HM19: Things we do for no reason

The pediatric version



Amit K. Pahwa, MD, FAAP; Nicola Orlov, MD, MPH, FAAP

Workshop title

Things we do for no reason (pediatrics)

Dr. Weijen W. Chang, pediatric editor of The Hospitalist, and chief of the division of pediatric hospital medicine at Baystate Children's Hospital, Springfield, Mass.

Dr. Weijen W. Chang

Session summary

As he began by stating the Institute of Medicine definition of high-value care (HVC), Amit K. Pahwa, MD, of Johns Hopkins Medicine, Baltimore, described HVC as the best care for the patient, with the optimal result for the circumstances, at the right price. But few pediatric residency programs provide education regarding HVC, with only 11% providing a formal HVC curriculum, as found by a survey of pediatric program directors and chief residents in a study published in 2017.

Dr. Pahwa then provided examples of cases in which HVC could be optimized, including reducing rebound bilirubin levels in neonatal hyperbilirubinemia, giving nasogastric feeds instead of IV hydration in bronchiolitis, reducing unnecessary vital sign checks, and providing apple juice supplemented with liquids of choice instead of more expensive oral electrolyte solutions.

Nicola Orlov, MD, of the University of Chicago presented another illustrative case which highlighted the need to reduce vital sign frequency when appropriate. This was linked to her work at Comer Children’s Hospital on reducing nighttime sleep disruptions in hospitalized children, as part of the SIESTA (Sleep for Inpatients: Empowering Staff to Act) study. This led to a significant reduction in nurse/physician interruptions during the study period.

Key takeaways for HM

  • High-value care (HVC) is a key focus of systems improvement in the field of pediatric hospital medicine.
  • Educational efforts for all levels of learners is inadequate currently, and needs to be augmented.
  • Quality improvement projects to promote HVC can lead not only to reduced costs, but improved quality and patient experience.

Dr. Chang is a pediatric hospitalist at Baystate Children’s Hospital in Springfield, Mass., and is the pediatric editor of The Hospitalist.

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