Pediatric Care Unit Research Articles

Primary care pediatricians and job satisfaction: a cross sectional study in the Lazio region

BackgroundThe Order of Physicians and Dentists of the Province of Rome aims at focusing on the satisfaction of healthcare personnel as an essential factor for the quality of medical care in the health sector. The aim of this study is to assess and prioritize the factors that can be linked to a higher or lower degree of job satisfaction in Primary Care Pediatricians (PCPs).MethodsThis study is a cross sectional survey. A questionnaire was administered to all primary care pediatricians registered to the Order, exploring in particular the work activity organization, the level of satisfaction in their professional life, and the level of perceived health. A pilot activity was conducted to validate the questionnaire. Fisher exact test and ordinal logistic regression (ologit) models were used for the univariate and multivariate analysis.ResultsThe highest level of job dissatisfaction, in both men and women, was found to be in the practice type without any form of association; among women, it reached an even higher level for those who had their own practice at a distance of 20–40 km from their home. Women, compared to men, maintained a lower level of job satisfaction also while working in Pediatric Primary Care Units (PPCUs). In PPCUs, for the same distance, females showed a more similar pattern to males. Men working in PPCUs, regardless of distance, declared a higher degree of job satisfaction. Both men and women, working as a group pediatrician or in PPCUs, did not show a significant difference in the level of job satisfaction.ConclusionsThe study contributes to a deeper understanding of the factors that may influence levels of career satisfaction in female and male PCPs. Therefore, research and interventions regarding job satisfaction should foster an organizational network connection among PCPs for their job and individual well-being, from a perspective of enhancing patient care. A major effort to improve work-life balance and career satisfaction among women is important, suggesting that interventions for improving job satisfaction could benefit from a gender-specific approach.

Sustainability of an Operating Room to Pediatric Postanesthesia Care Unit Handoff Tool

The purpose of this quality improvement (QI) project was to reintroduce and assess the feasibility of a standardized, electronic health record (EHR) handoff tool and to evaluate the sustainability of a structured, team-based approach in a pediatric postanesthesia care unit (PACU). This QI project used an observational pre-post design using two separate convenience samples of handoffs and perianesthesia providers. A standardized EHR handoff tool was reintroduced for operating room to pediatric PACU handoff communication. Handoffs between anesthesia providers, surgery team members, and PACU nurses were observed pre- and postreintroduction of the EHR handoff tool. Anesthesia providers and PACU RNs received training for giving and receiving handoffs and were provided directions on locating the EHR handoff tool. A bedside audit of items communicated for the six handoff phases (introductions, situation, background, assessment, recommendations, and questions), handoff duration, team member participation, and handoff tool utilization were performed for 149 handoffs pre- and 146 handoffs postimplementation. To evaluate sustainability, the audits were compared to postimplementation data from the 2014 pilot handoff project. Following reintroduction, EHR handoff tool use increased from 4% to 19%. There was a statistically significant increase in items communicated for three of the six handoff phases when using the EHR tool (P < .05). There was no statistically significant increase in handoff duration (mean=3.66 minutes, SD=1.57 minutes) with the EHR handoff tool. Surgical team member presence for the team-based handoff increased from 90.7% pre to 95.9% post. Provider compliance with the team-based handoff approach, which includes a PACU RN, surgical team member, and anesthesia team member present for handoff, was sustained and increased 6 years postimplementation. Feedback from anesthesia providers and PACU RNs indicated mixed reports of satisfaction with the EHR tool, perceived handoff efficiency, and consistency in both giving and receiving handoff. Adherence to five of the six structured handoff phases, except introductions, was sustained and even improved 6 years following implementation. Evidence-based practice for handoff communication supports the use of a team approach and standardized EHR handoff tools. The reintroduction of a standardized EHR handoff tool improved the completeness of information transfer, yet did not lead to widespread adoption nor improved user satisfaction. There is an ongoing need to identify adoptable and sustainable perioperative handoff methods.

