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Patient safety
Introduction
The topic of Patient Safety became a major priority for healthcare providers in 1999 when the Institute of Medicine (IOM) report entitled To Err is Human focused attention on patient safety and medical errors. The Institute of Medicine defined safety as freedom from accidental injury and error as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. The IOM report estimated that between 44,000 to 98,000 Americans die each year as a result of medical errors which exceed the number attributable to the 8th leading cause of death in America. Total national costs of preventable adverse events are estimated to be up to $29 billion. Since the initial publication of the 1999 IOM report, there have been a number of local, state, and national programs focused on reducing error. Efforts over the past few years have attempted to better classify errors by the harm caused, allowing targeted interventions to specifically address these more clinically significant events. Children, as a vulnerable population, are at particular risk for medical errors and specifically medication errors. Pediatric hospitalists have an exceptional opportunity to promote patient safety and help develop systems that will reduce harm in the inpatient arena.
Knowledge
Pediatric hospitalists should be able to:
Identify the basic principles of patient safety as outlined in the original 1999 IOM report.
Describe the culture necessary for successful safety efforts. Define Just culture.
Define commonly used terms and tools of Patient Safety such as reliability, transparency, adverse medical event, harm, preventable errors, failure mode effects analysis (FMEA), root cause analysis (RCA) and trigger tool.
Name common patient safety practices and enhancements including pre‐printed order sets, practice guidelines, electronic health information systems, bar coding, time‐outs, and others. Explain how new errors can be associated with the introduction of these enhancements.
Discuss why errors are more often a result of systems failures rather than individual failures.
Explain how decreasing unwanted variability in care impacts patient safety.
Illustrate that building safety into everyday processes of care is the most effective way to reduce or prevent errors.
Describe how patient safety is threatened by poor information transfer and failed communication.
Discuss strategies for effective, efficient, and safe communications that impact all aspects of patient care such as handoffs between healthcare providers, team rounds, family engagement, and others. List the strengths and limitations of different communication methods.
Describe the effects of sleep quality and quantity on healthcare providers and the impact on patient safety.
Summarize the components of family centered care and discuss the importance of engaging patients and the family/caregiver in safety efforts.
Define the role of the Joint Commission (TJC) in hospital accreditation and describe how pediatric hospitalists can help assure relevant standards are met.
Articulate TJC guidelines on patient safety and the National Patient Safety Goals.
Discuss factors unique to children that lead to increased risk for medication errors, attending to weight‐based dosing, developmental physiology, compounding and drug delivery methods, and others.
Discuss how financial reimbursement from private and government payers can be tied to preventable patient safety events.
List the common national societies and agencies [such as the Institute for Healthcare Improvement (IHI), American Academy of Pediatrics (AAP), TJC, Centers for Medicare and Medicaid Services (CMS)] influencing inpatient pediatric safety measures and describe pediatric hospitalists' role in responding to their statements.
Delineate the role of pediatric hospitalists in assuring proper supervision of trainees and the impact of this on patient safety.
Skills
Pediatric hospitalists should be able to:
Arrange safe and efficient hospital admissions and discharges, addressing issues such as level of nursing care needed and coordination of care, respectively.
Proactively identify sources of potential patient harm, including environmental and personal factors that affect your ability to render safe medical care. Develop a plan to address appropriate negative influences.
Consistently adhere to patient safety principles when providing direct patient care such as when ordering treatment, performing procedures, and communicating care plans.
Set performance standards and expectations for patient safety in the hospital setting.
Educate trainees, nursing staff, ancillary staff and peers on basic safety principles.
Demonstrate proficiency in using the institution's safety reporting system.
Work effectively and collaboratively with safety teams, utilizing safety tools including reduction of process complexity, building in redundancy, improving team functioning and identifying team members' assumptions.
Implement and serve as a physician champion for patient safety initiatives that protect children from harm.
Actively contribute during ad hoc and sentinel event reviews.
Disclose medical errors clearly, concisely and completely to patients and/or caregivers.
Attitudes
Pediatric hospitalists should be able to:
Seek opportunities to be involved in strategies to eliminate harm.
Role model effective infection control practices in daily patient care activities.
Build an awareness of the need for and will for change to make patient safety a high and consistent priority.
Model behavior and take initiative in reporting medical errors.
Work collaboratively to help create an open culture of safety within the institution.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Engage the hospital senior management, the hospital board of directors and the medical staff leadership in making patient safety one of the top strategic priorities for the institution.
Advocate for the necessary information systems and other infrastructure to secure accurate data and assure success with safety initiatives.
Participate on patient safety committees at the group or systems level and seek opportunities to serve as medical safety officers or medical safety consultants locally or nationally.
Introduction
The topic of Patient Safety became a major priority for healthcare providers in 1999 when the Institute of Medicine (IOM) report entitled To Err is Human focused attention on patient safety and medical errors. The Institute of Medicine defined safety as freedom from accidental injury and error as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. The IOM report estimated that between 44,000 to 98,000 Americans die each year as a result of medical errors which exceed the number attributable to the 8th leading cause of death in America. Total national costs of preventable adverse events are estimated to be up to $29 billion. Since the initial publication of the 1999 IOM report, there have been a number of local, state, and national programs focused on reducing error. Efforts over the past few years have attempted to better classify errors by the harm caused, allowing targeted interventions to specifically address these more clinically significant events. Children, as a vulnerable population, are at particular risk for medical errors and specifically medication errors. Pediatric hospitalists have an exceptional opportunity to promote patient safety and help develop systems that will reduce harm in the inpatient arena.
Knowledge
Pediatric hospitalists should be able to:
Identify the basic principles of patient safety as outlined in the original 1999 IOM report.
Describe the culture necessary for successful safety efforts. Define Just culture.
Define commonly used terms and tools of Patient Safety such as reliability, transparency, adverse medical event, harm, preventable errors, failure mode effects analysis (FMEA), root cause analysis (RCA) and trigger tool.
Name common patient safety practices and enhancements including pre‐printed order sets, practice guidelines, electronic health information systems, bar coding, time‐outs, and others. Explain how new errors can be associated with the introduction of these enhancements.
Discuss why errors are more often a result of systems failures rather than individual failures.
Explain how decreasing unwanted variability in care impacts patient safety.
Illustrate that building safety into everyday processes of care is the most effective way to reduce or prevent errors.
Describe how patient safety is threatened by poor information transfer and failed communication.
Discuss strategies for effective, efficient, and safe communications that impact all aspects of patient care such as handoffs between healthcare providers, team rounds, family engagement, and others. List the strengths and limitations of different communication methods.
Describe the effects of sleep quality and quantity on healthcare providers and the impact on patient safety.
Summarize the components of family centered care and discuss the importance of engaging patients and the family/caregiver in safety efforts.
Define the role of the Joint Commission (TJC) in hospital accreditation and describe how pediatric hospitalists can help assure relevant standards are met.
Articulate TJC guidelines on patient safety and the National Patient Safety Goals.
Discuss factors unique to children that lead to increased risk for medication errors, attending to weight‐based dosing, developmental physiology, compounding and drug delivery methods, and others.
Discuss how financial reimbursement from private and government payers can be tied to preventable patient safety events.
List the common national societies and agencies [such as the Institute for Healthcare Improvement (IHI), American Academy of Pediatrics (AAP), TJC, Centers for Medicare and Medicaid Services (CMS)] influencing inpatient pediatric safety measures and describe pediatric hospitalists' role in responding to their statements.
Delineate the role of pediatric hospitalists in assuring proper supervision of trainees and the impact of this on patient safety.
Skills
Pediatric hospitalists should be able to:
Arrange safe and efficient hospital admissions and discharges, addressing issues such as level of nursing care needed and coordination of care, respectively.
Proactively identify sources of potential patient harm, including environmental and personal factors that affect your ability to render safe medical care. Develop a plan to address appropriate negative influences.
Consistently adhere to patient safety principles when providing direct patient care such as when ordering treatment, performing procedures, and communicating care plans.
Set performance standards and expectations for patient safety in the hospital setting.
Educate trainees, nursing staff, ancillary staff and peers on basic safety principles.
Demonstrate proficiency in using the institution's safety reporting system.
Work effectively and collaboratively with safety teams, utilizing safety tools including reduction of process complexity, building in redundancy, improving team functioning and identifying team members' assumptions.
Implement and serve as a physician champion for patient safety initiatives that protect children from harm.
Actively contribute during ad hoc and sentinel event reviews.
Disclose medical errors clearly, concisely and completely to patients and/or caregivers.
Attitudes
Pediatric hospitalists should be able to:
Seek opportunities to be involved in strategies to eliminate harm.
Role model effective infection control practices in daily patient care activities.
Build an awareness of the need for and will for change to make patient safety a high and consistent priority.
Model behavior and take initiative in reporting medical errors.
Work collaboratively to help create an open culture of safety within the institution.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Engage the hospital senior management, the hospital board of directors and the medical staff leadership in making patient safety one of the top strategic priorities for the institution.
Advocate for the necessary information systems and other infrastructure to secure accurate data and assure success with safety initiatives.
Participate on patient safety committees at the group or systems level and seek opportunities to serve as medical safety officers or medical safety consultants locally or nationally.
Introduction
The topic of Patient Safety became a major priority for healthcare providers in 1999 when the Institute of Medicine (IOM) report entitled To Err is Human focused attention on patient safety and medical errors. The Institute of Medicine defined safety as freedom from accidental injury and error as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. The IOM report estimated that between 44,000 to 98,000 Americans die each year as a result of medical errors which exceed the number attributable to the 8th leading cause of death in America. Total national costs of preventable adverse events are estimated to be up to $29 billion. Since the initial publication of the 1999 IOM report, there have been a number of local, state, and national programs focused on reducing error. Efforts over the past few years have attempted to better classify errors by the harm caused, allowing targeted interventions to specifically address these more clinically significant events. Children, as a vulnerable population, are at particular risk for medical errors and specifically medication errors. Pediatric hospitalists have an exceptional opportunity to promote patient safety and help develop systems that will reduce harm in the inpatient arena.
Knowledge
Pediatric hospitalists should be able to:
Identify the basic principles of patient safety as outlined in the original 1999 IOM report.
Describe the culture necessary for successful safety efforts. Define Just culture.
Define commonly used terms and tools of Patient Safety such as reliability, transparency, adverse medical event, harm, preventable errors, failure mode effects analysis (FMEA), root cause analysis (RCA) and trigger tool.
Name common patient safety practices and enhancements including pre‐printed order sets, practice guidelines, electronic health information systems, bar coding, time‐outs, and others. Explain how new errors can be associated with the introduction of these enhancements.
Discuss why errors are more often a result of systems failures rather than individual failures.
Explain how decreasing unwanted variability in care impacts patient safety.
Illustrate that building safety into everyday processes of care is the most effective way to reduce or prevent errors.
Describe how patient safety is threatened by poor information transfer and failed communication.
Discuss strategies for effective, efficient, and safe communications that impact all aspects of patient care such as handoffs between healthcare providers, team rounds, family engagement, and others. List the strengths and limitations of different communication methods.
Describe the effects of sleep quality and quantity on healthcare providers and the impact on patient safety.
Summarize the components of family centered care and discuss the importance of engaging patients and the family/caregiver in safety efforts.
Define the role of the Joint Commission (TJC) in hospital accreditation and describe how pediatric hospitalists can help assure relevant standards are met.
Articulate TJC guidelines on patient safety and the National Patient Safety Goals.
Discuss factors unique to children that lead to increased risk for medication errors, attending to weight‐based dosing, developmental physiology, compounding and drug delivery methods, and others.
Discuss how financial reimbursement from private and government payers can be tied to preventable patient safety events.
List the common national societies and agencies [such as the Institute for Healthcare Improvement (IHI), American Academy of Pediatrics (AAP), TJC, Centers for Medicare and Medicaid Services (CMS)] influencing inpatient pediatric safety measures and describe pediatric hospitalists' role in responding to their statements.
Delineate the role of pediatric hospitalists in assuring proper supervision of trainees and the impact of this on patient safety.
Skills
Pediatric hospitalists should be able to:
Arrange safe and efficient hospital admissions and discharges, addressing issues such as level of nursing care needed and coordination of care, respectively.
Proactively identify sources of potential patient harm, including environmental and personal factors that affect your ability to render safe medical care. Develop a plan to address appropriate negative influences.
Consistently adhere to patient safety principles when providing direct patient care such as when ordering treatment, performing procedures, and communicating care plans.
Set performance standards and expectations for patient safety in the hospital setting.
Educate trainees, nursing staff, ancillary staff and peers on basic safety principles.
Demonstrate proficiency in using the institution's safety reporting system.
Work effectively and collaboratively with safety teams, utilizing safety tools including reduction of process complexity, building in redundancy, improving team functioning and identifying team members' assumptions.
Implement and serve as a physician champion for patient safety initiatives that protect children from harm.
Actively contribute during ad hoc and sentinel event reviews.
