General Paediatric Ward Research Articles

Hospitalization rate and costs in acute lymphoblastic leukemia of childhood in a low-income group: Financial impact in Northeast Mexico.

Acute lymphoblastic leukemia (ALL) is one of the main and most expensive and prolonged causes of hospitalization for childhood cancer. We describe the hospitalization rate and its costs for an open population with ALL in a low-middle income country. We retrospectively analyzed 449 hospital admissions for 101 pediatric patients with ALL over 8 years. Clinical files and electronic databases were scrutinized to document causes, duration, readmission rate, costs, and outcome of each admission. Hospitalizations were divided into two categories: general pediatric ward and pediatric intensive care unit (PICU). Hospitalization rates and its costs per patient were estimated considering person-time at risk. Patients had an admission rate of 2.09 hospitalizations per patient-year and median length of stay per admission was 5 days. Most admissions occurred during the first 2 years from diagnosis. Mean cost per day was 239 US dollars (USD) and mean cost per stay was 2,246 USD versus 1,016 and 19,004 USD (P = 0.001) in the PICU, respectively. Total hospitalization cost per patient per year (PPPY) was 5,991 USD for high-risk patients and 3,038 USD for standard-risk patients. Patients between ages 1 and 9 years had a PPPY cost of $4,057; while for children younger than 1 year or older than 9 years, it was 7,463 USD. The popular medical insurance program covered 70% of hospitalizations and 63% of its total cost; patients contributed 2%, with the hospital absorbing 35%. Hospitalizations for children with ALL were less expensive than in high-income countries but had a significant cost to low-income families and to the healthcare system.

Próba wykorzystania „Małego Międzynarodowego Kwestionariusza Neuropsychiatrycznego dla Dzieci i Młodzieży (MINI Kid)” w celu oceny częstości występowania zaburzeń psychicznych u pacjentów oddziałów dziecięcych

IntroductionInterviews used for scientific purposes constitute a diagnostic tool intended for studies both of adults and kids. Structured interviews constitute a tool characterised by high inter-rater reliability and test-retest reliability. Goal of the studiesAnalysis of the frequency of occurrence of mental disorders in children aged 14−17 subject to inpatient stay due to various paediatric reasons and evaluation of the usefulness of the “Mini-International Neuropsychiatric Interview for Kids” in detecting mental disorders in children. MethodStudies over adolescents made use of the Mini-International Neuropsychiatric Interview for Kids, which is a fully structured tool covering 25 mental disorders. The study covered a group of 106 patients of General Paediatric Wards −79 girls and 27 boys. ResultsThe frequency of mental disorders in the studied group amounted to 41.5% (44.3% girls; 33.3% boys). Concomitance of at least two mental disorders was confirmed in 42% of the patients with the diagnosis in the interview. Statistical analysis showed a relationship between more frequent occurrence of mental disorders among the adolescents and low birth weight, being raised by a mother and a stepfather or guardians not being biological parents. A relationship between more frequent occurrence of mental disorders among the youth and the age and education of the parents, the number of siblings was not proven. ConclusionsThe frequency of diagnosing mental disorders with the use of MINI Kids in adolescents subject to inpatient stay due to paediatric reasons reaches 41%. Each patient with diagnosed mental disorder with the use of the MINI Kids should be subject to psychiatric/psychological examination to verify the diagnosis. MINI Kids is an easy and simple tool for screening assessment of the occurrence of mental disorders among children and should be applied in hospital practice to assess the risk of mental disorders in children.

General paediatric inpatient deaths over a 15-year period.

