surveys were administered, with completion rates of 18% (112/621) in English and 62% (25/40) in Spanish. On a 10-point scale, the overall satisfaction of Spanish speakers (median 10, IQR 10-10) was higher than that of English speakers (median 9, IQR 8-10; P=.001). Both English- and Spanish-speaking patients used IP telehealth for visits with their primary IP care team, subspecialty consultants, and other clinicians. Hospital tablets were used more often than personal devices, and only English-speaking patients used personal laptops. Patients and their families encountered challenges with log-in, team coordination with multiple users, and equipment availability. Interpreters encountered challenges with audio and video quality, communication, safety, and Wi-Fi access. Conclusions Both English- and Spanish-speaking patients reported high satisfaction using IP telehealth across multiple disciplines despite the workflow challenges identified by interpreters. Significant investment is needed to provide robust infrastructure to support use by all patients, especially the integration of multiple users to provide interpreter services for patients with LEP.
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