Disclose medical errors clearly, concisely and completely to patients and/or caregivers.
Attitudes
Pediatric hospitalists should be able to:
Seek opportunities to be involved in strategies to eliminate harm.
Role model effective infection control practices in daily patient care activities.
Build an awareness of the need for and will for change to make patient safety a high and consistent priority.
Model behavior and take initiative in reporting medical errors.
Work collaboratively to help create an open culture of safety within the institution.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Engage the hospital senior management, the hospital board of directors and the medical staff leadership in making patient safety one of the top strategic priorities for the institution.
Advocate for the necessary information systems and other infrastructure to secure accurate data and assure success with safety initiatives.
Participate on patient safety committees at the group or systems level and seek opportunities to serve as medical safety officers or medical safety consultants locally or nationally.
Copyright © 2010 Society of Hospital Medicine
Ethics
Introduction
Morality is the right or wrong of human conduct, where ethics is the disciplined study of the justification for rules of human conduct. Morality concerns obligations of what ought to be and what virtues should be cultivated to sustain a truly moral society. The field of bioethics (or medical ethics) applies theory to address ethical issues in medicine, including those that arise during the care of patients as well as those focused on organizations and policy. Bioethics focuses on what morality should be for patients, healthcare professionals, healthcare institutions, and healthcare policy. The rights and responsibilities of patients and the fiduciary responsibility of healthcare providers to patients are central to this definition. Pediatric hospitalists must have a basic knowledge of ethical principles to provide balanced, ethical care.
Knowledge
Pediatric hospitalists should be able to:
Describe the core principles of ethics: beneficence, justice, respect for autonomy, and non‐maleficence.
Discuss the four virtues of a fiduciary‐ self‐effacement, self‐sacrifice, compassion, and integrity.
Identify the elements of informed consent and describe the concept of informed assent.
Describe special circumstances impacting the informed consent process specific to the pediatric population, such as patients in the juvenile justice system, ward of the court, emancipated minors, child protection cases, and others.
Describe the role and composition of the hospital Ethics Committee.
Compare and contrast the fiduciary responsibilities of the institution, insurer, and healthcare provider and discuss the impact of these on delivery of ethical patient care.
Distinguish between substantive justice (concern that the outcomes of a process is fair) and procedural justice (concern that the decision‐making process itself is fair).
Describe how ethical principles can inform development of healthcare policy.
Give examples of how patients and the family/caregiver meet ethical obligations to healthcare professionals (such as engagement in informed consent), to others in the household (such as discussions on undue burden to other members), and society (such as appropriate allocation of resources).
Explain the concept of medical futility and its shortcomings.
Skills
Pediatric hospitalists should be able to:
Apply ethical principles to daily patient care.
Obtain informed consent and assent, as appropriate.
Access legal support as needed to obtain consent to treat as appropriate in special circumstances.
Communicate effectively, maintaining confidentiality and patient privacy.
Identify situations involving ethical conflict, and take steps to resolve this conflict.
Consult the Ethics Committee/Team appropriately.
Attitudes
Pediatric hospitalists should be able to:
Acknowledge personal biases that impact ethical decision‐making.
Recognize gaps in knowledge and seek opportunities for ethics education.
Role model ethical practices.
Systems Organization and Improvement
In order to improve efficiency and quality in their organizations, pediatric hospitalists should:
Work with hospital administration to identify and modify institutional practices and policies to assure ethical healthcare delivery.
Advocate for healthcare policy that ensures appropriate access to healthcare services for children.
Introduction
Morality is the right or wrong of human conduct, where ethics is the disciplined study of the justification for rules of human conduct. Morality concerns obligations of what ought to be and what virtues should be cultivated to sustain a truly moral society. The field of bioethics (or medical ethics) applies theory to address ethical issues in medicine, including those that arise during the care of patients as well as those focused on organizations and policy. Bioethics focuses on what morality should be for patients, healthcare professionals, healthcare institutions, and healthcare policy. The rights and responsibilities of patients and the fiduciary responsibility of healthcare providers to patients are central to this definition. Pediatric hospitalists must have a basic knowledge of ethical principles to provide balanced, ethical care.
Knowledge
Pediatric hospitalists should be able to:
Describe the core principles of ethics: beneficence, justice, respect for autonomy, and non‐maleficence.
Discuss the four virtues of a fiduciary‐ self‐effacement, self‐sacrifice, compassion, and integrity.
Identify the elements of informed consent and describe the concept of informed assent.
Describe special circumstances impacting the informed consent process specific to the pediatric population, such as patients in the juvenile justice system, ward of the court, emancipated minors, child protection cases, and others.
Describe the role and composition of the hospital Ethics Committee.
Compare and contrast the fiduciary responsibilities of the institution, insurer, and healthcare provider and discuss the impact of these on delivery of ethical patient care.
Distinguish between substantive justice (concern that the outcomes of a process is fair) and procedural justice (concern that the decision‐making process itself is fair).
Describe how ethical principles can inform development of healthcare policy.
Give examples of how patients and the family/caregiver meet ethical obligations to healthcare professionals (such as engagement in informed consent), to others in the household (such as discussions on undue burden to other members), and society (such as appropriate allocation of resources).
Explain the concept of medical futility and its shortcomings.
Skills
Pediatric hospitalists should be able to:
Apply ethical principles to daily patient care.
Obtain informed consent and assent, as appropriate.
Access legal support as needed to obtain consent to treat as appropriate in special circumstances.
Communicate effectively, maintaining confidentiality and patient privacy.
Identify situations involving ethical conflict, and take steps to resolve this conflict.
Consult the Ethics Committee/Team appropriately.
Attitudes
Pediatric hospitalists should be able to:
Acknowledge personal biases that impact ethical decision‐making.
Recognize gaps in knowledge and seek opportunities for ethics education.
Role model ethical practices.
Systems Organization and Improvement
In order to improve efficiency and quality in their organizations, pediatric hospitalists should:
Work with hospital administration to identify and modify institutional practices and policies to assure ethical healthcare delivery.
Advocate for healthcare policy that ensures appropriate access to healthcare services for children.
Introduction
Morality is the right or wrong of human conduct, where ethics is the disciplined study of the justification for rules of human conduct. Morality concerns obligations of what ought to be and what virtues should be cultivated to sustain a truly moral society. The field of bioethics (or medical ethics) applies theory to address ethical issues in medicine, including those that arise during the care of patients as well as those focused on organizations and policy. Bioethics focuses on what morality should be for patients, healthcare professionals, healthcare institutions, and healthcare policy. The rights and responsibilities of patients and the fiduciary responsibility of healthcare providers to patients are central to this definition. Pediatric hospitalists must have a basic knowledge of ethical principles to provide balanced, ethical care.
Knowledge
Pediatric hospitalists should be able to:
Describe the core principles of ethics: beneficence, justice, respect for autonomy, and non‐maleficence.
Discuss the four virtues of a fiduciary‐ self‐effacement, self‐sacrifice, compassion, and integrity.
Identify the elements of informed consent and describe the concept of informed assent.
Describe special circumstances impacting the informed consent process specific to the pediatric population, such as patients in the juvenile justice system, ward of the court, emancipated minors, child protection cases, and others.
Describe the role and composition of the hospital Ethics Committee.
Compare and contrast the fiduciary responsibilities of the institution, insurer, and healthcare provider and discuss the impact of these on delivery of ethical patient care.
Distinguish between substantive justice (concern that the outcomes of a process is fair) and procedural justice (concern that the decision‐making process itself is fair).
Describe how ethical principles can inform development of healthcare policy.
Give examples of how patients and the family/caregiver meet ethical obligations to healthcare professionals (such as engagement in informed consent), to others in the household (such as discussions on undue burden to other members), and society (such as appropriate allocation of resources).
Explain the concept of medical futility and its shortcomings.
Skills
Pediatric hospitalists should be able to:
Apply ethical principles to daily patient care.
Obtain informed consent and assent, as appropriate.
Access legal support as needed to obtain consent to treat as appropriate in special circumstances.
Communicate effectively, maintaining confidentiality and patient privacy.
Identify situations involving ethical conflict, and take steps to resolve this conflict.
Consult the Ethics Committee/Team appropriately.
Attitudes
Pediatric hospitalists should be able to:
Acknowledge personal biases that impact ethical decision‐making.
Recognize gaps in knowledge and seek opportunities for ethics education.
Role model ethical practices.
Systems Organization and Improvement
In order to improve efficiency and quality in their organizations, pediatric hospitalists should:
Work with hospital administration to identify and modify institutional practices and policies to assure ethical healthcare delivery.
Advocate for healthcare policy that ensures appropriate access to healthcare services for children.
Copyright © 2010 Society of Hospital Medicine
Non‐invasive monitoring
Introduction
Collection and monitoring of objective data such as vital signs and pulse oximetry measurements are essential components of care for hospitalized children. Combined with clinical assessments, these data are critical when making therapeutic or diagnostic decisions. A complete understanding of non‐invasive monitoring techniques is necessary to accurately interpret the data generated. Pediatric hospitalists regularly incorporate this data into their clinical practice and, especially when overseeing procedural sedation or emergent clinical situations, may be responsible for implementing or supervising the appropriate type and level of monitoring.
Knowledge
Pediatric hospitalists should be able to:
List the different types of non‐invasive monitoring techniques and devices that are available and describe the indications for each.
Compare and contrast the types and level of monitoring generally available on the inpatient ward compared to the intensive care unit or other care settings.
Describe the proper procedures for common non‐invasive monitoring techniques, including vital sign measurement, cardiopulmonary monitoring, pulse oximetry, and capnography.
List the limitations or complications associated with common non‐invasive monitoring techniques, such as inadequate wave form for pulse oximetry.
Discuss the importance of accurate and timely interpretation of information generated by monitoring devices, as well as the importance of an immediate response when abnormal data is noted.
Skills
Pediatric hospitalists should be able to:
Determine the type and level of monitoring needed based on the clinical situation and medical complexity of the patient.
Identify the need for a higher or lower level of monitoring as changes in the clinical status occur and transfer the patient to the appropriate inpatient setting.
Ensure proper placement of monitoring equipment (e.g., placement of monitor leads) and execution of proper technique (e.g., use of correct size blood pressure cuff) in order to obtain accurate data.
Correctly interpret monitoring data and respond with appropriate actions.
Attitudes
Pediatric hospitalists should be able to:
Assume responsibility for ordering the appropriate monitoring and interpreting monitoring data.
Collaborate with nurses, subspecialists, and other healthcare providers to determine the appropriate level of monitoring and the corresponding care setting, especially when clinical changes occur.
Communicate effectively with patients and the family/caregiver regarding the need for non‐invasive monitoring, the findings, and the care plan.
Systems Organization and Improvement
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 procedures and policies related to non‐invasive monitoring.
Work with hospital administration, biomedical engineering, and others to obtain high quality and reliable monitoring equipment.
Lead, coordinate, or participate in the development of continuing education programs focused on non‐invasive monitoring and the interpretation of related data.
Lead, coordinate or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction into monitoring strategies.
Introduction
Collection and monitoring of objective data such as vital signs and pulse oximetry measurements are essential components of care for hospitalized children. Combined with clinical assessments, these data are critical when making therapeutic or diagnostic decisions. A complete understanding of non‐invasive monitoring techniques is necessary to accurately interpret the data generated. Pediatric hospitalists regularly incorporate this data into their clinical practice and, especially when overseeing procedural sedation or emergent clinical situations, may be responsible for implementing or supervising the appropriate type and level of monitoring.
Knowledge
Pediatric hospitalists should be able to:
List the different types of non‐invasive monitoring techniques and devices that are available and describe the indications for each.
Compare and contrast the types and level of monitoring generally available on the inpatient ward compared to the intensive care unit or other care settings.
Describe the proper procedures for common non‐invasive monitoring techniques, including vital sign measurement, cardiopulmonary monitoring, pulse oximetry, and capnography.
List the limitations or complications associated with common non‐invasive monitoring techniques, such as inadequate wave form for pulse oximetry.
Discuss the importance of accurate and timely interpretation of information generated by monitoring devices, as well as the importance of an immediate response when abnormal data is noted.
Skills
Pediatric hospitalists should be able to:
Determine the type and level of monitoring needed based on the clinical situation and medical complexity of the patient.
Identify the need for a higher or lower level of monitoring as changes in the clinical status occur and transfer the patient to the appropriate inpatient setting.
Ensure proper placement of monitoring equipment (e.g., placement of monitor leads) and execution of proper technique (e.g., use of correct size blood pressure cuff) in order to obtain accurate data.
Correctly interpret monitoring data and respond with appropriate actions.
Attitudes
Pediatric hospitalists should be able to:
Assume responsibility for ordering the appropriate monitoring and interpreting monitoring data.
Collaborate with nurses, subspecialists, and other healthcare providers to determine the appropriate level of monitoring and the corresponding care setting, especially when clinical changes occur.