To retrospectively review trends of general paediatric inpatient deaths at a tertiary care children's hospital over a 15-year period. Data were collected for all patients who died on the general paediatric wards or paediatric intensive care unit (PICU) during 1998, 2005 or 2012 and had a 'general paediatric condition'-an underlying condition or diagnosis that would normally result in admission to a general paediatric ward. Data were related to: demographics, health services utilization, information about provision and orders related to cardiopulmonary resuscitation (CPR) at time of death and involvement of palliative care services. Eighty-five inpatients met inclusion criteria: 35 in 1998, 27 in 2005 and 23 in 2012. Nearly 95% of general paediatric patients who died in 1998 did so in the PICU, 59.3% in 2005 and 69.6% in 2012. The median age of death decreased from 3 years in 1998 to 2 years in 2012. The proportion of patients with 'no CPR' orders at time of death increased from 31.4% in 1998 to 87.0% in 2012. Similarly, the proportion of patients with palliative care team involvement prior to death increased from less than 10% in 1998 to 73.9% in 2012. The absolute number of inpatient general paediatric deaths has decreased from 1998 to 2012 at this hospital. A larger proportion of these deaths are occurring on the general paediatric wards rather than in the PICU over time. 'No CPR' orders and palliative care consultations are becoming more prevalent in these patients prior to death.

Paediatric in-patient prescribing errors in Malaysia: a cross-sectional multicentre study.

Background There is a lack of large comprehensive studies in developing countries on paediatric in-patient prescribing errors in different settings. Objectives To determine the characteristics of in-patient prescribing errors among paediatric patients. Setting General paediatric wards, neonatal intensive care units and paediatric intensive care units in government hospitals in Malaysia. Methods This is a cross-sectional multicentre study involving 17 participating hospitals. Drug charts were reviewed in each ward to identify the prescribing errors. All prescribing errors identified were further assessed for their potential clinical consequences, likely causes and contributing factors. Main outcome measures Incidence, types, potential clinical consequences, causes and contributing factors of the prescribing errors. Results The overall prescribing error rate was 9.2% out of 17,889 prescribed medications. There was no significant difference in the prescribing error rates between different types of hospitals or wards. The use of electronic prescribing had a higher prescribing error rate than manual prescribing (16.9 vs 8.2%, p<0.05). Twenty eight (1.7%) prescribing errors were deemed to have serious potential clinical consequences and 2 (0.1%) were judged to be potentially fatal. Most of the errors were attributed to human factors, i.e. performance or knowledge deficit. The most common contributing factors were due to lack of supervision or of knowledge. Conclusions Although electronic prescribing may potentially improve safety, it may conversely cause prescribing errors due to suboptimal interfaces and cumbersome work processes. Junior doctors need specific training in paediatric prescribing and close supervision to reduce prescribing errors in paediatric in-patients.

Pediatric antibiotic stewardship: successful interventions to reduce broad-spectrum antibiotic use on general pediatric wards.

Antibiotic stewardship programs (ASP) optimize antibiotic usage and combat antibiotic resistance of bacteria. The objective of this study was to assess the impact of specific ASP interventions on antibiotic consumption in general pediatric wards. We conducted a prospective study to compare a pre-intervention (Sept.-Dec. 2014) and post-intervention (Sept.-Dec. 2015) period. An ASP bundle was established including (1) infectious diseases (ID) ward rounds (prospective-audit-with-feedback), (2) ID consultation service, (3) internal guidelines on empiric antibiotic therapy. Medical records on four general pediatric wards were reviewed daily to analyze: (1) antibiotic consumption, (2) antibiotic dosage ranges according to local guidelines, and (3) guideline adherence for community-acquired pneumonia (CAP). Antibiotic prescribing for 273 patients (pre-intervention) was compared to 263 patients (post-intervention). Antibiotic prescription rate did not change (30.6 vs. 30.5%). However, overall days-of-therapy and length-of-therapy decreased by 10.5 and 7.7%, respectively. Use of cephalosporins and fluoroquinolones decreased by 35.5 and 59.9%, whereas the use of penicillins increased by 15.0%. An increase in dosage accuracy was noted (78.8 vs. 97.6%) and guideline adherence for CAP improved from 39.5 to 93.5%. Between the two study periods, no adverse effects regarding length of hospital stay and in-hospital mortality were observed. Our data demonstrate that implementation of an ASP was associated with a profound improvement of rational antibiotic use and, therefore, patient safety. Considering the relatively short observation period, the long-term effects of our ASP bundle need to be further investigated.

