All that Wheezes is not Asthma or Bronchiolitis.

Wheezing is a common finding across patients of all age groups presenting to the emergency department and being hospitalized for respiratory distress, with most patients responding to standard therapeutics and having readily apparent diagnoses of asthma or bronchiolitis. We describe several clinical entities that may present with wheezing and respiratory distress, calling attention to the broad differential that may masquerade as asthma or bronchiolitis, and potentially lead to misdiagnosis, delayed diagnosis, or inappropriate treatment.

Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value.

OBJECTIVES: The health care system faces ongoing challenges due to low-value care. Building on the first pediatric hospital medicine contribution to the American Board of Internal Medicine Foundation Choosing Wisely Campaign, a working group was convened to identify additional priorities for improving health care value for hospitalized children. METHODS: A study team composed of nominees from national pediatric medical professional societies was convened, including pediatric hospitalists with expertise in clinical care, hospital leadership, and research. The study team surveyed national pediatric hospitalist LISTSERVs for suggestions, condensed similar responses, and performed a literature search of articles published in the previous 10 years. Using a modified Delphi process, the team completed a series of structured ratings of feasibility and validity and facilitated group discussion. The sum of final mean validity and feasibility scores was used to identify the 5 highest priority recommendations. RESULTS: Two hundred seven respondents suggested 397 preliminary recommendations, yielding 74 unique recommendations that underwent evidence review and rating. The 5 highest-scoring recommendations had a focus on the following aspects of hospital care: (1) length of intravenous antibiotic therapy before transition to oral antibiotics, (2) length of stay for febrile infants evaluated for serious bacterial infection, (3) phototherapy for neonatal hyperbilirubinemia, (4) antibiotic therapy for community-acquired pneumonia, and (5) initiation of intravenous antibiotics in infants with maternal risk factors for sepsis. CONCLUSIONS: We propose that pediatric hospitalists can use this list to prioritize quality improvement and scholarly work focused on improving the value and quality of patient care for hospitalized children.

Improving Standardization of Paging Communication Using Quality Improvement Methodology.

BACKGROUND AND OBJECTIVES: Paging is a primary mode of communication in hospitals, but message quality varies. With this project, we aimed to standardize paging, thus improving end user (EU) satisfaction, patient safety, and efficiency. Objectives were to increase the percent of pages containing 6 critical elements (CEs) (ie, the sender's first and last name, a 7-digit callback number, patient name, room number, and urgency indicator [information only, call, or come] to 90%); improve EU satisfaction to 80% rating paging communication as good or excellent; and decrease the frequency of safety events related to paging. METHODS: This multidisciplinary, system-wide quality improvement study was conducted at our stand-alone academic children's hospital. CEs were determined by EU consensus. Outcome measures were inclusion of all 6 CEs, provider satisfaction, and frequency of safety events. Process measures were inclusion of individual CEs and appropriateness and timeliness of response to pages. Balancing measures included number of work-arounds (WAs). Interventions included education, engineering a platform with required fields, and optimization enhancements. Statistical process control charts (p-charts; XmR) were used to track the impact of interventions. RESULTS: Special-cause improvement was noted in use of all 6 CEs (4.4%-79.7%) and individual CEs. EU satisfaction improved from 50% to 85% rating paging communication as good or excellent. Safety events related to paging remain infrequent. Specific WA use decreased by 60%. CONCLUSIONS: System-wide use of required fields produced significant improvement in inclusion of all 6 CEs and EU satisfaction. WAs were curbed by improving the ease of CE incorporation. Required fields should be considered at institutions seeking improved paging communication.