Communicate effectively with patients and the family/caregiver regarding the need for non‐invasive monitoring, the findings, and the care plan.
Systems Organization and Improvement
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 procedures and policies related to non‐invasive monitoring.
Work with hospital administration, biomedical engineering, and others to obtain high quality and reliable monitoring equipment.
Lead, coordinate, or participate in the development of continuing education programs focused on non‐invasive monitoring and the interpretation of related data.
Lead, coordinate or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction into monitoring strategies.
Introduction
Collection and monitoring of objective data such as vital signs and pulse oximetry measurements are essential components of care for hospitalized children. Combined with clinical assessments, these data are critical when making therapeutic or diagnostic decisions. A complete understanding of non‐invasive monitoring techniques is necessary to accurately interpret the data generated. Pediatric hospitalists regularly incorporate this data into their clinical practice and, especially when overseeing procedural sedation or emergent clinical situations, may be responsible for implementing or supervising the appropriate type and level of monitoring.
Knowledge
Pediatric hospitalists should be able to:
List the different types of non‐invasive monitoring techniques and devices that are available and describe the indications for each.
Compare and contrast the types and level of monitoring generally available on the inpatient ward compared to the intensive care unit or other care settings.
Describe the proper procedures for common non‐invasive monitoring techniques, including vital sign measurement, cardiopulmonary monitoring, pulse oximetry, and capnography.
List the limitations or complications associated with common non‐invasive monitoring techniques, such as inadequate wave form for pulse oximetry.
Discuss the importance of accurate and timely interpretation of information generated by monitoring devices, as well as the importance of an immediate response when abnormal data is noted.
Skills
Pediatric hospitalists should be able to:
Determine the type and level of monitoring needed based on the clinical situation and medical complexity of the patient.
Identify the need for a higher or lower level of monitoring as changes in the clinical status occur and transfer the patient to the appropriate inpatient setting.
Ensure proper placement of monitoring equipment (e.g., placement of monitor leads) and execution of proper technique (e.g., use of correct size blood pressure cuff) in order to obtain accurate data.
Correctly interpret monitoring data and respond with appropriate actions.
Attitudes
Pediatric hospitalists should be able to:
Assume responsibility for ordering the appropriate monitoring and interpreting monitoring data.
Collaborate with nurses, subspecialists, and other healthcare providers to determine the appropriate level of monitoring and the corresponding care setting, especially when clinical changes occur.
Communicate effectively with patients and the family/caregiver regarding the need for non‐invasive monitoring, the findings, and the care plan.
Systems Organization and Improvement
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 procedures and policies related to non‐invasive monitoring.
Work with hospital administration, biomedical engineering, and others to obtain high quality and reliable monitoring equipment.
Lead, coordinate, or participate in the development of continuing education programs focused on non‐invasive monitoring and the interpretation of related data.
Lead, coordinate or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction into monitoring strategies.
Copyright © 2010 Society of Hospital Medicine
Kawasaki disease
Introduction
Kawasaki Disease (KD), also known as mucocutaneous lymph node syndrome, is a multisystem inflammatory disease of childhood. It most commonly presents in children under the age of two, however has been seen up to 12 years of age. Diagnosis can be difficult, as the classic signs and symptoms may not all manifest and the presentation may mimic other causes of fever and rash. Although many organs may be affected, those related to the cardiac system are the most concerning and persistent. Coronary aneurysms have been reported to occur in up to 20% of untreated children with KD. If diagnosed and treated promptly, the cardiac complications can be reduced. Therefore, it is important that pediatric hospitalists have a complete understanding of the diagnostic criteria and treatment of KD.
Knowledge
Pediatric hospitalists should be able to:
Discuss current established criteria and guidelines for diagnosis and treatment.
Define incomplete KD and note age groups in which this is more common.
List the broad categories of alternate diagnoses, and give examples from each.
Discuss the appropriate laboratory and imaging studies that aid in diagnosis.
Explain the pathophysiology of the disease, including the current understanding of development and manifestation of cardiac complications.
Define refractory KD and the list factors that indicate the need for further treatment.
Describe current best practice treatments, including approach toward persistent fever.
Compare and contrast the risks, benefits, and side effects of available treatments such as immunoglobulin, steroids, anti‐platelet medications and immunomodulators.
Cite risk factors associated with increased cardiac complications.
Discuss the immediate and long term follow‐up needed including impact, if any, on physical activity and sports participation.
List appropriate discharge criteria for KD.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose KD by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Promptly consult appropriate subspecialists to assist in evaluation and treatment.
Correctly interpret laboratory and imaging results.
Recognize features of alternate diagnoses and order relevant diagnostic studies as indicated.
Perform careful reassessments daily and as needed, note changes in clinical status and respond with appropriate actions.
Initiate prompt treatment once the diagnosis is established.
Anticipate and treat complications and side effects of instituted therapies.
Identify treatment failure and institute appropriate repeat or alternate therapy.
Demonstrate basic proficiency in reading electrocardiograms.
Coordinate care with subspecialists and the primary care provider, and arrange an appropriate transition and follow‐up plans for after hospital discharge.
Attitudes
Pediatric hospitalists should be able to:
Communicate effectively with patients, the family/caregiver, and other healthcare providers regarding findings and care plans.
Educate patients and the family/caregiver on the natural course of disease.
Collaborate with subspecialists and the primary care provider to ensure coordinated longitudinal care for children with KD.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in early multidisciplinary care to promote efficient diagnosis, treatment and discharge of patients with KD.
Work with hospital staff and subspecialists to educate other healthcare providers regarding the diagnosis and treatment of KD.
Lead, coordinate or participate in community education efforts regarding KD.
Introduction
Kawasaki Disease (KD), also known as mucocutaneous lymph node syndrome, is a multisystem inflammatory disease of childhood. It most commonly presents in children under the age of two, however has been seen up to 12 years of age. Diagnosis can be difficult, as the classic signs and symptoms may not all manifest and the presentation may mimic other causes of fever and rash. Although many organs may be affected, those related to the cardiac system are the most concerning and persistent. Coronary aneurysms have been reported to occur in up to 20% of untreated children with KD. If diagnosed and treated promptly, the cardiac complications can be reduced. Therefore, it is important that pediatric hospitalists have a complete understanding of the diagnostic criteria and treatment of KD.
Knowledge
Pediatric hospitalists should be able to:
Discuss current established criteria and guidelines for diagnosis and treatment.
Define incomplete KD and note age groups in which this is more common.
List the broad categories of alternate diagnoses, and give examples from each.
Discuss the appropriate laboratory and imaging studies that aid in diagnosis.
Explain the pathophysiology of the disease, including the current understanding of development and manifestation of cardiac complications.
Define refractory KD and the list factors that indicate the need for further treatment.
Describe current best practice treatments, including approach toward persistent fever.
Compare and contrast the risks, benefits, and side effects of available treatments such as immunoglobulin, steroids, anti‐platelet medications and immunomodulators.
Cite risk factors associated with increased cardiac complications.
Discuss the immediate and long term follow‐up needed including impact, if any, on physical activity and sports participation.
List appropriate discharge criteria for KD.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose KD by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Promptly consult appropriate subspecialists to assist in evaluation and treatment.
Correctly interpret laboratory and imaging results.
Recognize features of alternate diagnoses and order relevant diagnostic studies as indicated.
Perform careful reassessments daily and as needed, note changes in clinical status and respond with appropriate actions.
Initiate prompt treatment once the diagnosis is established.
Anticipate and treat complications and side effects of instituted therapies.
Identify treatment failure and institute appropriate repeat or alternate therapy.
Demonstrate basic proficiency in reading electrocardiograms.
Coordinate care with subspecialists and the primary care provider, and arrange an appropriate transition and follow‐up plans for after hospital discharge.
Attitudes
Pediatric hospitalists should be able to:
Communicate effectively with patients, the family/caregiver, and other healthcare providers regarding findings and care plans.
Educate patients and the family/caregiver on the natural course of disease.
Collaborate with subspecialists and the primary care provider to ensure coordinated longitudinal care for children with KD.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in early multidisciplinary care to promote efficient diagnosis, treatment and discharge of patients with KD.
Work with hospital staff and subspecialists to educate other healthcare providers regarding the diagnosis and treatment of KD.
Lead, coordinate or participate in community education efforts regarding KD.
Introduction
Kawasaki Disease (KD), also known as mucocutaneous lymph node syndrome, is a multisystem inflammatory disease of childhood. It most commonly presents in children under the age of two, however has been seen up to 12 years of age. Diagnosis can be difficult, as the classic signs and symptoms may not all manifest and the presentation may mimic other causes of fever and rash. Although many organs may be affected, those related to the cardiac system are the most concerning and persistent. Coronary aneurysms have been reported to occur in up to 20% of untreated children with KD. If diagnosed and treated promptly, the cardiac complications can be reduced. Therefore, it is important that pediatric hospitalists have a complete understanding of the diagnostic criteria and treatment of KD.
Knowledge
Pediatric hospitalists should be able to:
Discuss current established criteria and guidelines for diagnosis and treatment.
Define incomplete KD and note age groups in which this is more common.
List the broad categories of alternate diagnoses, and give examples from each.
Discuss the appropriate laboratory and imaging studies that aid in diagnosis.
Explain the pathophysiology of the disease, including the current understanding of development and manifestation of cardiac complications.
Define refractory KD and the list factors that indicate the need for further treatment.
Describe current best practice treatments, including approach toward persistent fever.
Compare and contrast the risks, benefits, and side effects of available treatments such as immunoglobulin, steroids, anti‐platelet medications and immunomodulators.
Cite risk factors associated with increased cardiac complications.
Discuss the immediate and long term follow‐up needed including impact, if any, on physical activity and sports participation.
List appropriate discharge criteria for KD.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose KD by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Promptly consult appropriate subspecialists to assist in evaluation and treatment.
Correctly interpret laboratory and imaging results.
Recognize features of alternate diagnoses and order relevant diagnostic studies as indicated.
Perform careful reassessments daily and as needed, note changes in clinical status and respond with appropriate actions.
Initiate prompt treatment once the diagnosis is established.
Anticipate and treat complications and side effects of instituted therapies.
Identify treatment failure and institute appropriate repeat or alternate therapy.
Demonstrate basic proficiency in reading electrocardiograms.
Coordinate care with subspecialists and the primary care provider, and arrange an appropriate transition and follow‐up plans for after hospital discharge.
Attitudes
Pediatric hospitalists should be able to:
Communicate effectively with patients, the family/caregiver, and other healthcare providers regarding findings and care plans.
Educate patients and the family/caregiver on the natural course of disease.
Collaborate with subspecialists and the primary care provider to ensure coordinated longitudinal care for children with KD.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Lead, coordinate or participate in early multidisciplinary care to promote efficient diagnosis, treatment and discharge of patients with KD.
Work with hospital staff and subspecialists to educate other healthcare providers regarding the diagnosis and treatment of KD.
Lead, coordinate or participate in community education efforts regarding KD.
Copyright © 2010 Society of Hospital Medicine
Urinary tract infections
Introduction
Infections of the urinary tract can involve any structure from the kidney to the urethra. Pyelonephritis exists when the infection involves the kidney. Urinary tract infections (UTI) occur in up to 2.8% of all children and 5% of febrile children. They result in 1.1 million office visits (0.7% of total visits) and 13,000 hospitalizations annually. Costs related to only the acute inpatient care of UTI are estimated at $180 million per year alone. The financial impact of subsequent follow‐up imaging, treatment, long‐term sequelae, and family/caregiver work loss is not well quantitated but is substantial. UTIs may be associated with urologic abnormalities in a significant percentage of young children with pyelonephritis. Pediatric hospitalists frequently encounter children with UTI and must remain current on strategies for diagnosis, treatment and follow‐up care for patients with UTIs.
Knowledge
Pediatric hospitalists should be able to:
Describe the abnormal anatomic and physiologic aspects of the urogenital system that may predispose children to UTIs at varying ages, such as posterior urethral valves, duplicated system, voiding dysfunction, chronic constipation, and others.
Describe the range of clinical presentations attending to differences by age.
Compare and contrast the short and long terms risks of lower versus upper urinary tract infection.
Define a positive urine culture and discuss how the method for obtaining and efficiency of processing urine influences results of cultures.
Identify pathogens that cause UTI in both the previously healthy host and those with underlying disease.
Describe appropriate antibiotic coverage for pathogens of concern with awareness of antibiotic resistance patterns within the local community.
Discuss the utility of commonly obtained laboratory tests such as urinalysis, urine gram stain, urine culture, blood culture, serum chemistries, and others.
Review the typical response to therapy, and list common complications of ineffective treatment.
Summarize current literature regarding treatment and evaluation for underlying abnormalities, including radiography.
List factors warranting subspecialty consultation or referral.
Discuss the potential acute and long‐term sequelae of treated and untreated UTI.