Clinical Outcomes of Bronchiolitis After Implementation of a General Ward High Flow Nasal Cannula Guideline.

The goal of this study was to assess the association of the introduction of a ward's high-flow nasal cannula (HFNC) guideline with clinical outcomes of infants with bronchiolitis. We conducted a retrospective, pre-post intervention study with an interrupted time series analysis of infants admitted with bronchiolitis between 2010 and 2014 at an urban, tertiary care children's hospital. Patients admitted in the 24 months before and after initiation of a guideline for HFNC use on the general wards were compared. The primary outcome was length of hospital stay. Secondary outcomes were PICU transfer rate and length of stay, intubation rate, and 30-day readmission, adjusted for season. A total of 1937 patients met inclusion criteria; 936 were admitted before and 1001 admitted after the introduction of HFNC use on the general wards. Comparing the 2 groups, the hospital-wide rate of HFNC use in bronchiolitis treatment increased after HFNC became available on the wards (23.9% vs 35.2%; P < .001). The ward's HFNC guideline was not associated with a change in preintervention trajectory of total hospital length of stay (P = .48), PICU length of stay (P = .06), or rate of PICU transfer (P = .97). There was also no difference in intubation rate or 30-day readmission between the 2 groups. Initiating a guideline for HFNC use on the general pediatric wards was associated with an increase in the use of the intervention with no significant change in total hospital length of stay, PICU length of stay and transfer rate, intubation rate, or 30-day readmission for patients with bronchiolitis.

Incidence and pattern of medication errors in a general paediatric ward in a developing nation.

Incidence and pattern of medication errors in a general paediatric ward in a developing nation.

Pattern of Admissions in the Department of Pediatrics at Benha Teaching Hospital, Egypt

Objectives: To determine pattern of admissions and to study the types of illness and their outcomes in relation to disease at General Pediatric Ward at Benha Teaching Hospital (BTH). Subjects and Methods: This study was a retrospective study. The study was conducted from 1st of May 2016 until end of December 2016. The study was done in the General Pediatric Ward at Benha Teaching Hospital (BTH). The medical record of all admissions searching for age, gender, address, mode of admission, referral source, duration of hospital stay and outcome. Results: Mean + SD of Duration of stays in days was (7.90 + 4.07). 28.2% of patients were admitted due to respiratory system related causes, 32.4% due to digestive system related causes, 6.5% due to cardiac system related causes, 6.5% due to neurological system related causes ,1.2% due to hepatic system related causes, 5.9% due to nutritional system related causes, 14.7% due to renal system related causes, 4.7% due to endocrinal system related causes. Conclusions: This study gives an overview of the pattern of Pediatric Medical admissions, catchment area and referral mode. The findings of this study increased the understanding of admission trends, referral area and source. Admissions load mainly contributed by under five years children with infection and they are directly approaching the Hospital.

Consistent Differences between Wound Culture and Osteoarticular Infection Staphylococcus aureus Susceptibilities and Institutional Antibiograms at a Children’s Hospital

