Sandra Gage, MD, PhD, FAAP, SFHM

To improve the pediatric data in the State of Hospital Medicine (SoHM) Report, the Practice Analysis Committee (PAC) developed a pediatric task force to recommend content specific to pediatric practice and garner support for survey participation. The pediatric hospital medicine (PHM) community responded with its usual enthusiasm, resulting in a threefold increase in PHM participation (99 groups), making the data from 2020 SoHM Report the most meaningful ever for pediatric practices.

However, data collection for the 2020 SoHM Report concluded in February, just before the face of medical practice and hospital care changed dramatically. A recent report at the virtual Pediatric Hospital Medicine meeting stated that pre–COVID-19 hospital operating margins had already taken a significant decline (from 5% to 2%-3%), putting pressure on pediatric programs in community settings that typically do not generate much revenue. After COVID-19, hospital revenues took an even greater downturn, affecting many hospital-based pediatric programs. While the future direction of many PHM programs remains unclear, the robust nature of the pediatric data in the 2020 SoHM Report defines where we were and where we once again hope to be. In addition, the PAC conducted a supplemental survey designed to assess the impact of COVID-19 on the practice of hospital medicine. Here’s a quick review of PHM highlights from the 2020 SoHM Report, with preliminary findings from the supplemental survey.

Diversity of service and scope of practice: pediatric hospitalist programs continue to provide a wide variety of services beyond care on inpatient wards, with the most common being procedure performance (56.6%), care of healthy newborns (51.5%), and rapid response team (38.4%) coverage. In addition, most PHM programs have a role in comanagement of a wide variety of patient populations, with the greatest presence among the surgical specialties. Approximately 90% of programs report some role in the care of patients admitted to general surgery, orthopedic surgery, and other surgical subspecialties. The role for comanagement with medical specialties remains diverse, with PHM programs routinely having some role in caring for patients hospitalized for neurologic, gastroenterological, cardiac concerns, and others. With the recent decline in hospital revenues affecting PHM practices, one way to ensure program value is to continue to diversify. Based on data from the 2020 SoHM report, broadening of clinical coverage will not require a significant change in practice for most PHM programs.

PHM board certification: With the first certifying exam for PHM taking place just months before SoHM data collection, the survey sought to establish a baseline percentage of providers board certified in PHM. With 98 groups responding, an average of 26.4% of PHM practitioners per group were reported to be board certified. While no difference was seen based on academic status, practitioners in PHM programs employed by a hospital, health system, or integrated delivery system were much more likely to be board certified than those employed by a university or medical school (31% vs. 20%). Regional differences were noted as well, with the East region reporting a much higher median proportion of PHM-certified physicians. It will be interesting to watch the trend in board certification status evolve over the upcoming years.

Anticipated change of budgeted full-time equivalents in the next year/post–COVID-19 analysis: Of the PHM programs responding to the SoHM Survey, 46.5% predicted an increase in budgeted full-time equivalents in the next year, while only 5.1% anticipated a decrease. Expecting this to change in response to COVID-19, the supplemental survey sought to update this information. Of the 30 PHM respondents to the supplemental survey, 41% instituted a temporary hiring freeze because of COVID-19, while 8.3% instituted a hiring freeze felt likely to be permanent. As PHM programs gear up for the next viral season, we wait to see whether the impact of COVID-19 will continue to be reflected in the volume and variety of patients admitted. It is clear that PHM programs will need to remain nimble to stay ahead of the changing landscape of practice in the days ahead. View all data by obtaining access to the 2020 SoHM Report at hospitalmedicine.org/sohm.

Many thanks to pediatric task force members Jack Percelay, MD; Vivien Kon-Ea Sun, MD; Marcos Mestre, MD; Ann Allen, MD; Dimple Khona, MD; Jeff Grill, MD; and Michelle Marks, MD.

Dr. Gage is director of faculty development, pediatric hospital medicine, at Phoenix Children’s Hospital, and associate professor of pediatrics at the University of Arizona, Phoenix.

To improve the pediatric data in the State of Hospital Medicine (SoHM) Report, the Practice Analysis Committee (PAC) developed a pediatric task force to recommend content specific to pediatric practice and garner support for survey participation. The pediatric hospital medicine (PHM) community responded with its usual enthusiasm, resulting in a threefold increase in PHM participation (99 groups), making the data from 2020 SoHM Report the most meaningful ever for pediatric practices.