Summarize the discharge plan attending to indications for short and long term parenteral and total antimicrobial therapy, repeat evaluations, and subspecialty referral by age.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose UTI by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Identify patients at risk for UTI.
Order appropriate diagnostic studies for the evaluation of suspected UTI.
Prescribe appropriate initial antimicrobial and supportive therapy based on history and physical examination.
Correctly interpret results of diagnostic testing and use results to guide diagnosis and management.
Correctly identify the need for and efficiently access appropriate consultants and support services needed to provide comprehensive care.
Identify when discharge criteria are met, and initiate efficient discharge orders and plans.
Communicate effectively with patients, the family/caregiver and the primary care provider to ensure appropriate post‐discharge testing and follow‐up.
Attitudes
Pediatric hospitalists should be able to:
Educate the family/caregiver on the expected course of illness, treatment options, and potential sequelae.
Recognize the importance of communicating with the primary care provider to ensure a safe, efficient, and effective discharge and post‐discharge care.
Collaborate with the healthcare team to ensure coordinated hospital care for children with UTI.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Collaborate with referring physicians (primary care, emergency medicine, and referring hospital physicians) to develop and sustain appropriate referral networks for evaluation, admission, or transfer of children with UTI.
Collaborate with subspecialists to ensure consistent, timely, and up‐to‐date evaluation and care in the inpatient setting.
Lead, coordinate or participate in the development and implementation of cost‐effective, safe, evidence‐based care pathways to standardize the evaluation and management of hospitalized children with UTI.
Introduction
Infections of the urinary tract can involve any structure from the kidney to the urethra. Pyelonephritis exists when the infection involves the kidney. Urinary tract infections (UTI) occur in up to 2.8% of all children and 5% of febrile children. They result in 1.1 million office visits (0.7% of total visits) and 13,000 hospitalizations annually. Costs related to only the acute inpatient care of UTI are estimated at $180 million per year alone. The financial impact of subsequent follow‐up imaging, treatment, long‐term sequelae, and family/caregiver work loss is not well quantitated but is substantial. UTIs may be associated with urologic abnormalities in a significant percentage of young children with pyelonephritis. Pediatric hospitalists frequently encounter children with UTI and must remain current on strategies for diagnosis, treatment and follow‐up care for patients with UTIs.
Knowledge
Pediatric hospitalists should be able to:
Describe the abnormal anatomic and physiologic aspects of the urogenital system that may predispose children to UTIs at varying ages, such as posterior urethral valves, duplicated system, voiding dysfunction, chronic constipation, and others.
Describe the range of clinical presentations attending to differences by age.
Compare and contrast the short and long terms risks of lower versus upper urinary tract infection.
Define a positive urine culture and discuss how the method for obtaining and efficiency of processing urine influences results of cultures.
Identify pathogens that cause UTI in both the previously healthy host and those with underlying disease.
Describe appropriate antibiotic coverage for pathogens of concern with awareness of antibiotic resistance patterns within the local community.
Discuss the utility of commonly obtained laboratory tests such as urinalysis, urine gram stain, urine culture, blood culture, serum chemistries, and others.
Review the typical response to therapy, and list common complications of ineffective treatment.
Summarize current literature regarding treatment and evaluation for underlying abnormalities, including radiography.
List factors warranting subspecialty consultation or referral.
Discuss the potential acute and long‐term sequelae of treated and untreated UTI.
Summarize the discharge plan attending to indications for short and long term parenteral and total antimicrobial therapy, repeat evaluations, and subspecialty referral by age.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose UTI by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Identify patients at risk for UTI.
Order appropriate diagnostic studies for the evaluation of suspected UTI.
Prescribe appropriate initial antimicrobial and supportive therapy based on history and physical examination.
Correctly interpret results of diagnostic testing and use results to guide diagnosis and management.
Correctly identify the need for and efficiently access appropriate consultants and support services needed to provide comprehensive care.
Identify when discharge criteria are met, and initiate efficient discharge orders and plans.
Communicate effectively with patients, the family/caregiver and the primary care provider to ensure appropriate post‐discharge testing and follow‐up.
Attitudes
Pediatric hospitalists should be able to:
Educate the family/caregiver on the expected course of illness, treatment options, and potential sequelae.
Recognize the importance of communicating with the primary care provider to ensure a safe, efficient, and effective discharge and post‐discharge care.
Collaborate with the healthcare team to ensure coordinated hospital care for children with UTI.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Collaborate with referring physicians (primary care, emergency medicine, and referring hospital physicians) to develop and sustain appropriate referral networks for evaluation, admission, or transfer of children with UTI.
Collaborate with subspecialists to ensure consistent, timely, and up‐to‐date evaluation and care in the inpatient setting.
Lead, coordinate or participate in the development and implementation of cost‐effective, safe, evidence‐based care pathways to standardize the evaluation and management of hospitalized children with UTI.
Introduction
Infections of the urinary tract can involve any structure from the kidney to the urethra. Pyelonephritis exists when the infection involves the kidney. Urinary tract infections (UTI) occur in up to 2.8% of all children and 5% of febrile children. They result in 1.1 million office visits (0.7% of total visits) and 13,000 hospitalizations annually. Costs related to only the acute inpatient care of UTI are estimated at $180 million per year alone. The financial impact of subsequent follow‐up imaging, treatment, long‐term sequelae, and family/caregiver work loss is not well quantitated but is substantial. UTIs may be associated with urologic abnormalities in a significant percentage of young children with pyelonephritis. Pediatric hospitalists frequently encounter children with UTI and must remain current on strategies for diagnosis, treatment and follow‐up care for patients with UTIs.
Knowledge
Pediatric hospitalists should be able to:
Describe the abnormal anatomic and physiologic aspects of the urogenital system that may predispose children to UTIs at varying ages, such as posterior urethral valves, duplicated system, voiding dysfunction, chronic constipation, and others.
Describe the range of clinical presentations attending to differences by age.
Compare and contrast the short and long terms risks of lower versus upper urinary tract infection.
Define a positive urine culture and discuss how the method for obtaining and efficiency of processing urine influences results of cultures.
Identify pathogens that cause UTI in both the previously healthy host and those with underlying disease.
Describe appropriate antibiotic coverage for pathogens of concern with awareness of antibiotic resistance patterns within the local community.
Discuss the utility of commonly obtained laboratory tests such as urinalysis, urine gram stain, urine culture, blood culture, serum chemistries, and others.
Review the typical response to therapy, and list common complications of ineffective treatment.
Summarize current literature regarding treatment and evaluation for underlying abnormalities, including radiography.
List factors warranting subspecialty consultation or referral.
Discuss the potential acute and long‐term sequelae of treated and untreated UTI.
Summarize the discharge plan attending to indications for short and long term parenteral and total antimicrobial therapy, repeat evaluations, and subspecialty referral by age.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose UTI by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Identify patients at risk for UTI.
Order appropriate diagnostic studies for the evaluation of suspected UTI.
Prescribe appropriate initial antimicrobial and supportive therapy based on history and physical examination.
Correctly interpret results of diagnostic testing and use results to guide diagnosis and management.
Correctly identify the need for and efficiently access appropriate consultants and support services needed to provide comprehensive care.
Identify when discharge criteria are met, and initiate efficient discharge orders and plans.
Communicate effectively with patients, the family/caregiver and the primary care provider to ensure appropriate post‐discharge testing and follow‐up.
Attitudes
Pediatric hospitalists should be able to:
Educate the family/caregiver on the expected course of illness, treatment options, and potential sequelae.
Recognize the importance of communicating with the primary care provider to ensure a safe, efficient, and effective discharge and post‐discharge care.
Collaborate with the healthcare team to ensure coordinated hospital care for children with UTI.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Collaborate with referring physicians (primary care, emergency medicine, and referring hospital physicians) to develop and sustain appropriate referral networks for evaluation, admission, or transfer of children with UTI.
Collaborate with subspecialists to ensure consistent, timely, and up‐to‐date evaluation and care in the inpatient setting.
Lead, coordinate or participate in the development and implementation of cost‐effective, safe, evidence‐based care pathways to standardize the evaluation and management of hospitalized children with UTI.
Copyright © 2010 Society of Hospital Medicine
Introduction to the Pediatric Hospital Medicine Core Competencies
Background
Pediatric Hospital Medicine continues to evolve as an area of specialization, with the refinement of a distinct knowledgebase and skill set focused on the provision of high quality general pediatric care in the inpatient setting. It is the latest site‐specific specialty to emerge from the field of general pediatrics, following a course similar to that charted by pediatric emergency medicine and pediatric critical care medicine in recent decades. The growth of the field has been spurred by a number of factors, including the converging needs for a dedicated emphasis on patient safety, quality improvement, throughput management, and teaching in the inpatient setting.
The number of practicing pediatric hospitalists is estimated to be approximately 2500 and rapidly increasing. To meet the educational needs of this growing cohort of pediatricians, local, regional, and national continuing medical education offerings occur on a regular basis. Furthermore, at least ten fellowships dedicated to advanced training in pediatric hospital medicine have been developed at academic institutions across North America. Despite this, there has been an absence of an accepted and peer‐reviewed framework for professional and curriculum development.
The Pediatric Hospital Medicine Core Competencies represent the first comprehensive attempt to more formally define the standards for the knowledge, skills, attitudes, and focus on systems improvements that are expected of all pediatric hospitalists, regardless of practice setting or location. It is the culmination of more than five years of planning, research, and development by the Society of Hospital Medicine Pediatric Core Curriculum Task Force, leaders within the Academic Pediatric Association and the American Academy of Pediatrics, and the editorial board. The competencies include contributions from over 80 pediatric hospitalists, content experts, and internal and external reviewers representing university and community hospitals, teaching and non‐teaching programs, and key societies and agencies involved in child health from all geographic regions of the United States and Canada. A companion article to Pediatric Hospital Medicine Core Competencies in this Supplement provides additional details regarding the project methodology.
Purpose
The Pediatric Hospital Medicine Core Competencies provide a framework for professional and curriculum development for all pediatric hospitalists. The framework is intended for use by hospital medicine program directors, directors of medical student clerkships, residency programs, fellowships, and continuing medical education, as well as other educators involved in curriculum development. The competencies do not focus on specific content, but rather general learning objectives within the skills, knowledge, and attitudes related to each topic. Attaining competency in the areas defined in these chapters is expected to require post‐residency training. This training is most likely to be obtained through a combination of work experience, local mentorship, and engagement in specific educational programs or fellowship. Pediatric hospitalists, directors, and educators can create specific instructional activities and methods chosen to reflect the characteristics of the intended learners and context of the practice environment.
Organization Structure
The Pediatric Hospital Medicine Core Competencies consist of 54 chapters, divided into four sections Common Clinical Diagnoses and Conditions, Specialized Clinical Services, Core Skills, and Healthcare Systems: Supporting and Advancing Child Health. Within each section, individual chapters on focused topics provide competencies in three domains of educational outcomes: the Cognitive Domain (Knowledge), the Psychomotor Domain (Skills), and the Affective Domain (Attitudes). To reflect the emphasis of hospital medicine practice on improving healthcare systems, a fourth section entitled Systems Organization and Improvement is also included. An attempt has been made to make the objectives timeless, allowing for creation of curriculum that can be nimble and reactive to new discoveries. Highly specific temporal changes in medicine are purposefully excluded, and instead the focus is on the drivers for these changes or advancements. Phrases and wording were selected to help guide the learning activities most likely to achieve each competency and to reflect the varied roles that pediatric hospitalists have in different practice settings. In this document, the terms child and children include infants, children, adolescents, and young adults up to the age of 21, in accordance of policies of the American Academy of Pediatrics. However, it is also understood that care is rendered in pediatric settings for patients who may surpass this upper age limit based on diagnosis or special healthcare needs. Finally, although the entire document can be a resource for comprehensive program development, each chapter is intended to stand alone and thus support curriculum development specific to the needs of individual programs.
Conclusion and Acknowledgement
The Pediatric Hospital Medicine Core Competencies are intended to provide standards for the knowledge, skills, and attitudes expected of all pediatric hospitalists and to provide a framework for ongoing professional and curriculum development for learners at all levels. We welcome feedback and evaluation from pediatric hospitalists and from all with whom we partner to improve the care for hospitalized children.
We wish to acknowledge the dedication of authors and associate editors, and the thoughtful review by the members of hospital organizations, accrediting bodies, and agencies listed in this supplement. This inaugural edition of the Pediatric Hospital Medicine Core Competenciesshould serve as the foundation from which the field of Pediatric Hospital Medicine will continue to evolve. We look forward with anticipation to future revisions as we reflect on our goals and advance our field.