BackgroundAggregate hospital and unit-based antibiograms guide empiric antibiotic decision making but may not best inform the microbiology of certain important presentations. In this analysis, Staphylococcus aureus (SA) susceptibilities specifically from wound specimens and in acute osteoarticular infections (OAI) were compared with available antibiograms at a freestanding children’s hospital.MethodsEncounter, billing, and electronic microbiology surveillance data were utilized to identify SA wound cultures and acute OAI (osteomyelitis and septic arthritis) cases at Women and Children’s Hospital of Buffalo, from 2013 to 2016. OAI cases’ medical records were reviewed to ensure diagnostic accuracy. SA wound and OAI specific data were tabulated and compared with published institutional antibiograms. General pediatric locations were defined as community clinics, the emergency room, and general pediatric wards, with intensive-care and oncology units excluded.ResultsSignificant discordance existed between general pediatrics SA susceptibilities in the aggregate antibiograms, with both wound cultures and OAI cases, for all 4 years: Figures 1 and 2. The proportion of SA that was methicillin-susceptible (MSSA) was consistently higher in wound specimens than in aggregate data (e.g., 63% vs. 53% in 2016; p≤ 0.01), and is increasing: 63% in 2015–16 vs. 53% in 2013–14, p ≤0.01. Clindamycin (clinda) susceptibility for all SA (MSSA + MRSA) was higher in wound cultures than aggregate data, 89% vs. 82% for 2013–2015 (p ≤ 0.01). For OAI cases, the proportion of MSSA was consistently ~20% higher than in aggregate data (2016: 79% vs. 53%, P = 0.05), and clinda susceptibility for all SA in this group appears to be decreasing: 83% in 2015–16 vs. 96% in 2013–14, P = 0.13.ConclusionWhile our institutional antibiograms created uncertainty, a wound culture review indicated that clinda remains an appropriate empiric choice for community-onset skin and soft-tissue infections. Conversely, an OAI specific analysis revealed a predominance of MSSA and higher rates of clinda-resistant SA, leading us to reappraise the empiric use of clinda in this subset. Pediatric facilities should emphasize stratified, specimen and clinical-context specific—rather than aggregate—antibiograms, especially for SA.Disclosures All authors: No reported disclosures.

Age is associated with latent tuberculosis in nurses

ObjectiveTo evaluate risk factors for developing latent tuberculosis (LTB) in Thai nurses. MethodsA comparison study was conducted at Srinagarind Hospital, Khon Kaen, Thailand. Clinical factors were compared between persons with tuberculin conversion and those without tuberculin conversion identified by tuberculin skin test. ResultsThere were 173 eligible persons with the LTB (34.7%). There were five workplaces where participants worked regularly including the general ward, surgical ward, pediatric ward, medical ward and critical care ward. In a multivariate model, two factors were significantly associated with LTB including age and history of tuberculosis in colleagues. The adjusted odds ratio (95% confidence interval) of both variables were 1.056 (1.004–1.104) and 0.202 (0.044–0.941). ConclusionsOlder age is associated with latent tuberculosis in nurses. LTB should be screened routinely and treated if diagnosed for nurses.

Use of Hypotonic Maintenance Intravenous Fluids and Hospital-Acquired Hyponatremia Remain Common in Children Admitted to a General Pediatric Ward.

To evaluate maintenance intravenous fluid-prescribing practices and the incidence of hospital-acquired hyponatremia in children admitted to a general pediatric ward. This is a prospective observational study conducted over a 2-month period in children ages 2 months to 5 years who were admitted to a general pediatric ward and who were receiving maintenance intravenous fluids. The composition, rate, and duration of intravenous fluids were chosen at the discretion of the treating physician. Serum biochemistries were obtained at baseline and 24 h following admission. Patients who were at high risk for developing hyponatremia or hypernatremia or had underlying chronic diseases or were receiving medications associated with a disorder in sodium and water homeostasis were excluded. Intravenous fluid composition and the incidence of hyponatremia (sodium <135 mEq/L) were assessed. Fifty-six children were enrolled. All received hypotonic fluids; 87.5% received 0.18% sodium chloride (NaCl) and 14.3% received 0.45% NaCl. Forty percent of patients (17/42) with a serum sodium (SNa) less than 140 mEq/L experienced a fall in SNa with 12.5% of all patients (7/56) developing hospital-acquired or aggravated hyponatremia (126-134 mEq/L) with fall in SNa between 2 and 10 mEq/L. Administration of hypotonic fluids was a prevalent practice in children admitted to a general pediatric ward and is associated with acute hospital-acquired hyponatremia.