However, data collection for the 2020 SoHM Report concluded in February, just before the face of medical practice and hospital care changed dramatically. A recent report at the virtual Pediatric Hospital Medicine meeting stated that pre–COVID-19 hospital operating margins had already taken a significant decline (from 5% to 2%-3%), putting pressure on pediatric programs in community settings that typically do not generate much revenue. After COVID-19, hospital revenues took an even greater downturn, affecting many hospital-based pediatric programs. While the future direction of many PHM programs remains unclear, the robust nature of the pediatric data in the 2020 SoHM Report defines where we were and where we once again hope to be. In addition, the PAC conducted a supplemental survey designed to assess the impact of COVID-19 on the practice of hospital medicine. Here’s a quick review of PHM highlights from the 2020 SoHM Report, with preliminary findings from the supplemental survey.

Diversity of service and scope of practice: pediatric hospitalist programs continue to provide a wide variety of services beyond care on inpatient wards, with the most common being procedure performance (56.6%), care of healthy newborns (51.5%), and rapid response team (38.4%) coverage. In addition, most PHM programs have a role in comanagement of a wide variety of patient populations, with the greatest presence among the surgical specialties. Approximately 90% of programs report some role in the care of patients admitted to general surgery, orthopedic surgery, and other surgical subspecialties. The role for comanagement with medical specialties remains diverse, with PHM programs routinely having some role in caring for patients hospitalized for neurologic, gastroenterological, cardiac concerns, and others. With the recent decline in hospital revenues affecting PHM practices, one way to ensure program value is to continue to diversify. Based on data from the 2020 SoHM report, broadening of clinical coverage will not require a significant change in practice for most PHM programs.

PHM board certification: With the first certifying exam for PHM taking place just months before SoHM data collection, the survey sought to establish a baseline percentage of providers board certified in PHM. With 98 groups responding, an average of 26.4% of PHM practitioners per group were reported to be board certified. While no difference was seen based on academic status, practitioners in PHM programs employed by a hospital, health system, or integrated delivery system were much more likely to be board certified than those employed by a university or medical school (31% vs. 20%). Regional differences were noted as well, with the East region reporting a much higher median proportion of PHM-certified physicians. It will be interesting to watch the trend in board certification status evolve over the upcoming years.

Anticipated change of budgeted full-time equivalents in the next year/post–COVID-19 analysis: Of the PHM programs responding to the SoHM Survey, 46.5% predicted an increase in budgeted full-time equivalents in the next year, while only 5.1% anticipated a decrease. Expecting this to change in response to COVID-19, the supplemental survey sought to update this information. Of the 30 PHM respondents to the supplemental survey, 41% instituted a temporary hiring freeze because of COVID-19, while 8.3% instituted a hiring freeze felt likely to be permanent. As PHM programs gear up for the next viral season, we wait to see whether the impact of COVID-19 will continue to be reflected in the volume and variety of patients admitted. It is clear that PHM programs will need to remain nimble to stay ahead of the changing landscape of practice in the days ahead. View all data by obtaining access to the 2020 SoHM Report at hospitalmedicine.org/sohm.

Many thanks to pediatric task force members Jack Percelay, MD; Vivien Kon-Ea Sun, MD; Marcos Mestre, MD; Ann Allen, MD; Dimple Khona, MD; Jeff Grill, MD; and Michelle Marks, MD.

Dr. Gage is director of faculty development, pediatric hospital medicine, at Phoenix Children’s Hospital, and associate professor of pediatrics at the University of Arizona, Phoenix.

To improve the pediatric data in the State of Hospital Medicine (SoHM) Report, the Practice Analysis Committee (PAC) developed a pediatric task force to recommend content specific to pediatric practice and garner support for survey participation. The pediatric hospital medicine (PHM) community responded with its usual enthusiasm, resulting in a threefold increase in PHM participation (99 groups), making the data from 2020 SoHM Report the most meaningful ever for pediatric practices.

However, data collection for the 2020 SoHM Report concluded in February, just before the face of medical practice and hospital care changed dramatically. A recent report at the virtual Pediatric Hospital Medicine meeting stated that pre–COVID-19 hospital operating margins had already taken a significant decline (from 5% to 2%-3%), putting pressure on pediatric programs in community settings that typically do not generate much revenue. After COVID-19, hospital revenues took an even greater downturn, affecting many hospital-based pediatric programs. While the future direction of many PHM programs remains unclear, the robust nature of the pediatric data in the 2020 SoHM Report defines where we were and where we once again hope to be. In addition, the PAC conducted a supplemental survey designed to assess the impact of COVID-19 on the practice of hospital medicine. Here’s a quick review of PHM highlights from the 2020 SoHM Report, with preliminary findings from the supplemental survey.

Diversity of service and scope of practice: pediatric hospitalist programs continue to provide a wide variety of services beyond care on inpatient wards, with the most common being procedure performance (56.6%), care of healthy newborns (51.5%), and rapid response team (38.4%) coverage. In addition, most PHM programs have a role in comanagement of a wide variety of patient populations, with the greatest presence among the surgical specialties. Approximately 90% of programs report some role in the care of patients admitted to general surgery, orthopedic surgery, and other surgical subspecialties. The role for comanagement with medical specialties remains diverse, with PHM programs routinely having some role in caring for patients hospitalized for neurologic, gastroenterological, cardiac concerns, and others. With the recent decline in hospital revenues affecting PHM practices, one way to ensure program value is to continue to diversify. Based on data from the 2020 SoHM report, broadening of clinical coverage will not require a significant change in practice for most PHM programs.