The Pediatric Hospital Medicine Core Competencies Editorial Board
Erin Stucky, MD
Mary C Ottolini, MD, MPH
Jennifer Maniscalco, MD, MPH
Background
Pediatric Hospital Medicine continues to evolve as an area of specialization, with the refinement of a distinct knowledgebase and skill set focused on the provision of high quality general pediatric care in the inpatient setting. It is the latest site‐specific specialty to emerge from the field of general pediatrics, following a course similar to that charted by pediatric emergency medicine and pediatric critical care medicine in recent decades. The growth of the field has been spurred by a number of factors, including the converging needs for a dedicated emphasis on patient safety, quality improvement, throughput management, and teaching in the inpatient setting.
The number of practicing pediatric hospitalists is estimated to be approximately 2500 and rapidly increasing. To meet the educational needs of this growing cohort of pediatricians, local, regional, and national continuing medical education offerings occur on a regular basis. Furthermore, at least ten fellowships dedicated to advanced training in pediatric hospital medicine have been developed at academic institutions across North America. Despite this, there has been an absence of an accepted and peer‐reviewed framework for professional and curriculum development.
The Pediatric Hospital Medicine Core Competencies represent the first comprehensive attempt to more formally define the standards for the knowledge, skills, attitudes, and focus on systems improvements that are expected of all pediatric hospitalists, regardless of practice setting or location. It is the culmination of more than five years of planning, research, and development by the Society of Hospital Medicine Pediatric Core Curriculum Task Force, leaders within the Academic Pediatric Association and the American Academy of Pediatrics, and the editorial board. The competencies include contributions from over 80 pediatric hospitalists, content experts, and internal and external reviewers representing university and community hospitals, teaching and non‐teaching programs, and key societies and agencies involved in child health from all geographic regions of the United States and Canada. A companion article to Pediatric Hospital Medicine Core Competencies in this Supplement provides additional details regarding the project methodology.
Purpose
The Pediatric Hospital Medicine Core Competencies provide a framework for professional and curriculum development for all pediatric hospitalists. The framework is intended for use by hospital medicine program directors, directors of medical student clerkships, residency programs, fellowships, and continuing medical education, as well as other educators involved in curriculum development. The competencies do not focus on specific content, but rather general learning objectives within the skills, knowledge, and attitudes related to each topic. Attaining competency in the areas defined in these chapters is expected to require post‐residency training. This training is most likely to be obtained through a combination of work experience, local mentorship, and engagement in specific educational programs or fellowship. Pediatric hospitalists, directors, and educators can create specific instructional activities and methods chosen to reflect the characteristics of the intended learners and context of the practice environment.
Organization Structure
The Pediatric Hospital Medicine Core Competencies consist of 54 chapters, divided into four sections Common Clinical Diagnoses and Conditions, Specialized Clinical Services, Core Skills, and Healthcare Systems: Supporting and Advancing Child Health. Within each section, individual chapters on focused topics provide competencies in three domains of educational outcomes: the Cognitive Domain (Knowledge), the Psychomotor Domain (Skills), and the Affective Domain (Attitudes). To reflect the emphasis of hospital medicine practice on improving healthcare systems, a fourth section entitled Systems Organization and Improvement is also included. An attempt has been made to make the objectives timeless, allowing for creation of curriculum that can be nimble and reactive to new discoveries. Highly specific temporal changes in medicine are purposefully excluded, and instead the focus is on the drivers for these changes or advancements. Phrases and wording were selected to help guide the learning activities most likely to achieve each competency and to reflect the varied roles that pediatric hospitalists have in different practice settings. In this document, the terms child and children include infants, children, adolescents, and young adults up to the age of 21, in accordance of policies of the American Academy of Pediatrics. However, it is also understood that care is rendered in pediatric settings for patients who may surpass this upper age limit based on diagnosis or special healthcare needs. Finally, although the entire document can be a resource for comprehensive program development, each chapter is intended to stand alone and thus support curriculum development specific to the needs of individual programs.
Conclusion and Acknowledgement
The Pediatric Hospital Medicine Core Competencies are intended to provide standards for the knowledge, skills, and attitudes expected of all pediatric hospitalists and to provide a framework for ongoing professional and curriculum development for learners at all levels. We welcome feedback and evaluation from pediatric hospitalists and from all with whom we partner to improve the care for hospitalized children.
We wish to acknowledge the dedication of authors and associate editors, and the thoughtful review by the members of hospital organizations, accrediting bodies, and agencies listed in this supplement. This inaugural edition of the Pediatric Hospital Medicine Core Competenciesshould serve as the foundation from which the field of Pediatric Hospital Medicine will continue to evolve. We look forward with anticipation to future revisions as we reflect on our goals and advance our field.
The Pediatric Hospital Medicine Core Competencies Editorial Board
Erin Stucky, MD
Mary C Ottolini, MD, MPH
Jennifer Maniscalco, MD, MPH
Background
Pediatric Hospital Medicine continues to evolve as an area of specialization, with the refinement of a distinct knowledgebase and skill set focused on the provision of high quality general pediatric care in the inpatient setting. It is the latest site‐specific specialty to emerge from the field of general pediatrics, following a course similar to that charted by pediatric emergency medicine and pediatric critical care medicine in recent decades. The growth of the field has been spurred by a number of factors, including the converging needs for a dedicated emphasis on patient safety, quality improvement, throughput management, and teaching in the inpatient setting.
The number of practicing pediatric hospitalists is estimated to be approximately 2500 and rapidly increasing. To meet the educational needs of this growing cohort of pediatricians, local, regional, and national continuing medical education offerings occur on a regular basis. Furthermore, at least ten fellowships dedicated to advanced training in pediatric hospital medicine have been developed at academic institutions across North America. Despite this, there has been an absence of an accepted and peer‐reviewed framework for professional and curriculum development.
The Pediatric Hospital Medicine Core Competencies represent the first comprehensive attempt to more formally define the standards for the knowledge, skills, attitudes, and focus on systems improvements that are expected of all pediatric hospitalists, regardless of practice setting or location. It is the culmination of more than five years of planning, research, and development by the Society of Hospital Medicine Pediatric Core Curriculum Task Force, leaders within the Academic Pediatric Association and the American Academy of Pediatrics, and the editorial board. The competencies include contributions from over 80 pediatric hospitalists, content experts, and internal and external reviewers representing university and community hospitals, teaching and non‐teaching programs, and key societies and agencies involved in child health from all geographic regions of the United States and Canada. A companion article to Pediatric Hospital Medicine Core Competencies in this Supplement provides additional details regarding the project methodology.
Purpose
The Pediatric Hospital Medicine Core Competencies provide a framework for professional and curriculum development for all pediatric hospitalists. The framework is intended for use by hospital medicine program directors, directors of medical student clerkships, residency programs, fellowships, and continuing medical education, as well as other educators involved in curriculum development. The competencies do not focus on specific content, but rather general learning objectives within the skills, knowledge, and attitudes related to each topic. Attaining competency in the areas defined in these chapters is expected to require post‐residency training. This training is most likely to be obtained through a combination of work experience, local mentorship, and engagement in specific educational programs or fellowship. Pediatric hospitalists, directors, and educators can create specific instructional activities and methods chosen to reflect the characteristics of the intended learners and context of the practice environment.
Organization Structure
The Pediatric Hospital Medicine Core Competencies consist of 54 chapters, divided into four sections Common Clinical Diagnoses and Conditions, Specialized Clinical Services, Core Skills, and Healthcare Systems: Supporting and Advancing Child Health. Within each section, individual chapters on focused topics provide competencies in three domains of educational outcomes: the Cognitive Domain (Knowledge), the Psychomotor Domain (Skills), and the Affective Domain (Attitudes). To reflect the emphasis of hospital medicine practice on improving healthcare systems, a fourth section entitled Systems Organization and Improvement is also included. An attempt has been made to make the objectives timeless, allowing for creation of curriculum that can be nimble and reactive to new discoveries. Highly specific temporal changes in medicine are purposefully excluded, and instead the focus is on the drivers for these changes or advancements. Phrases and wording were selected to help guide the learning activities most likely to achieve each competency and to reflect the varied roles that pediatric hospitalists have in different practice settings. In this document, the terms child and children include infants, children, adolescents, and young adults up to the age of 21, in accordance of policies of the American Academy of Pediatrics. However, it is also understood that care is rendered in pediatric settings for patients who may surpass this upper age limit based on diagnosis or special healthcare needs. Finally, although the entire document can be a resource for comprehensive program development, each chapter is intended to stand alone and thus support curriculum development specific to the needs of individual programs.
Conclusion and Acknowledgement
The Pediatric Hospital Medicine Core Competencies are intended to provide standards for the knowledge, skills, and attitudes expected of all pediatric hospitalists and to provide a framework for ongoing professional and curriculum development for learners at all levels. We welcome feedback and evaluation from pediatric hospitalists and from all with whom we partner to improve the care for hospitalized children.
We wish to acknowledge the dedication of authors and associate editors, and the thoughtful review by the members of hospital organizations, accrediting bodies, and agencies listed in this supplement. This inaugural edition of the Pediatric Hospital Medicine Core Competenciesshould serve as the foundation from which the field of Pediatric Hospital Medicine will continue to evolve. We look forward with anticipation to future revisions as we reflect on our goals and advance our field.
The Pediatric Hospital Medicine Core Competencies Editorial Board
Erin Stucky, MD
Mary C Ottolini, MD, MPH
Jennifer Maniscalco, MD, MPH
Copyright © 2010 Society of Hospital Medicine
Health information systems
Introduction
Health information systems encompass the range of technology in health care used to acquire, store, deliver and analyze medical data. In the hospital environment, this technology is one of the most important components to the delivery of high‐quality and safe care. In particular, healthcare provider order entry, has been shown to reduce medical errors, while systems that display recently completed laboratory testing may decrease redundant testing. Despite these benefits, hospitals have been slow to adopt these technologies. The Institute of Medicine and the Department of Health and Human Services have recognized this fact and have begun serious efforts to improve the adoption of electronic medical information systems in all health care environments. Pediatric hospitalists use these systems for clinical care, education, quality improvement efforts and research and can assist with assessing and implementing systems
Knowledge
Pediatric hospitalists should be able to:
Compare and contrast the varied health information systems used to manage medical information across different hospital settings, especially with regard to the differences between adult and pediatric needs.
Describe the importance of proper storage and retrieval of protected health information.
Discuss the impact of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule on health information systems security.
Explain the value of clinical decision support in rendering patient care.
Compare and contrast the influence of electronic health information on practice management, clinical decision‐making, quality improvement projects and performance of research.
Identify at least one improvement in patient safety that can be realized with institution of an electronic medical record.
Describe how hospital policies and procedures impact information systems operations, and that in turn delivery of health care to children influences these policies, procedures, and systems.
Describe the basic organization of the information technology department.
Describe resources that can be accessed to address questions about information systems such as a hospital HELP desk, vendor support lines, or online access to other healthcare providers who use the system.
Delineate how staff dedicated to information technology support quality and safety efforts and data retrieval.
List information resources and tools available to support life‐long learning.
Discuss the importance of pediatric hospitalists in creating, modifying, and evaluating changes to health information systems.
Describe the unique needs of children in regard to information technology, and the importance of careful design and implementation of health information systems in hospitals and clinics that care for children.
Skills
Pediatric hospitalists should be able to:
Demonstrate proficiency with foundational computer skills (email, literature searching, downloading and uploading files.) and common computer applications (word processing, spreadsheet use, and presentation software) as well as the local provider order entry system.
Skillfully access and use web‐based educational resources for continuing education and enrichment of trainee learning experiences.
Effectively and efficiently utilize local health information systems for clinical care, education, and performance of projects as appropriate within the context of the local system.
Assist in creation of order sets and documentation templates.
Assess the value of rules and alerts and assist with editing these as appropriate.
Attitudes
Pediatric hospitalists should be able to:
Be accountable for working to ensure the successful functioning of health information systems.
Advocate for the proper alignment of health information systems choices with clinical needs.
Effectively communicate with information systems managers.
Respect patient confidentiality by using the security‐directed features of information systems.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Participate in appropriate hospital committees and assist with information technology solutions to address causes of unsafe care.
Work with hospital administrators and the Medical Staff to integrate new technologies to the practice of medicine (such as telemedicine, medical decision making, computerized medical records, electronic information networks and others).
Seek opportunities to improve the role of information technology in managing costs, quality improvement efforts, and research, if applicable.
Introduction
Health information systems encompass the range of technology in health care used to acquire, store, deliver and analyze medical data. In the hospital environment, this technology is one of the most important components to the delivery of high‐quality and safe care. In particular, healthcare provider order entry, has been shown to reduce medical errors, while systems that display recently completed laboratory testing may decrease redundant testing. Despite these benefits, hospitals have been slow to adopt these technologies. The Institute of Medicine and the Department of Health and Human Services have recognized this fact and have begun serious efforts to improve the adoption of electronic medical information systems in all health care environments. Pediatric hospitalists use these systems for clinical care, education, quality improvement efforts and research and can assist with assessing and implementing systems
Knowledge
Pediatric hospitalists should be able to:
Compare and contrast the varied health information systems used to manage medical information across different hospital settings, especially with regard to the differences between adult and pediatric needs.