ASSESSING PHARMACEUTICAL CARE NEEDS OF PAEDIATRIC IN-PATIENTS: A TEAM BASED APPROACH

AimsTo pilot a novel approach to providing pharmaceutical care to paediatric inpatients using structured referral and assessment tools. Using standardised referral criteria to ensure patients are assessed by appropriately skilled...

INHALER COUNSELLING, THE REAL DEAL OR JUST FRESH AIR?

AimTo evaluate whether healthcare professionals within the local community are able to counsel paediatric patients on the essential steps required for drug delivery with multi-dose inhalers (MDI), MDIs with a...

A REALLY WHEEZY WAY TO SAVE MONEY

AimTo compare the palatability of oral non-soluble and oral soluble prednisolone tablets in paediatric patients admitted to the general paediatric wards in an acute London Trust.MethodAs part of ongoing quality...

My non-verbal communication skills made a big difference

Towards the end of the second year of my child nursing degree, I worked on a general paediatric ward. One day a teenage girl was admitt ed with high blood glucose levels.

The financial burden of malnutrition in hospitalized pediatric patients under five years of age

BackgroundUnder-five children are a medically fragile group which is compromised by hospitalization. Malnutrition in those patients not only increases complications and mortality but also affects hospital resource utilization. Therefore, this study was conducted to clarify the impact of malnutrition on hospital expenditures. MethodsThis prospective cohort study was performed at a tertiary hospital in Thailand. Under-five children who were admitted to general pediatric wards were included. Demographic data, the length of stay (LOS), and anthropometric measurements at admission were recorded. The classification of wasting and stunting were defined according to the World Health Organization (WHO) classification. Moreover, all hospital expenses were calculated directly based on the actual billing including the total hospital cost, cost of bed, enteral formula, medications, medical apparatus and procedures, nursing care, investigations and surgery. ResultsOne-hundred and five patients with a mean age of 26.8 ± 1.8 months were included. The majority of them were males (61%) with the leading cause of infectious disease. According to the prevalence of malnutrition, the percentage of patients who had only stunting or wasting were 24.8% and 10.5%, respectively while 15.2% of all patients had both stunting and wasting. Regardless of stunting, the wasting patients had a significantly higher cost of bed, enteral formula, nursing care, and medical apparatus. Particularly, the highest costs of all expenditures including the total hospital cost were found in patients who were both stunted and wasting. Apart from the financial burdens, the wasting patients stayed longer in the hospital and the LOS also significantly correlated with the total hospital cost (r = 0.84, p = 0.01). ConclusionsThe present study underscores the high prevalence of malnutrition in under-five pediatric patients. The malnourished patients, in particular the wasting group, had longer LOS and consequently had increased hospital expenses.

Cerebral function monitoring on a general paediatric ward: feasibility and potential.

Cerebral function monitoring is widely used in neonatal intensive care, but its potential role in assessment of older infants is scarcely reported. We reviewed the use of cerebral function monitoring on a general paediatric ward in a series of young infants admitted with abnormal movements. Review of the amplitude-integrated EEG obtained by cerebral function monitoring revealed electrographic seizures in four of seven infants monitored. We also surveyed general paediatric wards in hospitals in our region of the UK to ask about current use of cerebral function monitoring and local availability of formal electroencephalography services. Cerebral function monitoring was not being used in the 16 other paediatric departments surveyed, and there was very limited provision for obtaining a full-array electroencephalogram out-of-hours. With adequate training and education, it is feasible to undertake cerebral function monitoring on a general paediatric ward. Continuous cerebral function monitoring is a tool that has potential use for detecting clinical seizures and augmenting clinical neuro-observations of young children admitted to a general paediatric ward. • In intensive care settings, cerebral function monitoring (CFM) has long been used for the continuous bedside monitoring of brain function in critically ill neonates, children and adults. • Very few studies have looked at the use of CFM outside of the intensive care setting, and it is presently unclear if CFM is used in the general paediatric ward. What is new: • CFM is presently not widely used in the general paediatric setting. • With appropriate training and support, CFM can be successfully introduced to the general paediatric ward with the potential to enhance the clinical monitoring of young infants admitted with abnormal movements.