PHM board certification: With the first certifying exam for PHM taking place just months before SoHM data collection, the survey sought to establish a baseline percentage of providers board certified in PHM. With 98 groups responding, an average of 26.4% of PHM practitioners per group were reported to be board certified. While no difference was seen based on academic status, practitioners in PHM programs employed by a hospital, health system, or integrated delivery system were much more likely to be board certified than those employed by a university or medical school (31% vs. 20%). Regional differences were noted as well, with the East region reporting a much higher median proportion of PHM-certified physicians. It will be interesting to watch the trend in board certification status evolve over the upcoming years.

Anticipated change of budgeted full-time equivalents in the next year/post–COVID-19 analysis: Of the PHM programs responding to the SoHM Survey, 46.5% predicted an increase in budgeted full-time equivalents in the next year, while only 5.1% anticipated a decrease. Expecting this to change in response to COVID-19, the supplemental survey sought to update this information. Of the 30 PHM respondents to the supplemental survey, 41% instituted a temporary hiring freeze because of COVID-19, while 8.3% instituted a hiring freeze felt likely to be permanent. As PHM programs gear up for the next viral season, we wait to see whether the impact of COVID-19 will continue to be reflected in the volume and variety of patients admitted. It is clear that PHM programs will need to remain nimble to stay ahead of the changing landscape of practice in the days ahead. View all data by obtaining access to the 2020 SoHM Report at hospitalmedicine.org/sohm.

Many thanks to pediatric task force members Jack Percelay, MD; Vivien Kon-Ea Sun, MD; Marcos Mestre, MD; Ann Allen, MD; Dimple Khona, MD; Jeff Grill, MD; and Michelle Marks, MD.

Dr. Gage is director of faculty development, pediatric hospital medicine, at Phoenix Children’s Hospital, and associate professor of pediatrics at the University of Arizona, Phoenix.

Introduction

Complaints related to the gastrointestinal (GI) and digestive system are common in childhood and may indicate the presence of a broad range of both routine and serious, life-threatening conditions. Pediatric hospitalists commonly encounter children who present with GI complaints such as abdominal pain, gastrointestinal bleeding, or feeding intolerance, as well as new or established GI conditions such as gastroesophageal reflux (GER), malabsorption, disorders of motility, and a variety of obstructive, infectious, and inflammatory diagnoses. Pediatric hospitalists are often tasked with identifying presenting signs and symptoms, initiating appropriate investigational studies and therapies, and coordinating care across subspecialties as appropriate.

Pediatric hospitalists should be able to:

• Discuss essential elements of the history for patients with GI complaints, including location, radiation, and duration of pain; emesis and stool pattern and description; pertinent non-GI symptoms such as rash, fever, and joint pain; and growth parameters and weight trend.
• Describe the differential diagnosis for common GI complaints for children of varying ages, including:

–Acute and chronic abdominal pain

–Emesis, with and without diarrhea

–Acute and chronic diarrhea

–Upper and lower GI bleeding

• Discuss disorders of other organ systems that may present with GI complaints, such as lower lobe pneumonia, urinary tract infection, and others.
• Describe medical and surgical urgent and emergent conditions that present with abdominal pain or a digestive disorder, such as intussusception, volvulus, biliary atresia, pyloric stenosis, Hirschsprung’s disease, and others.
• Describe the unique diagnostic considerations for adolescents with abdominal pain, including sexually transmitted infections and pelvic inflammatory disease, pregnancy related conditions, and testicular conditions.
• Discuss organisms associated with common infections of the GI tract, including those of the esophagus, stomach, small intestines, and colon.
• Compare and contrast the epidemiology, historical elements, and physical examination findings for various infectious or inflammatory conditions, such as pancreatitis, cholecystitis, hepatitis, and inflammatory bowel disease (IBD).
• Compare and contrast the clinical presentation, radiographic findings, and pharmacologic and non-pharmacologic treatment modalities for physiologic GER versus GER disease.
• Describe common causes of dysphagia and dysmotility, such as congenital anomalies, neurological impairment, and others, and discuss approaches to evaluation and treatment.
• Explain the indications for hospital admission, including clinical monitoring, fluid resuscitation, correction of electrolyte disturbances, and further diagnostic evaluation.
• Explain the indications for diagnostic laboratory and imaging tests, attending to variation by age, predictive value of tests, and cost-effectiveness.
• Describe common laboratory, imaging, endoscopic, and pathologic findings associated with specific GI disorders, such as eosinophilic esophagitis, IBD, Celiac Disease, and others.
• Discuss indications for subspecialty consultation, including speech and feeding therapy, radiology, gastroenterology, and surgery.
• Discuss indications for patient transfer to a referral center, such as need for pediatric-specific services not available at the local facility.
• Describe specific clinical discharge criteria for hospitalized patients with various GI disorders.