Describe the importance of proper storage and retrieval of protected health information.
Discuss the impact of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule on health information systems security.
Explain the value of clinical decision support in rendering patient care.
Compare and contrast the influence of electronic health information on practice management, clinical decision‐making, quality improvement projects and performance of research.
Identify at least one improvement in patient safety that can be realized with institution of an electronic medical record.
Describe how hospital policies and procedures impact information systems operations, and that in turn delivery of health care to children influences these policies, procedures, and systems.
Describe the basic organization of the information technology department.
Describe resources that can be accessed to address questions about information systems such as a hospital HELP desk, vendor support lines, or online access to other healthcare providers who use the system.
Delineate how staff dedicated to information technology support quality and safety efforts and data retrieval.
List information resources and tools available to support life‐long learning.
Discuss the importance of pediatric hospitalists in creating, modifying, and evaluating changes to health information systems.
Describe the unique needs of children in regard to information technology, and the importance of careful design and implementation of health information systems in hospitals and clinics that care for children.
Skills
Pediatric hospitalists should be able to:
Demonstrate proficiency with foundational computer skills (email, literature searching, downloading and uploading files.) and common computer applications (word processing, spreadsheet use, and presentation software) as well as the local provider order entry system.
Skillfully access and use web‐based educational resources for continuing education and enrichment of trainee learning experiences.
Effectively and efficiently utilize local health information systems for clinical care, education, and performance of projects as appropriate within the context of the local system.
Assist in creation of order sets and documentation templates.
Assess the value of rules and alerts and assist with editing these as appropriate.
Attitudes
Pediatric hospitalists should be able to:
Be accountable for working to ensure the successful functioning of health information systems.
Advocate for the proper alignment of health information systems choices with clinical needs.
Effectively communicate with information systems managers.
Respect patient confidentiality by using the security‐directed features of information systems.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Participate in appropriate hospital committees and assist with information technology solutions to address causes of unsafe care.
Work with hospital administrators and the Medical Staff to integrate new technologies to the practice of medicine (such as telemedicine, medical decision making, computerized medical records, electronic information networks and others).
Seek opportunities to improve the role of information technology in managing costs, quality improvement efforts, and research, if applicable.
Introduction
Health information systems encompass the range of technology in health care used to acquire, store, deliver and analyze medical data. In the hospital environment, this technology is one of the most important components to the delivery of high‐quality and safe care. In particular, healthcare provider order entry, has been shown to reduce medical errors, while systems that display recently completed laboratory testing may decrease redundant testing. Despite these benefits, hospitals have been slow to adopt these technologies. The Institute of Medicine and the Department of Health and Human Services have recognized this fact and have begun serious efforts to improve the adoption of electronic medical information systems in all health care environments. Pediatric hospitalists use these systems for clinical care, education, quality improvement efforts and research and can assist with assessing and implementing systems
Knowledge
Pediatric hospitalists should be able to:
Compare and contrast the varied health information systems used to manage medical information across different hospital settings, especially with regard to the differences between adult and pediatric needs.
Describe the importance of proper storage and retrieval of protected health information.
Discuss the impact of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule on health information systems security.
Explain the value of clinical decision support in rendering patient care.
Compare and contrast the influence of electronic health information on practice management, clinical decision‐making, quality improvement projects and performance of research.
Identify at least one improvement in patient safety that can be realized with institution of an electronic medical record.
Describe how hospital policies and procedures impact information systems operations, and that in turn delivery of health care to children influences these policies, procedures, and systems.
Describe the basic organization of the information technology department.
Describe resources that can be accessed to address questions about information systems such as a hospital HELP desk, vendor support lines, or online access to other healthcare providers who use the system.
Delineate how staff dedicated to information technology support quality and safety efforts and data retrieval.
List information resources and tools available to support life‐long learning.
Discuss the importance of pediatric hospitalists in creating, modifying, and evaluating changes to health information systems.
Describe the unique needs of children in regard to information technology, and the importance of careful design and implementation of health information systems in hospitals and clinics that care for children.
Skills
Pediatric hospitalists should be able to:
Demonstrate proficiency with foundational computer skills (email, literature searching, downloading and uploading files.) and common computer applications (word processing, spreadsheet use, and presentation software) as well as the local provider order entry system.
Skillfully access and use web‐based educational resources for continuing education and enrichment of trainee learning experiences.
Effectively and efficiently utilize local health information systems for clinical care, education, and performance of projects as appropriate within the context of the local system.
Assist in creation of order sets and documentation templates.
Assess the value of rules and alerts and assist with editing these as appropriate.
Attitudes
Pediatric hospitalists should be able to:
Be accountable for working to ensure the successful functioning of health information systems.
Advocate for the proper alignment of health information systems choices with clinical needs.
Effectively communicate with information systems managers.
Respect patient confidentiality by using the security‐directed features of information systems.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Participate in appropriate hospital committees and assist with information technology solutions to address causes of unsafe care.
Work with hospital administrators and the Medical Staff to integrate new technologies to the practice of medicine (such as telemedicine, medical decision making, computerized medical records, electronic information networks and others).
Seek opportunities to improve the role of information technology in managing costs, quality improvement efforts, and research, if applicable.
Copyright © 2010 Society of Hospital Medicine
Diabetes mellitus
Introduction
Diabetes mellitus, a disorder of glucose homeostasis, is increasing in incidence and prevalence in pediatrics. Although Type 1 diabetes is more frequently diagnosed in children, there has recently been a significant rise in the incidence of Type 2 diabetes, particularly among adolescents in certain ethnic groups. The increasing incidence of Type 2 diabetes parallels the increasing incidence of obesity in the population. In addition to the medical complications associated with this chronic disease, both forms of diabetes have profound social and emotional impacts on the child. Pediatric hospitalists frequently encounter both children with new‐onset diabetes and known diabetics requiring hospitalization because of poor disease control, illness, or elective procedures. Pediatric hospitalists are often in the best position to provide both immediate care for children with diabetes as well as to coordinate care across multiple specialties when necessary.
Knowledge
Pediatric hospitalists should be able to:
Compare and contrast the epidemiology and pathophysiology of Type 1 with Type 2 diabetes attending to differences in impairment of glucose regulation and occurrence of ketoacidosis.
List common alternate causes of hyperglycemia, such as stress, drug, or steroid‐induced hyperglycemia and give examples of situations in which insulin administration is indicated.
Discuss the importance of completing a thorough review of systems and family history and a full physical examination in order to identify polyendocrinopathies.
Describe the role of obesity in the metabolic syndrome and Type 2 diabetes.
List and explain the laboratory tests used to determine the type of diabetes, assess glucose control, and identify complications or co‐morbidities of diabetes (such as glutamic acid decarboxylase, insulin auto antibodies, islet cell antibodies, hemoglobin A1c, thyroid panel, and celiac panel).
Describe the initial management of diabetic ketoacidosis (DKA), attending to fluid delivery, electrolyte monitoring, mental status assessments, frequency of repeated blood testing, and appropriate patient placement based on local facility services.
Define criteria for escalating care in the context of severe acidosis, altered mental status, and effects of electrolyte disturbances.
Summarize the approach toward management and education after stabilization of DKA.
Discuss the importance of including cultural and ethnic practices when creating a diabetes management plan.
Discuss potential complications that may result from treatment, including hypoglycemia and electrolyte imbalances
Identify the co‐morbidities commonly associated with both Type 1 and Type 2 diabetes.
Describe the different formulations of and delivery systems for insulin.
Review the principles of carbohydrate counting.
Discuss short and long‐term prognostic factors associated with complications of poor glucose control.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose diabetes and its complications by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Correctly recognize and determine the cause of DKA in the patient with known diabetes by efficiently performing an accurate history and physical examination and ordering appropriate diagnostic tests.
Order appropriate diagnostic testing for patients with new onset diabetes or diabetes exacerbations.
Implement an evidence‐based treatment plan.
Correctly order insulin doses and delivery systems (such as continuous infusion, subcutaneous, and others) and other classes of drugs used in the treatment of diabetes.
Recognize and manage both hyperglycemia and hypoglycemia with particular attention to complications that may arise during treatment.
Recognize the indications for escalating levels of care and promptly initiate appropriate actions.
Identify the indications for in hospital consultation and obtain prompt consultation with an endocrinologist or other subspecialist as appropriate.
Access available support services such as social work, child life, nutrition, and others to ensure a comprehensive management approach.
Clearly articulate discharge criteria and outpatient long term management strategies for patients and the family/caregiver.
Coordinate care and education for patients and the family/caregiver with other healthcare providers.
Coordinate care with subspecialists and the primary care provider and arrange an appropriate transition plan for hospital discharge.
Attitudes
Pediatric hospitalists should be able to:
Communicate effectively with patients maintaining awareness of the unique needs of pre‐adolescent and adolescent age groups.
Discuss the importance of a healthy lifestyle in promoting optimal disease management with patients and the family/caregiver.
Recognize that acute and chronic psychosocial factors impact the ability of patients and the family/caregiver to appropriately manage the disease.
Recognize the importance of the multidisciplinary team approach in the management of diabetes in children, including involvement of the primary care provider, endocrinologist, nutritionist, social worker, psychologist, child life, and school representative.
Maintain awareness of local populations which may have multiple risk factors for diabetes
Collaborate with subspecialists and the primary care provider to ensure coordinated longitudinal care for children with diabetes.
Systems Organization and Improvement
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 diabetes.
Work with hospital administration, hospital staff, subspecialists and community organizations to affect system‐wide processes to improve the transition of care from hospital to the ambulatory setting.
Lead, coordinate or participate in system‐wide processes within the hospital to promote therapeutic safety and vigilance in the use of hypoglycemic agents.
Lead, coordinate or participate in educational events to promote awareness of and familiarity with national guidelines for management strategies, new therapeutic and pharmacologic agents and the use of medical devices to improve and monitor glucose homeostasis.
Introduction
Diabetes mellitus, a disorder of glucose homeostasis, is increasing in incidence and prevalence in pediatrics. Although Type 1 diabetes is more frequently diagnosed in children, there has recently been a significant rise in the incidence of Type 2 diabetes, particularly among adolescents in certain ethnic groups. The increasing incidence of Type 2 diabetes parallels the increasing incidence of obesity in the population. In addition to the medical complications associated with this chronic disease, both forms of diabetes have profound social and emotional impacts on the child. Pediatric hospitalists frequently encounter both children with new‐onset diabetes and known diabetics requiring hospitalization because of poor disease control, illness, or elective procedures. Pediatric hospitalists are often in the best position to provide both immediate care for children with diabetes as well as to coordinate care across multiple specialties when necessary.
Knowledge
Pediatric hospitalists should be able to:
Compare and contrast the epidemiology and pathophysiology of Type 1 with Type 2 diabetes attending to differences in impairment of glucose regulation and occurrence of ketoacidosis.
List common alternate causes of hyperglycemia, such as stress, drug, or steroid‐induced hyperglycemia and give examples of situations in which insulin administration is indicated.
Discuss the importance of completing a thorough review of systems and family history and a full physical examination in order to identify polyendocrinopathies.
Describe the role of obesity in the metabolic syndrome and Type 2 diabetes.
List and explain the laboratory tests used to determine the type of diabetes, assess glucose control, and identify complications or co‐morbidities of diabetes (such as glutamic acid decarboxylase, insulin auto antibodies, islet cell antibodies, hemoglobin A1c, thyroid panel, and celiac panel).
Describe the initial management of diabetic ketoacidosis (DKA), attending to fluid delivery, electrolyte monitoring, mental status assessments, frequency of repeated blood testing, and appropriate patient placement based on local facility services.
Define criteria for escalating care in the context of severe acidosis, altered mental status, and effects of electrolyte disturbances.
Summarize the approach toward management and education after stabilization of DKA.
Discuss the importance of including cultural and ethnic practices when creating a diabetes management plan.
Discuss potential complications that may result from treatment, including hypoglycemia and electrolyte imbalances
Identify the co‐morbidities commonly associated with both Type 1 and Type 2 diabetes.
Describe the different formulations of and delivery systems for insulin.
Review the principles of carbohydrate counting.
Discuss short and long‐term prognostic factors associated with complications of poor glucose control.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose diabetes and its complications by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Correctly recognize and determine the cause of DKA in the patient with known diabetes by efficiently performing an accurate history and physical examination and ordering appropriate diagnostic tests.
Order appropriate diagnostic testing for patients with new onset diabetes or diabetes exacerbations.
Implement an evidence‐based treatment plan.
Correctly order insulin doses and delivery systems (such as continuous infusion, subcutaneous, and others) and other classes of drugs used in the treatment of diabetes.
Recognize and manage both hyperglycemia and hypoglycemia with particular attention to complications that may arise during treatment.
Recognize the indications for escalating levels of care and promptly initiate appropriate actions.
Identify the indications for in hospital consultation and obtain prompt consultation with an endocrinologist or other subspecialist as appropriate.
