Documentation of Tobacco, Alcohol, and Drug Screening in Hospitalized Adolescents.

OBJECTIVES: To examine the frequency of documented screening for tobacco, alcohol, and drug use in hospitalized adolescents on the pediatric hospitalist service. PATIENTS AND METHODS: This was a retrospective chart review of adolescents aged 14 to 17 years hospitalized at a large urban academic children's hospital in the Northeast from 2013 to 2015. Only patients admitted directly to the hospitalist service and only the first admission (if multiple occurred) were included. Patients presenting for psychiatric illness, ingestions, or impaired neurologic functioning were excluded. Admission history and physical (H&P) notes were reviewed to identify documented screening for tobacco, alcohol, and drug use. χ2 tests and 95% confidence intervals (CIs) were used to compare screenings for each substance and assess for associations of patient and encounter characteristics. RESULTS: A total of 443 charts met criteria for inclusion. The majority of adolescents were girls (n = 286; 64.6%), and mean age was 15.6 years (SD: 1.1). The H&P notes included notation of screening for tobacco use in 75.4% (95% CI: 71.1%-79.3%), alcohol use in 56.4% (95% CI: 51.7%-61.1%), and drug use in 37.9% (95% CI: 33.4%-42.6%) of charts. Girls were 1.4 times more likely to have of documented screening for alcohol use than boys. The admission diagnosis category was significantly associated with documentation of alcohol screening. Tobacco and drug screening frequency did not differ on the basis of sex, age, or diagnosis category. CONCLUSIONS: Documentation of substance use screening was not universal in admission H&P notes. These discrepancies suggest a need for improvements in screening protocols and documentation methods.

Impact of 4 Components of Instructional Design Video on Medical Student Medical Decision Making During the Inpatient Rounding Experience.

INTRODUCTION: The Four Components of Instructional Design (4C-ID) Model has been used to teach Medical Decision Making (MDM), a core competency recognized by the Liaison Committee for Medical Education. 4 Components of Instructional Design (4C-ID) has been applied in general medical education, but not the inpatient clerkship setting. A 4C-ID video for inpatient rounding, like postpartum rounding in Ob/Gyn, could help improve MDM on busy services. METHODS: Students in the third year Ob/Gyn clerkship were randomized by clerkship group to receive a 20-minute postpartum rounding video, based on 4C-ID principles, or usual teaching. MDM and knowledge were assessed pre-/postintervention with the Diagnostic Thinking Inventory and a case-based evaluation. Satisfaction was assessed with Likert style questions. RESULTS: Seventy-eight students were randomized (36 control, 42 intervention). Both groups had equal baseline measures of MDM and knowledge, and similar postclerkship MDM. The intervention group demonstrated higher knowledge postclerkship (17.1, 22.6 p < 0.001). Students in the intervention felt prepared by the video, and would recommend it. Students in the control group reported higher satisfaction with their postpartum rounding experience (3.9, 3.5 p = 0.04). DISCUSSION: Videos are easy to incorporate teaching platforms for medical students, however, the 4C-ID based video in this study did not increase student MDM. In addition, educators should use caution when integrating video into coursework as use of video may lead to decreased student satisfaction as it did in this study.

Documentation of Sexual History in Hospitalized Adolescents on the General Pediatrics Service.

OBJECTIVES: To determine the frequency of sexual history taking and the associated characteristics of hospitalized adolescents in the pediatric hospitalist service. METHODS: A retrospective chart review of adolescents 14 to 18 years old who were admitted to the pediatric hospitalist service at an urban, academic children's hospital in the Northeast from 2013 to 2015 was conducted. Repeat admissions, admissions to specialty services, and charts that noted impairment because of psychosis, cognitive delay, or illness severity were excluded. For charts that met the criteria, the admission history and physical was carefully reviewed for a notation of sexual history. For those with documentation, sexual activity status and a risk level assessment were recorded. Patient demographics and admission characteristics were extracted. χ2 tests and logistic regression were used to examine differences between those with sexual history and those without. RESULTS: A total of 752 charts met the criteria for inclusion. The majority of adolescents were girls (n = 506; 67.3%); the mean age was 15.7 years (SD = 1.2). Girls had 2.99 (95% confidence interval [CI] 2.18-4.11) higher odds of documentation than boys, and older adolescents had 1.41 (95% CI 1.03-1.91) higher odds than younger adolescents. Documentation did not differ significantly on the basis of admission type (medical or psychiatric), admission time, patient race and/or ethnicity, or provider gender. Among those with a documented sexual history, risk-level details were often omitted. CONCLUSIONS: Sexual history taking does not occur universally for hospitalized adolescents. Girls were screened more often than boys despite similar rates of sexual activity. The inpatient admission may be a missed opportunity for harm-reduction counseling and adherence to sexually transmitted infection testing guidelines.