Pediatric hospitalists should be able to:

• Diagnose disorders of the GI tract and digestive system by efficiently performing an accurate history and physical examination, with specific focus on the oral pharynx, anus and rectum, abdomen, and integument, determining if key features of diseases are present.
• Formulate a targeted differential diagnosis based on elements from the history and physical examination to direct the need for further investigation.
• Identify and effectively manage complications of GI disorders such as sepsis, ileus or obstruction, and GI bleeding.
• Formulate an individualized, evidence-based evaluation and treatment plan, including fluid and nutritional management, laboratory and radiological testing, coordination of endoscopic and surgical interventions, medication, and pain management.
• Adhere to infection control practices when indicated.
• Engage consultants efficiently and appropriately when indicated.
• Communicate effectively with the family/caregivers and healthcare providers regarding findings and care plans.
• Coordinate care with the primary care provider and subspecialists if indicated and arrange an appropriate transition plan for hospital discharge.

Pediatric hospitalists should be able to:

• Recognize the importance of coordinating care for diagnostic tests and treatment between subspecialists, such as gastroenterologists, radiologists, and surgeons.
• Realize responsibility for effective communication with the patients, the family/caregivers, subspecialists, and primary care providers regarding diagnostic findings, plan of care, and anticipatory guidance after discharge.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management for hospitalized children with GI disorders.
• Collaborate with hospital administration to create and sustain a process to follow up on laboratory tests pending at discharge.

Introduction

Complaints related to the gastrointestinal (GI) and digestive system are common in childhood and may indicate the presence of a broad range of both routine and serious, life-threatening conditions. Pediatric hospitalists commonly encounter children who present with GI complaints such as abdominal pain, gastrointestinal bleeding, or feeding intolerance, as well as new or established GI conditions such as gastroesophageal reflux (GER), malabsorption, disorders of motility, and a variety of obstructive, infectious, and inflammatory diagnoses. Pediatric hospitalists are often tasked with identifying presenting signs and symptoms, initiating appropriate investigational studies and therapies, and coordinating care across subspecialties as appropriate.

Pediatric hospitalists should be able to:

• Discuss essential elements of the history for patients with GI complaints, including location, radiation, and duration of pain; emesis and stool pattern and description; pertinent non-GI symptoms such as rash, fever, and joint pain; and growth parameters and weight trend.
• Describe the differential diagnosis for common GI complaints for children of varying ages, including:

–Acute and chronic abdominal pain

–Emesis, with and without diarrhea

–Acute and chronic diarrhea

–Upper and lower GI bleeding

• Discuss disorders of other organ systems that may present with GI complaints, such as lower lobe pneumonia, urinary tract infection, and others.
• Describe medical and surgical urgent and emergent conditions that present with abdominal pain or a digestive disorder, such as intussusception, volvulus, biliary atresia, pyloric stenosis, Hirschsprung’s disease, and others.
• Describe the unique diagnostic considerations for adolescents with abdominal pain, including sexually transmitted infections and pelvic inflammatory disease, pregnancy related conditions, and testicular conditions.
• Discuss organisms associated with common infections of the GI tract, including those of the esophagus, stomach, small intestines, and colon.
• Compare and contrast the epidemiology, historical elements, and physical examination findings for various infectious or inflammatory conditions, such as pancreatitis, cholecystitis, hepatitis, and inflammatory bowel disease (IBD).
• Compare and contrast the clinical presentation, radiographic findings, and pharmacologic and non-pharmacologic treatment modalities for physiologic GER versus GER disease.
• Describe common causes of dysphagia and dysmotility, such as congenital anomalies, neurological impairment, and others, and discuss approaches to evaluation and treatment.
• Explain the indications for hospital admission, including clinical monitoring, fluid resuscitation, correction of electrolyte disturbances, and further diagnostic evaluation.
• Explain the indications for diagnostic laboratory and imaging tests, attending to variation by age, predictive value of tests, and cost-effectiveness.
• Describe common laboratory, imaging, endoscopic, and pathologic findings associated with specific GI disorders, such as eosinophilic esophagitis, IBD, Celiac Disease, and others.
• Discuss indications for subspecialty consultation, including speech and feeding therapy, radiology, gastroenterology, and surgery.
• Discuss indications for patient transfer to a referral center, such as need for pediatric-specific services not available at the local facility.
• Describe specific clinical discharge criteria for hospitalized patients with various GI disorders.

