Fibromatosis Colli: A Case Report.

Fibromatosis colli is a rare, usually self-limiting condition caused by a benign tumor in the sternocleidomastoid muscle. The tumor occurs most often during infancy and can be clinically associated with torticollis. Accurate diagnosis of fibromatosis colli is important to avoid unnecessary invasive interventions. Radiographic imaging is fundamental to differentiating this benign tumor from other causes of neck masses/swelling in infants. In this article, we discuss the case of a 4-month old child who presented with a head tilt and had imaging that favored a diagnosis of fibromatosis colli.

The Ask Me to Explain Campaign: A 90-Day Intervention to Promote Patient and Family Involvement in Care in a Pediatric Emergency Department.

BACKGROUND: Patient satisfaction is a central outcome measure of patient-centered care and is associated with improved patient safety, but the effect of specific interventions in pediatric emergency medicine on patient satisfaction is not well studied. In 2013 the University of Chicago Medicine Comer Children's Hospital's Pediatric Emergency Department identified substantial room for improvement in communication both among physicians and nurses and between hospital staff and patients. A pilot study was conducted to quantify the impact of a specific package of improvement activities on patient satisfaction in the Pediatric Emergency Department. METHODS: Using a 90-day action plan (December 2013- February 2014), the Ask Me to Explain campaign included visual signage to remind clinicians and staff to focus on addressing the concerns of their patients. Providers were educated on the campaign tools, their purpose, and how to use them to initiate discussion and provide answers to patient concerns. Education was then spread to support staff throughout the department. The primary outcome measure was the response to questions on a patient satisfaction survey delivered by a third-party vendor, specifically, "Likelihood of your recommending our Emergency Department to others." RESULTS: "Top Box" scores increased for all questions during the 90-day intervention period. Specifically, staff sensitivity to patient concerns increased from 44.0% to 59.2% (p = 0.041), and patient satisfaction with being informed about delays increased from 34.7% to 51.1% (p = 0.024). Interestingly, patient satisfaction either remained above baseline or continued to improve for all questions after the campaign had concluded. CONCLUSION: A 90-day action plan may provide a successful template for improving communication between providers and patients in a pediatric emergency department or in other health care settings.

Developing An Analytic Approach to Understanding the Patient Care Experience.

The amount of data available to health-care institutions regarding the patient care experience has grown tremendously. Purposeful approaches to condensing, interpreting, and disseminating these data are becoming necessary to further understand how clinical and operational constructs relate to patient satisfaction with their care, identify areas for improvement, and accurately measure the impact of initiatives designed to improve the patient experience. We set out to develop an analytic reporting tool deeply rooted in the patient voice that would compile patient experience data obtained throughout the medical center.

Pediatric left-without-being-seen patients: what happens to them after they leave the pediatric emergency department?

OBJECTIVES: The objective of this study was to evaluate what happens to the children who leave without being seen (LWBS) in an urban Pediatric Emergency Department (PED). METHODS: Patient advocates contacted families whose children LWBS in the PED via phone call and utilized a standardized questionnaire to interview them regarding medical care sought after leaving the PED. Questions asked included the following: Was further medical care sought by the family for the child? If so, where was the care obtained? Did the patient no longer require care? The family was also asked if the advocate could help make an appointment for medical care for the child. RESULTS: From April 2009 to September 2011, 3874 LWBS patients from the PED at the University of Chicago Comer Children's Hospital were called by patient advocates. Sixty-five percent (n = 2521) of these children's families were reached by phone. More than 50% of patients contacted sought medical care elsewhere, planned to seek care, or had scheduled an appointment for follow-up medical care. When contacted, 21% of the families felt that no further medical appointment/care was needed, and 23% refused assistance. CONCLUSIONS: Left-without-being-seen rates continued to be an ongoing issue for physicians in the PED. More than half of the contacted patients who LWBS were cared for elsewhere either on the day of the visit or later. This information obtained provides an initial look into understanding what happens to an urban PED patient population that leaves before receiving care in the PED.

Severe facial and ocular injuries from a potato gun.

Potato guns or spud guns are homemade firearms built primarily for recreational use. Information on how to make these can be found easily by searching the topic on the Internet. There is a surplus of Web sites dedicated to providing information to anyone looking to make one of their own. We present an interesting case that illustrates the extent of trauma, which can be caused by these dangerous devices. Despite the growing information available for consumers of any age, there is little information for clinicians regarding these devices and the serious threat of injury that they pose. The current trauma and injury databases, unfortunately, do not gather data pertaining specifically to these devices. In addition, because they are homemade and primarily built for recreational purposes, their use is not controlled or regulated by the government. It is important for clinicians to be aware of homemade firearms such as potato guns, be prepared to manage injury from these devices, and as with other weapons or firearms provide patients and families with the appropriate anticipatory guidance.

Creating healthy camp experiences.

The American Academy of Pediatrics has created recommendations for health appraisal and preparation of young people before participation in day or resident camps and to guide health and safety practices for children at camp. These recommendations are intended for parents, primary health care providers, and camp administration and health center staff. Although camps have diverse environments, there are general guidelines that apply to all situations and specific recommendations that are appropriate under special conditions. This policy statement has been reviewed and is supported by the American Camp Association.