Cincinnati Children's Hospital Medical Center Research Articles

016—Nurses' Perceptions of Pediatric Pain Assessment Scales

Purpose: The purpose of this study is to survey nurses' perceptions of ease of use and effectiveness of five pain assessment scales currently in use at Cincinnati Children's Hospital Medical Center (CCHMC). The scales are the Neonatal Infant Pain Scale, the Children's Hospital of Eastern Ontario Pain Scale, the Oucher Scale, the Visual Analog Scale, and the COMFORT Scale.

Examination of aerodynamic measures and strain by vibratory source

Patients with laryngotracheal stenosis often require airway reconstruction. Following surgical intervention, voicing may be produced with either a glottic or supraglottic vibratory source. The objective of this study was to compare average airflow, estimated subglottal pressure, and expert perceptual rating of strain between children with glottic and supraglottic vibratory sources post-airway reconstruction. This study was a non-randomized prospective study conducted at the Cincinnati Children's Hospital Medical Center (CCHMC), Center for Pediatric Voice Disorders, and included 12 participants with a diagnosis of subglottic stenosis, post-laryngotracheal reconstruction. Expert perceptual ratings of strain were significantly higher for participants with supraglottic versus glottic voicing (P = 0.0001). Although the mean airflow measure was higher for participants with glottic phonation and mean pressure measure was higher for those with supraglottic voicing, these comparisons failed to reach significance. Patients who exhibit supraglottic phonation patterns demonstrate greater strain during speech, as well as potential alterations to aerodynamic patterns. The significant differences in perceived strain by vibratory source are noteworthy, as perceptual quality is always a patient's motivation to seek treatment.

Lessons from a Successful Implementation of a Computerized Provider Order Entry System

The electronic health record (EHR) can improve patient safety, care efficiency, cost effectiveness and regulatory compliance. Cincinnati Children's Hospital Medical Center (CCHMC) has successfully implemented an Integrating Clinical Information System (ICIS) that includes Computerized Provider Order Entry (CPOE). This review describes some of the unanticipated challenges and solutions identified during the implementation of ICIS. Data for this paper was derived from user-generated feedback within the ICIS. Feedback reports were reviewed and placed into categories based on root cause of the issue. Recurring issues or problems which led to potential or actual patient injury are included. NINE DISTINCT CHALLENGES WERE IDENTIFIED: 1) Deterioration in communication; 2) Excessive system alerts to users; 3) Unrecognized discontinuation of medications; 4) Unintended loss of orders; 5) Loss of orders during implementation; 6) Amplification of errors; 7) Unintentional generation of patient care orders by system analysts; 8) Persistence of specific patient care order instructions; 9) Verbal orders entered under the incorrect clinician. Unanticipated challenges are expected when implementing EHRs. The implementation plan for any EHR should include methods to identify, evaluate and repair problems quickly. While continued challenges with this complex system are expected, we believe that the EHR will continue to facilitate improved patient care and safety. The lessons learned at CCHMC will permit other institutions to avoid some of these challenges and design robust processes to detect and respond to problems in a timely fashion to ensure implementation success.

Preparing Clinical Text for Use in Biomedical Research

Approximately 57 different types of clinical annotations construct a patient’s medical record. These annotations include radiology reports, discharge summaries, and surgical and nursing notes. Hospitals typically produce millions of text-based medical records over the course of a year. These records are essential for the delivery of care, but many are underutilized or not utilized at all for clinical research. The textual data found in these annotations is a rich source of insights into aspects of clinical care and the clinical delivery system. Recent regulatory actions, however, require that, in many cases, data not obtained through informed consent or data not related to the delivery of care must be made anonymous (as referred to by regulators as harmless), before they can be used. This article describes a practical approach with which Cincinnati Children’s Hospital Medical Center (CCHMC), a large pediatric academic medical center with more than 761,000 annual patient encounters, developed open source software for making pediatric clinical text harmless without losing its rich meaning. Development of the software dealt with many of the issues that often arise in natural language processing, such as data collection, disambiguation, and data scrubbing.

Better safe than sorry: one agency's successful safety and security strategies.

The Home Healthcare and Protective Services Departments of Cincinnati Children's Hospital Medical Center (CCHMC) pooled their expertise to develop a comprehensive safety and security program for the visiting clinical staff. This article describes the program, various training sessions and modules, and the escort program provided by the Protective Services officers.

Childhood injuries and deaths due to falls from windows

Unintentional injuries are the leading cause of death in children, and falls are the most common type of unintentional injury in the US. The incidence of falls from windows, a common cause of death in urban areas, has not been described outside major cities such as New York and Chicago, and rates in urban and suburban areas have not been compared. To estimate the incidence and identify the population at risk for falls from windows among children in Hamilton County, Ohio. Retrospective case series identified using Cincinnati Children's Hospital Medical Center (CHMC) Trauma Registry. Hamilton County, Ohio, which has urban and nonurban areas. Children less than 15 years old residing in Hamilton County, Ohio, presenting to CHMC in Cincinnati, Ohio, after a fall from a window between January 1, 1991, and December 31, 1997. Annual incidence by age, race, gender, and residence of those who fell from windows. Over the 7-year study period, 86 (6.3%) of 1,363 falls were from windows. The mortality rate for falls from windows was 4.7%, compared to 0.07% for all other falls presenting to CHMC (P<.0001). Children 0-4 years old had a higher rate of falls than children aged 5-14 (14.6/100,000 vs. 2.0/100,000) (P<.0001). Males were twice as likely to fall as females (P<.016), and black children were three times more likely to fall than non-black children (P<.002). The incidence of falls in the city of Cincinnati was four times that of the non-urban area (P<.0002). Injuries from falls from windows are a public health problem in Hamilton County, Ohio, especially for young, urban children.