Pediatric hospitalists should be able to:

• Diagnose disorders of the GI tract and digestive system by efficiently performing an accurate history and physical examination, with specific focus on the oral pharynx, anus and rectum, abdomen, and integument, determining if key features of diseases are present.
• Formulate a targeted differential diagnosis based on elements from the history and physical examination to direct the need for further investigation.
• Identify and effectively manage complications of GI disorders such as sepsis, ileus or obstruction, and GI bleeding.
• Formulate an individualized, evidence-based evaluation and treatment plan, including fluid and nutritional management, laboratory and radiological testing, coordination of endoscopic and surgical interventions, medication, and pain management.
• Adhere to infection control practices when indicated.
• Engage consultants efficiently and appropriately when indicated.
• Communicate effectively with the family/caregivers and healthcare providers regarding findings and care plans.
• Coordinate care with the primary care provider and subspecialists if indicated and arrange an appropriate transition plan for hospital discharge.

Pediatric hospitalists should be able to:

• Recognize the importance of coordinating care for diagnostic tests and treatment between subspecialists, such as gastroenterologists, radiologists, and surgeons.
• Realize responsibility for effective communication with the patients, the family/caregivers, subspecialists, and primary care providers regarding diagnostic findings, plan of care, and anticipatory guidance after discharge.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management for hospitalized children with GI disorders.
• Collaborate with hospital administration to create and sustain a process to follow up on laboratory tests pending at discharge.

Introduction

Complaints related to the gastrointestinal (GI) and digestive system are common in childhood and may indicate the presence of a broad range of both routine and serious, life-threatening conditions. Pediatric hospitalists commonly encounter children who present with GI complaints such as abdominal pain, gastrointestinal bleeding, or feeding intolerance, as well as new or established GI conditions such as gastroesophageal reflux (GER), malabsorption, disorders of motility, and a variety of obstructive, infectious, and inflammatory diagnoses. Pediatric hospitalists are often tasked with identifying presenting signs and symptoms, initiating appropriate investigational studies and therapies, and coordinating care across subspecialties as appropriate.

Pediatric hospitalists should be able to:

• Discuss essential elements of the history for patients with GI complaints, including location, radiation, and duration of pain; emesis and stool pattern and description; pertinent non-GI symptoms such as rash, fever, and joint pain; and growth parameters and weight trend.
• Describe the differential diagnosis for common GI complaints for children of varying ages, including:

–Acute and chronic abdominal pain

–Emesis, with and without diarrhea

–Acute and chronic diarrhea

–Upper and lower GI bleeding

• Discuss disorders of other organ systems that may present with GI complaints, such as lower lobe pneumonia, urinary tract infection, and others.
• Describe medical and surgical urgent and emergent conditions that present with abdominal pain or a digestive disorder, such as intussusception, volvulus, biliary atresia, pyloric stenosis, Hirschsprung’s disease, and others.
• Describe the unique diagnostic considerations for adolescents with abdominal pain, including sexually transmitted infections and pelvic inflammatory disease, pregnancy related conditions, and testicular conditions.
• Discuss organisms associated with common infections of the GI tract, including those of the esophagus, stomach, small intestines, and colon.
• Compare and contrast the epidemiology, historical elements, and physical examination findings for various infectious or inflammatory conditions, such as pancreatitis, cholecystitis, hepatitis, and inflammatory bowel disease (IBD).
• Compare and contrast the clinical presentation, radiographic findings, and pharmacologic and non-pharmacologic treatment modalities for physiologic GER versus GER disease.
• Describe common causes of dysphagia and dysmotility, such as congenital anomalies, neurological impairment, and others, and discuss approaches to evaluation and treatment.
• Explain the indications for hospital admission, including clinical monitoring, fluid resuscitation, correction of electrolyte disturbances, and further diagnostic evaluation.
• Explain the indications for diagnostic laboratory and imaging tests, attending to variation by age, predictive value of tests, and cost-effectiveness.
• Describe common laboratory, imaging, endoscopic, and pathologic findings associated with specific GI disorders, such as eosinophilic esophagitis, IBD, Celiac Disease, and others.
• Discuss indications for subspecialty consultation, including speech and feeding therapy, radiology, gastroenterology, and surgery.
• Discuss indications for patient transfer to a referral center, such as need for pediatric-specific services not available at the local facility.
• Describe specific clinical discharge criteria for hospitalized patients with various GI disorders.

