ABSTRACT
OBJECTIVES: Bronchiolitis is a leading cause of pediatric hospitalization. Treatment focuses on supportive care including supplemental oxygen for hypoxemia. High-flow nasal cannula (HFNC) has emerged as a modality to provide respiratory support with or without supplemental oxygen. At a freestanding children's hospital, inappropriate supplemental oxygen was frequently used. This study aimed to decrease the proportion of patients started on supplemental oxygen without documented hypoxemia from â¼90% to <70% and the proportion of patients weaned from HFNC without supplemental oxygen to nasal cannula with supplemental oxygen from â¼23% to <10%. METHODS: A multidisciplinary taskforce was convened to develop an evidence-based protocol for HFNC usage. Data collection was obtained among patients aged <2 years admitted with bronchiolitis from September 2018 to September 2021. Institution-wide protocol changes occurred in November 2019 and October 2020, with ongoing education and evaluation. Data were summarized using statistical process control charts. RESULTS: Following implementation of a revised protocol in October 2020, the percentage of patients without documented hypoxemia (defined as an oxygen saturation <90% on pulse oximetry) who were inappropriately started on supplemental oxygen decreased from a baseline of 90.2% to 57.2%. At the same time, the percentage of patients weaned from HFNC without nasal cannula oxygen decreased from a baseline of 23.1% to 4.7%. CONCLUSIONS: Using supplemental oxygen in the absence of hypoxemia in bronchiolitis is an example of low-value care. Implementation of focused, standardized protocols with concurrent education can feasibly decrease inappropriate and unnecessary use of supplemental oxygen in children with bronchiolitis.
Subject(s)
Bronchiolitis , Cannula , Humans , Child , Infant , Bronchiolitis/therapy , Oxygen , Hospitalization , Hypoxia/etiology , Hypoxia/therapy , Oxygen Inhalation TherapyABSTRACT
OBJECTIVES: Bronchiolitis is a viral respiratory infection that can progress to acute respiratory failure. This study evaluated the variability of hospital-wide high-flow nasal cannula (HFNC) usage outside of the ICU and its association with length of stay (LOS) and cost among pediatric patients admitted with bronchiolitis. METHODS: This study included patients <2 years old admitted with bronchiolitis between September 1, 2018 and March 31, 2019. Hospitals were divided into groups based on the proportion of patients among those who had never been in the ICU who received HFNC (non-ICU HFNC usage [NIHU]). We performed hierarchical mixed-model linear regression to estimate the association of NIHU with LOS and cost using multiplicative ratios (MR) and 95% confidence intervals (CI), both (1) unadjusted and (2) after adjusting for demographics, clinical characteristics, and individual utilization of HFNC and/or ICU. RESULTS: Unadjusted LOS was longer for patients in moderate (MR 1.14; 95% CI 1.11-1.18) and high (MR 1.26; 95% CI 1.22-1.30) NIHU hospitals. Adjusted LOS was longer in moderate (MR 1.03; 95% CI 1.01-1.06), and high (MR 1.08; 95% CI 1.05-1.11) NIHU hospitals. Unadjusted total cost was higher for patients in moderate (MR 1.20; 95% CI 1.16-1.25) and high (MR 1.26; 95% CI 1.22-1.31) NIHU hospitals. Adjusted total cost was higher for patients in moderate (MR 1.05; 95% CI 1.03-1.08), and high (MR 1.05; 95% CI 1.02-1.08) NIHU hospitals. CONCLUSIONS: In this study, increased NIHU is associated with increased LOS and total cost.
Subject(s)
Cannula , Hospitals , Humans , Child , Child, Preschool , Critical Care , Length of Stay , HospitalizationABSTRACT
Although Fusobacterium necrophorum is well described as an emerging pathogen of acute mastoiditis in young children, infection with other anaerobes can lead to similar severe sequelae including intracranial and extracranial suppurative thrombophlebitis and sepsis. We describe a patient whose unremarkable exposure history assumed increased significance upon obtaining the results of 16S next generation sequencing from a surgical specimen. The novel pathogen Bacteroides pyogenes is reviewed herein.
Subject(s)
Fusobacterium Infections , Lemierre Syndrome , Thrombophlebitis , Bacteroides/genetics , Child , Child, Preschool , Fusobacterium Infections/diagnosis , Fusobacterium Infections/drug therapy , Fusobacterium necrophorum , Humans , Lemierre Syndrome/diagnosis , Lemierre Syndrome/drug therapyABSTRACT
Professional identity formation (PIF) of medical students encompasses how students learn to think, do, and act as physicians. A key component of PIF is socialization, which includes mentoring. Mentoring influences students' career specialty choice, while providing a safe and nurturing environment to form their own professional identities. Mentoring of medical students by orthopedic surgeons may increase interest in the specialty. Suggestions for utilizing mentoring for the PIF of medical students and to increase diversity in orthopedics are discussed.
Subject(s)
Mentoring , Orthopedics/education , Self Concept , Social Identification , Students, Medical/psychology , Career Choice , Clinical Competence , Faculty, Medical/psychology , Humans , Orthopedic Surgeons/psychologyABSTRACT
This article explores the current state of the residency match in 2020 with a focus on orthopedic surgery, analyzing the utility of current applicant screening methods in producing future generations of competent surgeons. Discussed are anticipated changes to the residency application process considering the COVID-19 pandemic and Step 1 becoming pass/fail in January 2022. Also explored are potential changes to improve the process for applicants and residency programs, such as identifying and using predictive factors of resident success in the applicant screening process, finding better ways to match applicants with programs, and increasing female and underrepresented minorities within orthopedics.