Access available support services such as social work, child life, nutrition, and others to ensure a comprehensive management approach.
Clearly articulate discharge criteria and outpatient long term management strategies for patients and the family/caregiver.
Coordinate care and education for patients and the family/caregiver with other healthcare providers.
Coordinate care with subspecialists and the primary care provider and arrange an appropriate transition plan for hospital discharge.
Attitudes
Pediatric hospitalists should be able to:
Communicate effectively with patients maintaining awareness of the unique needs of pre‐adolescent and adolescent age groups.
Discuss the importance of a healthy lifestyle in promoting optimal disease management with patients and the family/caregiver.
Recognize that acute and chronic psychosocial factors impact the ability of patients and the family/caregiver to appropriately manage the disease.
Recognize the importance of the multidisciplinary team approach in the management of diabetes in children, including involvement of the primary care provider, endocrinologist, nutritionist, social worker, psychologist, child life, and school representative.
Maintain awareness of local populations which may have multiple risk factors for diabetes
Collaborate with subspecialists and the primary care provider to ensure coordinated longitudinal care for children with diabetes.
Systems Organization and Improvement
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 diabetes.
Work with hospital administration, hospital staff, subspecialists and community organizations to affect system‐wide processes to improve the transition of care from hospital to the ambulatory setting.
Lead, coordinate or participate in system‐wide processes within the hospital to promote therapeutic safety and vigilance in the use of hypoglycemic agents.
Lead, coordinate or participate in educational events to promote awareness of and familiarity with national guidelines for management strategies, new therapeutic and pharmacologic agents and the use of medical devices to improve and monitor glucose homeostasis.
Introduction
Diabetes mellitus, a disorder of glucose homeostasis, is increasing in incidence and prevalence in pediatrics. Although Type 1 diabetes is more frequently diagnosed in children, there has recently been a significant rise in the incidence of Type 2 diabetes, particularly among adolescents in certain ethnic groups. The increasing incidence of Type 2 diabetes parallels the increasing incidence of obesity in the population. In addition to the medical complications associated with this chronic disease, both forms of diabetes have profound social and emotional impacts on the child. Pediatric hospitalists frequently encounter both children with new‐onset diabetes and known diabetics requiring hospitalization because of poor disease control, illness, or elective procedures. Pediatric hospitalists are often in the best position to provide both immediate care for children with diabetes as well as to coordinate care across multiple specialties when necessary.
Knowledge
Pediatric hospitalists should be able to:
Compare and contrast the epidemiology and pathophysiology of Type 1 with Type 2 diabetes attending to differences in impairment of glucose regulation and occurrence of ketoacidosis.
List common alternate causes of hyperglycemia, such as stress, drug, or steroid‐induced hyperglycemia and give examples of situations in which insulin administration is indicated.
Discuss the importance of completing a thorough review of systems and family history and a full physical examination in order to identify polyendocrinopathies.
Describe the role of obesity in the metabolic syndrome and Type 2 diabetes.
List and explain the laboratory tests used to determine the type of diabetes, assess glucose control, and identify complications or co‐morbidities of diabetes (such as glutamic acid decarboxylase, insulin auto antibodies, islet cell antibodies, hemoglobin A1c, thyroid panel, and celiac panel).
Describe the initial management of diabetic ketoacidosis (DKA), attending to fluid delivery, electrolyte monitoring, mental status assessments, frequency of repeated blood testing, and appropriate patient placement based on local facility services.
Define criteria for escalating care in the context of severe acidosis, altered mental status, and effects of electrolyte disturbances.
Summarize the approach toward management and education after stabilization of DKA.
Discuss the importance of including cultural and ethnic practices when creating a diabetes management plan.
Discuss potential complications that may result from treatment, including hypoglycemia and electrolyte imbalances
Identify the co‐morbidities commonly associated with both Type 1 and Type 2 diabetes.
Describe the different formulations of and delivery systems for insulin.
Review the principles of carbohydrate counting.
Discuss short and long‐term prognostic factors associated with complications of poor glucose control.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose diabetes and its complications by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Correctly recognize and determine the cause of DKA in the patient with known diabetes by efficiently performing an accurate history and physical examination and ordering appropriate diagnostic tests.
Order appropriate diagnostic testing for patients with new onset diabetes or diabetes exacerbations.
Implement an evidence‐based treatment plan.
Correctly order insulin doses and delivery systems (such as continuous infusion, subcutaneous, and others) and other classes of drugs used in the treatment of diabetes.
Recognize and manage both hyperglycemia and hypoglycemia with particular attention to complications that may arise during treatment.
Recognize the indications for escalating levels of care and promptly initiate appropriate actions.
Identify the indications for in hospital consultation and obtain prompt consultation with an endocrinologist or other subspecialist as appropriate.
Access available support services such as social work, child life, nutrition, and others to ensure a comprehensive management approach.
Clearly articulate discharge criteria and outpatient long term management strategies for patients and the family/caregiver.
Coordinate care and education for patients and the family/caregiver with other healthcare providers.
Coordinate care with subspecialists and the primary care provider and arrange an appropriate transition plan for hospital discharge.
Attitudes
Pediatric hospitalists should be able to:
Communicate effectively with patients maintaining awareness of the unique needs of pre‐adolescent and adolescent age groups.
Discuss the importance of a healthy lifestyle in promoting optimal disease management with patients and the family/caregiver.
Recognize that acute and chronic psychosocial factors impact the ability of patients and the family/caregiver to appropriately manage the disease.
Recognize the importance of the multidisciplinary team approach in the management of diabetes in children, including involvement of the primary care provider, endocrinologist, nutritionist, social worker, psychologist, child life, and school representative.
Maintain awareness of local populations which may have multiple risk factors for diabetes
Collaborate with subspecialists and the primary care provider to ensure coordinated longitudinal care for children with diabetes.
Systems Organization and Improvement
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 diabetes.
Work with hospital administration, hospital staff, subspecialists and community organizations to affect system‐wide processes to improve the transition of care from hospital to the ambulatory setting.
Lead, coordinate or participate in system‐wide processes within the hospital to promote therapeutic safety and vigilance in the use of hypoglycemic agents.
Lead, coordinate or participate in educational events to promote awareness of and familiarity with national guidelines for management strategies, new therapeutic and pharmacologic agents and the use of medical devices to improve and monitor glucose homeostasis.
Copyright © 2010 Society of Hospital Medicine
Sickle cell disease
Introduction
Sickle cell disease is the most common autosomal recessive disease in African American individuals. It occurs in 1 in 625 live births to African‐American couples. While it is most common in African Americans, it also occurs in individuals of Hispanic, Arabic, Native American and Caucasian heritage. Sickle cell disease results from a single base‐pair substitution of thymine for adenine resulting in valine instead of glutamine in the sixth position of the Beta‐globin molecule. Sickle cell disease results when this substitution occurs in a homozygous state. Less severe forms occur when the heterozygote state is combined with a second variant Beta‐globin chain such as hemoglobin C or Betao‐thalassemia. Clinical manifestations result from polymerization of the abnormal hemoglobin and sickling of the red cells. The clinical manifestations most important to pediatric hospitalists include recurrent and chronic pain from dactylitis and vaso‐occlusive crises, acute chest syndrome, increased susceptibility to infections, aplastic crisis, splenic sequestration, cerebral vascular accidents and priapism. Pediatric hospitalists commonly encounter patients with known or suspected sickle cell disease and care for the various complications associated with the disease.
Knowledge
Pediatric hospitalists should be able to:
Review the genetics and pathophysiology underlying the variants of sickle cell disease and their complications.
Compare and contrast common sickle crisis presentations by age group.
Explain the impact of newborn screening on preventative care.
Describe the signs and symptoms of dactylitis, vaso‐occlusive crisis, sepsis, acute chest syndrome, aplastic crisis, splenic sequestration, cerebrovascular accidents and priapism.
Describe indications for hospital admission, and escalation to intensive care.
Identify the goals of inpatient therapy, attending to both acute and chronic needs.
Summarize the roles of members of a comprehensive clinical care team, such as patients, family/caregiver, subspecialty physicians, social worker, pharmacist, physical therapist, discharge planner, psychologist and others.
Discuss the therapeutic options available for complications of sickle cell disease and describe the rationale for choosing a specific management plan.
Explain the approach toward acute and chronic pain management.
Cite reasons for transfer to a referral center in cases requiring pediatric‐specific services not available at the local facility.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose sickle cell disease and/or its complications by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Order appropriate laboratory and radiographic testing based on history and physical examination findings.
Create a comprehensive evaluation and management plan including the use of antimicrobial therapy, intravenous fluid hydration, pain management, transfusion therapy, and initiation of cardiovascular and pulmonary supportive care measures.
Identify patients with worsening status and respond with appropriate actions.
Consult subspecialists in a timely manner when appropriate.
Attitudes
Pediatric hospitalists should be able to:
Communicate effectively with patients and the family/caregiver regarding the disease process, expectations of inpatient therapy and transition of care to the outpatient arena.
Collaborate with subspecialists and the primary care provider and to ensure coordinated longitudinal care for children with sickle cell disease.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Collaborate with a multidisciplinary team consisting of subspecialty physicians, social workers, pharmacists, physical therapists, discharge planners and psychologists to improve quality of care, increase patient satisfaction and facilitate timely discharge from the acute care setting.
Identify existing limitations for optimal care within the current hospital setting and work with hospital administration and community partners to develop and sustain appropriate referral systems and coordinated transfers of care.
Lead, coordinate or participate in the development of coordinated discharge plans and programs in the local community.
Introduction
Sickle cell disease is the most common autosomal recessive disease in African American individuals. It occurs in 1 in 625 live births to African‐American couples. While it is most common in African Americans, it also occurs in individuals of Hispanic, Arabic, Native American and Caucasian heritage. Sickle cell disease results from a single base‐pair substitution of thymine for adenine resulting in valine instead of glutamine in the sixth position of the Beta‐globin molecule. Sickle cell disease results when this substitution occurs in a homozygous state. Less severe forms occur when the heterozygote state is combined with a second variant Beta‐globin chain such as hemoglobin C or Betao‐thalassemia. Clinical manifestations result from polymerization of the abnormal hemoglobin and sickling of the red cells. The clinical manifestations most important to pediatric hospitalists include recurrent and chronic pain from dactylitis and vaso‐occlusive crises, acute chest syndrome, increased susceptibility to infections, aplastic crisis, splenic sequestration, cerebral vascular accidents and priapism. Pediatric hospitalists commonly encounter patients with known or suspected sickle cell disease and care for the various complications associated with the disease.
Knowledge
Pediatric hospitalists should be able to:
Review the genetics and pathophysiology underlying the variants of sickle cell disease and their complications.
Compare and contrast common sickle crisis presentations by age group.
Explain the impact of newborn screening on preventative care.
Describe the signs and symptoms of dactylitis, vaso‐occlusive crisis, sepsis, acute chest syndrome, aplastic crisis, splenic sequestration, cerebrovascular accidents and priapism.
Describe indications for hospital admission, and escalation to intensive care.
Identify the goals of inpatient therapy, attending to both acute and chronic needs.
Summarize the roles of members of a comprehensive clinical care team, such as patients, family/caregiver, subspecialty physicians, social worker, pharmacist, physical therapist, discharge planner, psychologist and others.
Discuss the therapeutic options available for complications of sickle cell disease and describe the rationale for choosing a specific management plan.
Explain the approach toward acute and chronic pain management.
Cite reasons for transfer to a referral center in cases requiring pediatric‐specific services not available at the local facility.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose sickle cell disease and/or its complications by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Order appropriate laboratory and radiographic testing based on history and physical examination findings.
Create a comprehensive evaluation and management plan including the use of antimicrobial therapy, intravenous fluid hydration, pain management, transfusion therapy, and initiation of cardiovascular and pulmonary supportive care measures.
Identify patients with worsening status and respond with appropriate actions.
Consult subspecialists in a timely manner when appropriate.
Attitudes
Pediatric hospitalists should be able to:
Communicate effectively with patients and the family/caregiver regarding the disease process, expectations of inpatient therapy and transition of care to the outpatient arena.
Collaborate with subspecialists and the primary care provider and to ensure coordinated longitudinal care for children with sickle cell disease.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Collaborate with a multidisciplinary team consisting of subspecialty physicians, social workers, pharmacists, physical therapists, discharge planners and psychologists to improve quality of care, increase patient satisfaction and facilitate timely discharge from the acute care setting.
Identify existing limitations for optimal care within the current hospital setting and work with hospital administration and community partners to develop and sustain appropriate referral systems and coordinated transfers of care.
Lead, coordinate or participate in the development of coordinated discharge plans and programs in the local community.