Pediatric hospitalists should be able to:

• Diagnose disorders of the GI tract and digestive system by efficiently performing an accurate history and physical examination, with specific focus on the oral pharynx, anus and rectum, abdomen, and integument, determining if key features of diseases are present.
• Formulate a targeted differential diagnosis based on elements from the history and physical examination to direct the need for further investigation.
• Identify and effectively manage complications of GI disorders such as sepsis, ileus or obstruction, and GI bleeding.
• Formulate an individualized, evidence-based evaluation and treatment plan, including fluid and nutritional management, laboratory and radiological testing, coordination of endoscopic and surgical interventions, medication, and pain management.
• Adhere to infection control practices when indicated.
• Engage consultants efficiently and appropriately when indicated.
• Communicate effectively with the family/caregivers and healthcare providers regarding findings and care plans.
• Coordinate care with the primary care provider and subspecialists if indicated and arrange an appropriate transition plan for hospital discharge.

Pediatric hospitalists should be able to:

• Recognize the importance of coordinating care for diagnostic tests and treatment between subspecialists, such as gastroenterologists, radiologists, and surgeons.
• Realize responsibility for effective communication with the patients, the family/caregivers, subspecialists, and primary care providers regarding diagnostic findings, plan of care, and anticipatory guidance after discharge.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management for hospitalized children with GI disorders.
• Collaborate with hospital administration to create and sustain a process to follow up on laboratory tests pending at discharge.

Introduction

Acute gastroenteritis (AGE) is one of the most common diseases of childhood. Admission to the hospital can be prevented in many cases with appropriate use of oral rehydration. Despite this, annual hospitalization rates in the United States have been reported to be as high 3 to 5 per 1000 US children, and the financial burden of emergency department care and hospitalization accounts for up to $350 million in costs annually. Although uncommon in developed countries, morbidity can be profound, and mortality can occur. Among hospitalized patients, complications including electrolyte abnormalities, sepsis, and malnutrition have been noted. Misdiagnosis of AGE may occur, particularly when vomiting is the predominant symptom, which can lead to inappropriate treatment for potentially life-threatening conditions. Pediatric hospitalists routinely encounter patients with AGE and should provide immediate medical care in an efficient and effective manner.

Pediatric hospitalists should be able to:

• Describe the signs, symptoms, and common or concerning complications of AGE, including electrolyte disturbances, dehydration, ileus, and hemolytic uremic syndrome.
• List the common pathogens and related epidemiologic factors for AGE depending upon age, immunization status, geographic location, and exposure and travel history.
• Discuss the pathophysiology of electrolyte disturbances in AGE.
• Discuss the indications for hospital admission, including the need for intravenous fluids, correction of fluid, electrolyte and acid base disturbances, close clinical monitoring, and/or further diagnostic evaluation.
• Discuss essential elements of the history for patients with AGE, including immunization status, water and food sources, method of food preparation, daycare attendance, and recent travel.
• Describe the elements of the physical examination that aid in the diagnosis of AGE and associated complications.
• Compare and contrast clinical findings associated with viral, bacterial, and parasitic AGE.
• Compare and contrast conditions with presentations like that of AGE or its complications, including critical medical and surgical diagnoses such as diabetic ketoacidosis, inborn errors of metabolism, malrotation with midgut volvulus, and bowel obstruction.
• Compare and contrast the differential diagnoses of isolated emesis, bilious emesis, and emesis with diarrhea.
• Describe the differences in approach toward diagnosis and treatment for patients with co-morbid conditions or immunosuppression.
• Discuss the role of infection control in the hospital, as well as public health reporting mandates.
• Describe the indications for diagnostic laboratory tests, including stool, blood, and urine studies, attending to age groups, predictive value of tests, and cost-effectiveness.
• Describe the indications and contraindications of the interventions used to manage the symptoms of AGE, including the role of oral rehydration solutions in the treatment of related dehydration.
• Discuss indications for specialty consultation, such as gastroenterology, nutrition, surgery, and others.
• Describe criteria for hospital discharge, including specific measures of clinical stability for safe care transition.

Pediatric hospitalists should be able to:

• Diagnose gastroenteritis by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
• Identify and correctly manage fluid, electrolyte, and acid base derangements.
• Assess patients efficiently and effectively for complications of gastroenteritis such as sepsis, ileus, and hemolytic uremic syndrome.
• Identify and appropriately treat patients at risk for AGE secondary to unusual pathogens.
• Direct a cost-effective and evidence-based evaluation and treatment plan, especially regarding laboratory studies, antibiotics, and oral or intravenous fluid resuscitation.
• Adhere consistently to infection control practices.
• Perform careful reassessments daily and as needed, note changes in clinical status, and respond with appropriate actions, taking care to consider alternative conditions as appropriate.
• Engage consultants efficiently when indicated.
• Communicate effectively with the family/caregivers and healthcare providers regarding findings and plans.
• Ensure coordination of care for diagnostic tests and treatment between subspecialists.
• Create a comprehensive discharge plan that can be expediently activated when appropriate.