Morbidity and mortality pattern among neonates admitted to the general paediatric ward of a secondary health care centre in the Niger delta region of Nigeria

Introduction: In Nigeria’s public hospitals, facilities for specialized neonatal care are few and available only in tertiary hospitals. However a greater number of neonates are delivered at the primary and secondary health care centres where these facilities are lacking. Thus, sick newborns are managed in the general paediatric ward along with other children and there is a likelihood of increased mortality in this group of neonates compared to those managed in standard neonatal units. Objective: To determine the morbidity and mortality pattern among neonates admitted to a general paediatric ward of a secondary health care facility. Method: This was a prospective cross sectional study of neonatal admissions and mortalities from January 2012 to December 2013. Result: A total of 655 neonates were admitted during the study period of which 68 were excluded. Of the 587 neonates analysed. 360 were males. The leading causes of admissions were neonatal sepsis, prematurity, perinatal asphyxia, haemorrhagic disease of the newborn and neonatal jaundice. There were 122 (20.3%) deaths with a male: female ratio of 1.7:1. Neonatal jaundice, prematurity and birth asphyxia had the highest case fatality rate. Conclusions: There were 20.3% deaths. The leading causes of admissions were neonatal sepsis, prematurity, perinatal asphyxia, haemorrhagic disease of the newborn and neonatal jaundice. DOI: http://dx.doi.org/10.4038/sljch.v45i2.7981 (Key words: Neonate, mortality, general paediatric ward)

Ward Rounds With or Without an Attending Physician: How Interns Learn Most Successfully

ObjectiveTo explore pediatric interns' perspectives on the educational value of general pediatric ward rounds, in particular their rounding experiences with and without an attending physician. MethodsQualitative study using individual interviews of pediatric interns (2013–2014) rotating on 2 general pediatric inpatient services at different institutions with different rounding team structures. In accordance with grounded theory methodology, data were analyzed using the constant comparative method. Codes were built using an iterative approach and organized into themes. ResultsTwenty pediatric interns participated in 25 interviews. Data analysis yielded 4 themes: what is being learned; learning environment on rounds; learning and work; and ways of learning. Senior residents generally taught practical aspects of patient care and attending physicians taught broader concepts with references to the medical literature. Rounds without an attending physician were perceived as less formal and promoted collaborative discussions with senior residents. Interns were more uncomfortable during rounds with an attending physician but appreciated how that facilitated their learning. Although patient care tasks provided opportunities for experiential learning, interns frequently perceived them to impede learning during rounds. Intern learning during ward rounds occurred via self-directed learning, interactive learning, and through caring for patients. Brief, clinically relevant teaching pearls and questioning clinical reasoning in a respectful manner were helpful. ConclusionsInterns learn different content and learn in different ways depending on the presence or absence of an attending physician at rounds. There might be educational value from rounding with teams that include and do not include an attending physician.

Brucellose : revue de la littérature à propos d’un cas pédiatrique

Brucellosis is an overlooked infection of widespread geographic distribution. This disease is rarely evoked when assessing unexplained pediatric fever, and only 20-30 cases (children and adults) are confirmed per year. Risk factors for contracting brucellosis are exposure to bodily fluids and consumption of unpasteurized dairy products from infected animals. Most cases of brucellosis are associated with traveling to or importing contaminated goods from endemic areas. Here, we report a case of brucellosis in a 16-month-old patient hospitalized for an acute febrile illness in a French general pediatric ward. An antibiotic regimen of rifampicin and co-trimoxazole given over 6 weeks led to successful cure without relapse. The child had eaten a cake made from unpasteurized goat's milk and imported from Oran, a region in Algeria. His mother had consumed the same cake and was hospitalized for brucellosis 15 days later. Clinicians should suspect brucellosis when encountering febrile patients who have traveled to endemic areas, been exposed to body fluids or products of abortion of farm animals, or consumed unpasteurized products.