Objective To determine the prevalence of depression and burnout among residents in paediatrics and to establish if a relation exists between these disorders and medication errors. Design Prospective cohort study. Setting Three urban freestanding children's hospitals in the United States. Participants 123 residents in three paediatric residency programmes. Main outcome measures Prevalence of depression using the Harvard national depression screening day scale, burnout using the Maslach burnout inventory, and rate of medication errors per resident month. Results 24 (20%) of the participating residents met the criteria for depression and 92 (74%) met the criteria for burnout. Active surveillance yielded 45 errors made by participants. Depressed residents made 6.2 times as many medication errors per resident month as residents who were not depressed: 1.55 (95% confidence interval 0.57 to 4.22) compared with 0.25 (0.14 to 0.46, P<0.001). Burnt out residents and non-burnt out residents made similar rates of errors per resident month: 0.45 (0.20 to 0.98) compared with 0.53 (0.21 to 1.33, P=0.2). Conclusions Depression and burnout are major problems among residents in paediatrics. Depressed residents made significantly more medical errors than their nondepressed peers; however, burnout did not seem to correlate with an increased rate of medical errors.

Context Readmission rates are used as an indicator of the quality of care that patients receive during a hospital admission and after discharge. Objective To determine the prevalence of pediatric readmissions and the magnitude of variation in pediatric readmission rates across hospitals. Design, Setting, Patients We analyzed 568,845 admissions at 72 children's hospitals between 7/1/2009 and 6/30/2010 in the National Association of Children's Hospitals and Related Institutions Case Mix dataset. We estimated hierarchical regression models for 30-day readmission rates by hospital, accounting for age and chronic condition indicators. Hospitals with adjusted readmission rates that were one standard deviation above and below the mean were defined as having “high” and “low” rates, respectively. Main Outcome Measure Thirty-day unplanned readmissions following admission for any diagnosis and for the 10 admission diagnoses with the highest readmission prevalence. Planned readmissions were identified with ICD-9-CM procedure codes. Results The 30-day unadjusted readmission rate for all hospitalized children was 6.5% (n=36,734). Adjusted rates were 28.6% greater in hospitals with high vs. low readmission rates [7.2% (95% CI 7.1–7.2%) vs. 5.6% (95% CI 5.6-5.6%)]. For the 10 admissions diagnoses with the highest readmission prevalence, the adjusted rates were 17.0% to 66.0% greater in hospitals with high vs. low readmission rates. For example, sickle cell rates were 20.1% (95% CI 20.0–20.3%) vs. 12.7% (95% CI 12.6–12.8%) in high vs. low hospitals, respectively. Conclusions Among patients admitted to acute care pediatric hospitals, the rate of unplanned readmissions at 30 days was 6.5%. There was wide variability in readmission rates across conditions and hospitals.

A large, prospective, multicenter observational study of pediatric EDIs was conducted at university-affiliated EDs. RSI is the method of choice for the majority of pediatric emergency intubations; it is associated with a high success rate and a low rate of serious adverse events. Pediatric intubation as practiced in academic EDs, with most initial attempts by emergency and pediatrics residents and fellows under attending physician supervision, is safe and highly successful.