Pediatric hospitalists should be able to:

• Realize responsibility for educating the family/caregivers on the natural course of the disease, identification and management of common complications, and infection control practices to manage expectations and decrease pathogen transmission.
• Ensure coordination of care for diagnostic tests and treatments between subspecialists.
• Exemplify and advocate for strict adherence to infection control practices.
• Exemplify effective communication with patients, the family/caregivers, and healthcare providers regarding findings, care plans, and anticipated health needs after discharge.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management for hospitalized children with AGE.
• Collaborate with hospital administration to create and sustain a process to follow up on laboratory tests pending at discharge.
• Collaborate with institutional infection control practitioners to improve processes to prevent nosocomial infection related to gastroenteritis.
• Lead, coordinate, or participate in efforts to assure consistent public health reporting of appropriate infections and response to trends.

Introduction

Acute gastroenteritis (AGE) is one of the most common diseases of childhood. Admission to the hospital can be prevented in many cases with appropriate use of oral rehydration. Despite this, annual hospitalization rates in the United States have been reported to be as high 3 to 5 per 1000 US children, and the financial burden of emergency department care and hospitalization accounts for up to $350 million in costs annually. Although uncommon in developed countries, morbidity can be profound, and mortality can occur. Among hospitalized patients, complications including electrolyte abnormalities, sepsis, and malnutrition have been noted. Misdiagnosis of AGE may occur, particularly when vomiting is the predominant symptom, which can lead to inappropriate treatment for potentially life-threatening conditions. Pediatric hospitalists routinely encounter patients with AGE and should provide immediate medical care in an efficient and effective manner.

Pediatric hospitalists should be able to:

• Describe the signs, symptoms, and common or concerning complications of AGE, including electrolyte disturbances, dehydration, ileus, and hemolytic uremic syndrome.
• List the common pathogens and related epidemiologic factors for AGE depending upon age, immunization status, geographic location, and exposure and travel history.
• Discuss the pathophysiology of electrolyte disturbances in AGE.
• Discuss the indications for hospital admission, including the need for intravenous fluids, correction of fluid, electrolyte and acid base disturbances, close clinical monitoring, and/or further diagnostic evaluation.
• Discuss essential elements of the history for patients with AGE, including immunization status, water and food sources, method of food preparation, daycare attendance, and recent travel.
• Describe the elements of the physical examination that aid in the diagnosis of AGE and associated complications.
• Compare and contrast clinical findings associated with viral, bacterial, and parasitic AGE.
• Compare and contrast conditions with presentations like that of AGE or its complications, including critical medical and surgical diagnoses such as diabetic ketoacidosis, inborn errors of metabolism, malrotation with midgut volvulus, and bowel obstruction.
• Compare and contrast the differential diagnoses of isolated emesis, bilious emesis, and emesis with diarrhea.
• Describe the differences in approach toward diagnosis and treatment for patients with co-morbid conditions or immunosuppression.
• Discuss the role of infection control in the hospital, as well as public health reporting mandates.
• Describe the indications for diagnostic laboratory tests, including stool, blood, and urine studies, attending to age groups, predictive value of tests, and cost-effectiveness.
• Describe the indications and contraindications of the interventions used to manage the symptoms of AGE, including the role of oral rehydration solutions in the treatment of related dehydration.
• Discuss indications for specialty consultation, such as gastroenterology, nutrition, surgery, and others.
• Describe criteria for hospital discharge, including specific measures of clinical stability for safe care transition.

Pediatric hospitalists should be able to:

• Diagnose gastroenteritis by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
• Identify and correctly manage fluid, electrolyte, and acid base derangements.
• Assess patients efficiently and effectively for complications of gastroenteritis such as sepsis, ileus, and hemolytic uremic syndrome.
• Identify and appropriately treat patients at risk for AGE secondary to unusual pathogens.
• Direct a cost-effective and evidence-based evaluation and treatment plan, especially regarding laboratory studies, antibiotics, and oral or intravenous fluid resuscitation.
• Adhere consistently to infection control practices.
• Perform careful reassessments daily and as needed, note changes in clinical status, and respond with appropriate actions, taking care to consider alternative conditions as appropriate.
• Engage consultants efficiently when indicated.
• Communicate effectively with the family/caregivers and healthcare providers regarding findings and plans.
• Ensure coordination of care for diagnostic tests and treatment between subspecialists.
• Create a comprehensive discharge plan that can be expediently activated when appropriate.

Pediatric hospitalists should be able to:

• Realize responsibility for educating the family/caregivers on the natural course of the disease, identification and management of common complications, and infection control practices to manage expectations and decrease pathogen transmission.
• Ensure coordination of care for diagnostic tests and treatments between subspecialists.
• Exemplify and advocate for strict adherence to infection control practices.
• Exemplify effective communication with patients, the family/caregivers, and healthcare providers regarding findings, care plans, and anticipated health needs after discharge.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management for hospitalized children with AGE.
• Collaborate with hospital administration to create and sustain a process to follow up on laboratory tests pending at discharge.
• Collaborate with institutional infection control practitioners to improve processes to prevent nosocomial infection related to gastroenteritis.
• Lead, coordinate, or participate in efforts to assure consistent public health reporting of appropriate infections and response to trends.