Introduction
Sickle cell disease is the most common autosomal recessive disease in African American individuals. It occurs in 1 in 625 live births to African‐American couples. While it is most common in African Americans, it also occurs in individuals of Hispanic, Arabic, Native American and Caucasian heritage. Sickle cell disease results from a single base‐pair substitution of thymine for adenine resulting in valine instead of glutamine in the sixth position of the Beta‐globin molecule. Sickle cell disease results when this substitution occurs in a homozygous state. Less severe forms occur when the heterozygote state is combined with a second variant Beta‐globin chain such as hemoglobin C or Betao‐thalassemia. Clinical manifestations result from polymerization of the abnormal hemoglobin and sickling of the red cells. The clinical manifestations most important to pediatric hospitalists include recurrent and chronic pain from dactylitis and vaso‐occlusive crises, acute chest syndrome, increased susceptibility to infections, aplastic crisis, splenic sequestration, cerebral vascular accidents and priapism. Pediatric hospitalists commonly encounter patients with known or suspected sickle cell disease and care for the various complications associated with the disease.
Knowledge
Pediatric hospitalists should be able to:
Review the genetics and pathophysiology underlying the variants of sickle cell disease and their complications.
Compare and contrast common sickle crisis presentations by age group.
Explain the impact of newborn screening on preventative care.
Describe the signs and symptoms of dactylitis, vaso‐occlusive crisis, sepsis, acute chest syndrome, aplastic crisis, splenic sequestration, cerebrovascular accidents and priapism.
Describe indications for hospital admission, and escalation to intensive care.
Identify the goals of inpatient therapy, attending to both acute and chronic needs.
Summarize the roles of members of a comprehensive clinical care team, such as patients, family/caregiver, subspecialty physicians, social worker, pharmacist, physical therapist, discharge planner, psychologist and others.
Discuss the therapeutic options available for complications of sickle cell disease and describe the rationale for choosing a specific management plan.
Explain the approach toward acute and chronic pain management.
Cite reasons for transfer to a referral center in cases requiring pediatric‐specific services not available at the local facility.
Skills
Pediatric hospitalists should be able to:
Correctly diagnose sickle cell disease and/or its complications by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
Order appropriate laboratory and radiographic testing based on history and physical examination findings.
Create a comprehensive evaluation and management plan including the use of antimicrobial therapy, intravenous fluid hydration, pain management, transfusion therapy, and initiation of cardiovascular and pulmonary supportive care measures.
Identify patients with worsening status and respond with appropriate actions.
Consult subspecialists in a timely manner when appropriate.
Attitudes
Pediatric hospitalists should be able to:
Communicate effectively with patients and the family/caregiver regarding the disease process, expectations of inpatient therapy and transition of care to the outpatient arena.
Collaborate with subspecialists and the primary care provider and to ensure coordinated longitudinal care for children with sickle cell disease.
Systems Organization and Improvement
In order to improve efficiency and quality within their organizations, pediatric hospitalists should:
Collaborate with a multidisciplinary team consisting of subspecialty physicians, social workers, pharmacists, physical therapists, discharge planners and psychologists to improve quality of care, increase patient satisfaction and facilitate timely discharge from the acute care setting.
Identify existing limitations for optimal care within the current hospital setting and work with hospital administration and community partners to develop and sustain appropriate referral systems and coordinated transfers of care.
Lead, coordinate or participate in the development of coordinated discharge plans and programs in the local community.
Copyright © 2010 Society of Hospital Medicine
Procedural sedation
Introduction
Sedation is often used to minimize procedure related pain and to provide decreased motion for diagnostic studies. Control of pain, anxiety and memory may minimize negative psychological responses to treatment and also lead to a higher success rate for the therapy or diagnostic test. Safe attainment of these goals requires careful preparation and decision‐making prior to the procedure, meticulous monitoring during the procedure, and application of skills to avoid or treat the complications of sedation including ability to rescue patients from a deeper level of sedation than intended. With appropriate training and experience, pediatric hospitalists can safely provide a range of sedation services for pediatric patients.
Knowledge
Pediatric hospitalists should be able to:
Describe the goals of sedation, such as pain control, anxiolysis, amnesia, and motion control.
List commonly used single or combinations of medications, and describe how each achieves the desired goal with the minimum risk of complications and side effects.
Compare and contrast the goals of isolated anxiolysis with minimal sedation, attending to issues such as medication choice and dosing, procedure, and patient past procedural history.
Define minimal sedation, moderate sedation, deep sedation, and general anesthesia as established by the American Society of Anesthesiologists (ASA), American Academy of Pediatrics (AAP), and The Joint Commission (TJC).
Discuss the pharmacology and effects of commonly used sedation medications, including planned effects and potential side effects.
Explain why non‐pharmacologic interventions such as bundling, glucose water pacifiers, family/caregiver presence, visual imagery, deep breathing, music and others are important adjuncts to medication use in mitigating the perception of pain and anxiety.
Explain the risks inherent with administration of sedating medications, and list the proper monitoring necessary to avoid or promptly recognize instability.
Describe how age, disease process, and anatomy may increase the risk of sedation complications.
Discuss the proper level of monitoring personnel necessary to maximize safety.
Review indications for use of common reversal drugs, including anticipated results and duration of rescue effects.
Skills
Pediatric hospitalists should be able to:
Perform a pre‐sedation evaluation and appropriately assign ASA class and delineate patient‐specific risks.
Correctly recognize patients at higher risk and efficiently refer to an anesthesiologist.
Correctly obtain informed consent from the family/caregiver.
Develop a sedation plan that is based on the pre‐sedation evaluation and considers goals for the sedation and risks to patients.
Communicate effectively with the healthcare team before, during, and after the sedation to ensure that safe and efficient care is rendered.
Identify complications and respond with appropriate actions.
Manage the airway and provide pediatric advanced life support in case of known or unexpected complications.
Order appropriate monitoring and correctly interpret monitor data.
Identify when recovery criteria are met, and initiate an appropriate discharge/transfer plan.
Attitudes
Pediatric hospitalists should be able to:
Work collaboratively with hospital staff and subspecialists to ensure coordinated planning and performance of sedation.
Communicate effectively with patients and the family/caregiver regarding the indications for, risks, benefits, and steps of sedation.
Systems Organization and Improvement
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 procedures and policies for performance of sedation for children.
Lead, coordinate or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction into procedural strategies.
Work with hospital staff and subspecialists to develop and implement management strategies for sedation.
Lead, coordinate or participate in the development and implementation of a system for review of the efficacy, efficiency and outcomes of intravenous access procedures.
Lead, coordinate or participate in the development and implementation of a system for review of the efficacy, efficiency and outcomes of sedation procedures.
Introduction
Sedation is often used to minimize procedure related pain and to provide decreased motion for diagnostic studies. Control of pain, anxiety and memory may minimize negative psychological responses to treatment and also lead to a higher success rate for the therapy or diagnostic test. Safe attainment of these goals requires careful preparation and decision‐making prior to the procedure, meticulous monitoring during the procedure, and application of skills to avoid or treat the complications of sedation including ability to rescue patients from a deeper level of sedation than intended. With appropriate training and experience, pediatric hospitalists can safely provide a range of sedation services for pediatric patients.
Knowledge
Pediatric hospitalists should be able to:
Describe the goals of sedation, such as pain control, anxiolysis, amnesia, and motion control.
List commonly used single or combinations of medications, and describe how each achieves the desired goal with the minimum risk of complications and side effects.
Compare and contrast the goals of isolated anxiolysis with minimal sedation, attending to issues such as medication choice and dosing, procedure, and patient past procedural history.
Define minimal sedation, moderate sedation, deep sedation, and general anesthesia as established by the American Society of Anesthesiologists (ASA), American Academy of Pediatrics (AAP), and The Joint Commission (TJC).
Discuss the pharmacology and effects of commonly used sedation medications, including planned effects and potential side effects.
Explain why non‐pharmacologic interventions such as bundling, glucose water pacifiers, family/caregiver presence, visual imagery, deep breathing, music and others are important adjuncts to medication use in mitigating the perception of pain and anxiety.
Explain the risks inherent with administration of sedating medications, and list the proper monitoring necessary to avoid or promptly recognize instability.
Describe how age, disease process, and anatomy may increase the risk of sedation complications.
Discuss the proper level of monitoring personnel necessary to maximize safety.
Review indications for use of common reversal drugs, including anticipated results and duration of rescue effects.
Skills
Pediatric hospitalists should be able to:
Perform a pre‐sedation evaluation and appropriately assign ASA class and delineate patient‐specific risks.
Correctly recognize patients at higher risk and efficiently refer to an anesthesiologist.
Correctly obtain informed consent from the family/caregiver.
Develop a sedation plan that is based on the pre‐sedation evaluation and considers goals for the sedation and risks to patients.
Communicate effectively with the healthcare team before, during, and after the sedation to ensure that safe and efficient care is rendered.
Identify complications and respond with appropriate actions.
Manage the airway and provide pediatric advanced life support in case of known or unexpected complications.
Order appropriate monitoring and correctly interpret monitor data.
Identify when recovery criteria are met, and initiate an appropriate discharge/transfer plan.
Attitudes
Pediatric hospitalists should be able to:
Work collaboratively with hospital staff and subspecialists to ensure coordinated planning and performance of sedation.
Communicate effectively with patients and the family/caregiver regarding the indications for, risks, benefits, and steps of sedation.
Systems Organization and Improvement
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 procedures and policies for performance of sedation for children.
Lead, coordinate or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction into procedural strategies.
Work with hospital staff and subspecialists to develop and implement management strategies for sedation.
Lead, coordinate or participate in the development and implementation of a system for review of the efficacy, efficiency and outcomes of intravenous access procedures.
Lead, coordinate or participate in the development and implementation of a system for review of the efficacy, efficiency and outcomes of sedation procedures.
Introduction
Sedation is often used to minimize procedure related pain and to provide decreased motion for diagnostic studies. Control of pain, anxiety and memory may minimize negative psychological responses to treatment and also lead to a higher success rate for the therapy or diagnostic test. Safe attainment of these goals requires careful preparation and decision‐making prior to the procedure, meticulous monitoring during the procedure, and application of skills to avoid or treat the complications of sedation including ability to rescue patients from a deeper level of sedation than intended. With appropriate training and experience, pediatric hospitalists can safely provide a range of sedation services for pediatric patients.
Knowledge
Pediatric hospitalists should be able to:
Describe the goals of sedation, such as pain control, anxiolysis, amnesia, and motion control.
List commonly used single or combinations of medications, and describe how each achieves the desired goal with the minimum risk of complications and side effects.
Compare and contrast the goals of isolated anxiolysis with minimal sedation, attending to issues such as medication choice and dosing, procedure, and patient past procedural history.
Define minimal sedation, moderate sedation, deep sedation, and general anesthesia as established by the American Society of Anesthesiologists (ASA), American Academy of Pediatrics (AAP), and The Joint Commission (TJC).
Discuss the pharmacology and effects of commonly used sedation medications, including planned effects and potential side effects.
Explain why non‐pharmacologic interventions such as bundling, glucose water pacifiers, family/caregiver presence, visual imagery, deep breathing, music and others are important adjuncts to medication use in mitigating the perception of pain and anxiety.
Explain the risks inherent with administration of sedating medications, and list the proper monitoring necessary to avoid or promptly recognize instability.
Describe how age, disease process, and anatomy may increase the risk of sedation complications.
Discuss the proper level of monitoring personnel necessary to maximize safety.
Review indications for use of common reversal drugs, including anticipated results and duration of rescue effects.
Skills
Pediatric hospitalists should be able to:
Perform a pre‐sedation evaluation and appropriately assign ASA class and delineate patient‐specific risks.
Correctly recognize patients at higher risk and efficiently refer to an anesthesiologist.
Correctly obtain informed consent from the family/caregiver.
Develop a sedation plan that is based on the pre‐sedation evaluation and considers goals for the sedation and risks to patients.
Communicate effectively with the healthcare team before, during, and after the sedation to ensure that safe and efficient care is rendered.
Identify complications and respond with appropriate actions.
Manage the airway and provide pediatric advanced life support in case of known or unexpected complications.
Order appropriate monitoring and correctly interpret monitor data.
Identify when recovery criteria are met, and initiate an appropriate discharge/transfer plan.
Attitudes
Pediatric hospitalists should be able to:
Work collaboratively with hospital staff and subspecialists to ensure coordinated planning and performance of sedation.
Communicate effectively with patients and the family/caregiver regarding the indications for, risks, benefits, and steps of sedation.
Systems Organization and Improvement
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 procedures and policies for performance of sedation for children.
Lead, coordinate or participate in the development and implementation of a system for review of family/caregiver and healthcare provider satisfaction into procedural strategies.
Work with hospital staff and subspecialists to develop and implement management strategies for sedation.
Lead, coordinate or participate in the development and implementation of a system for review of the efficacy, efficiency and outcomes of intravenous access procedures.
Lead, coordinate or participate in the development and implementation of a system for review of the efficacy, efficiency and outcomes of sedation procedures.
Copyright © 2010 Society of Hospital Medicine