Introduction

Acute gastroenteritis (AGE) is one of the most common diseases of childhood. Admission to the hospital can be prevented in many cases with appropriate use of oral rehydration. Despite this, annual hospitalization rates in the United States have been reported to be as high 3 to 5 per 1000 US children, and the financial burden of emergency department care and hospitalization accounts for up to $350 million in costs annually. Although uncommon in developed countries, morbidity can be profound, and mortality can occur. Among hospitalized patients, complications including electrolyte abnormalities, sepsis, and malnutrition have been noted. Misdiagnosis of AGE may occur, particularly when vomiting is the predominant symptom, which can lead to inappropriate treatment for potentially life-threatening conditions. Pediatric hospitalists routinely encounter patients with AGE and should provide immediate medical care in an efficient and effective manner.

Pediatric hospitalists should be able to:

• Describe the signs, symptoms, and common or concerning complications of AGE, including electrolyte disturbances, dehydration, ileus, and hemolytic uremic syndrome.
• List the common pathogens and related epidemiologic factors for AGE depending upon age, immunization status, geographic location, and exposure and travel history.
• Discuss the pathophysiology of electrolyte disturbances in AGE.
• Discuss the indications for hospital admission, including the need for intravenous fluids, correction of fluid, electrolyte and acid base disturbances, close clinical monitoring, and/or further diagnostic evaluation.
• Discuss essential elements of the history for patients with AGE, including immunization status, water and food sources, method of food preparation, daycare attendance, and recent travel.
• Describe the elements of the physical examination that aid in the diagnosis of AGE and associated complications.
• Compare and contrast clinical findings associated with viral, bacterial, and parasitic AGE.
• Compare and contrast conditions with presentations like that of AGE or its complications, including critical medical and surgical diagnoses such as diabetic ketoacidosis, inborn errors of metabolism, malrotation with midgut volvulus, and bowel obstruction.
• Compare and contrast the differential diagnoses of isolated emesis, bilious emesis, and emesis with diarrhea.
• Describe the differences in approach toward diagnosis and treatment for patients with co-morbid conditions or immunosuppression.
• Discuss the role of infection control in the hospital, as well as public health reporting mandates.
• Describe the indications for diagnostic laboratory tests, including stool, blood, and urine studies, attending to age groups, predictive value of tests, and cost-effectiveness.
• Describe the indications and contraindications of the interventions used to manage the symptoms of AGE, including the role of oral rehydration solutions in the treatment of related dehydration.
• Discuss indications for specialty consultation, such as gastroenterology, nutrition, surgery, and others.
• Describe criteria for hospital discharge, including specific measures of clinical stability for safe care transition.

Pediatric hospitalists should be able to:

• Diagnose gastroenteritis by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
• Identify and correctly manage fluid, electrolyte, and acid base derangements.
• Assess patients efficiently and effectively for complications of gastroenteritis such as sepsis, ileus, and hemolytic uremic syndrome.
• Identify and appropriately treat patients at risk for AGE secondary to unusual pathogens.
• Direct a cost-effective and evidence-based evaluation and treatment plan, especially regarding laboratory studies, antibiotics, and oral or intravenous fluid resuscitation.
• Adhere consistently to infection control practices.
• Perform careful reassessments daily and as needed, note changes in clinical status, and respond with appropriate actions, taking care to consider alternative conditions as appropriate.
• Engage consultants efficiently when indicated.
• Communicate effectively with the family/caregivers and healthcare providers regarding findings and plans.
• Ensure coordination of care for diagnostic tests and treatment between subspecialists.
• Create a comprehensive discharge plan that can be expediently activated when appropriate.

Pediatric hospitalists should be able to:

• Realize responsibility for educating the family/caregivers on the natural course of the disease, identification and management of common complications, and infection control practices to manage expectations and decrease pathogen transmission.
• Ensure coordination of care for diagnostic tests and treatments between subspecialists.
• Exemplify and advocate for strict adherence to infection control practices.
• Exemplify effective communication with patients, the family/caregivers, and healthcare providers regarding findings, care plans, and anticipated health needs after discharge.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management for hospitalized children with AGE.
• Collaborate with hospital administration to create and sustain a process to follow up on laboratory tests pending at discharge.
• Collaborate with institutional infection control practitioners to improve processes to prevent nosocomial infection related to gastroenteritis.
• Lead, coordinate, or participate in efforts to assure consistent public health reporting of appropriate infections and response to trends.