Evaluation of a Standard Handover Tool at a Pediatric Tertiary Care Unit in Oman.

Background The handover system is a great communication tool physicians use to transfer and receive patients' care-related information. The introduction of structured handover tools has resulted in a dramatic reduction in hospital-acquired injuries. We hypothesize that the I-PASS handover tool will improve both written and verbal communication without compromising the handover duration. The current study aims to improve the quality of care and patient safety by evaluating the applicability of I-PASS handover in the Child Health Department at Sultan Qaboos University Hospital, Oman. Results A total of 20 trainees were enrolled in this study.After the implementation of I-PASS, 70% (14/20) of the respondents thought that the handover was well-structured, compared to 30% (6/20) prior to the implementation of I-PASS (P = .003). Due to I-PASS, about 80% of the participants could identify deteriorating patients and around 60% were confident in addressing emergencies. The I-PASS handover technique has raised participants' satisfaction from 80% to 95%. Before I-PASS, the mean adherence rate across all 10 variables was 28.7/50 (57.4%), compared to the post-I-PASS rate of 47/50 (94%). Conclusion The I-PASS system is a feasible and flexible clinical handover tool. This study showed that I-PASS has improved on-call handovers and patient safety.

Severe acute malnutrition among infants under 6 months of age in the teaching hospital of Borgou / Alibori in Northen Benin

Background: Acute malnutrition in infants under six months is a scourge that is little studied in relation to the global problem of child malnutrition. This paper aims to describe the sociodemographic, clinical, therapeutic, and outcome features of this phenomenon in the Teaching Hospital of Borgou /Alibori based in Parakou in northern Benin. Patients and methods: This was a two years case-control retrospective and descriptive study carried out in the pediatric care unit of the said hospital from January 1, 2016, to December 31, 2018. It included infants aged 1 to 6 months presenting with severe acute malnutrition defined according to the WHO criteria. Variables investigated were sociodemographic, clinical, therapeutic, and outcome-related. Results: Total of 78 out of 508 infants less than 6 months of age were severely malnourished (5.35%). Their mean age was 4.65 months±1.28. Contributory factors were early dietary diversification (69.2%), and maternal death (14.1%). Marasmus and kwashiorkor were their clinical expressions. Associated complications were gastrointestinal infections (38.5%), septicemia (17.9%), and HIV infection (5.1%). Diluted F-100 was the most used therapeutic food (46.1%) with a recovery rate estimated at 41% and mortality at 19.3%. Conclusion: Severe acute malnutrition in infants under six months of age is real and it involves three out of twenty infants admitted to the hospital. In-hospital mortality is significant. It is urgent to review the policies related to exclusive breast feeding promotion.

Understanding the effects of overnight vital signs monitoring on sleep duration and disruptions in hospitalized children: A scoping review

ProblemOvernight vital signs are typically taken every four hours on pediatric acute care units, despite limited evidence supporting the efficacy of this practice. Vital signs are often ordered and collected without considering the patient's clinical status or potential impact that they may have on sleep. We sought to understand the impact that overnight vital sign monitoring has on sleep duration and disruptions among hospitalized children in an acute care setting. Eligibility criteriaWe conducted a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols extension for scoping reviews (PRISMA-ScR). Studies were included if they addressed the relationship between vital signs monitoring and sleep among children hospitalized in an acute care unit. SampleEleven studies from 2012 to 2022 were included in the final review. ResultsVital signs monitoring is the most common sleep disruptor among hospitalized children in acute care units and early evidence suggests that minimizing overnight vital signs may be a safe intervention for clinically stable children. Methods for measuring sleep duration and disruptions are heterogenous and validated tools are not often used. Finally, nurses report comfort with forgoing overnight vital signs when their patient's clinical status is stable. ConclusionDespite a lack of evidence regarding the efficacy of every 4 h vital signs, overnight vital signs monitoring is consistently the greatest disruptor to sleep for hospitalized children. ImplicationsNurses should play a central role in guiding vital signs monitoring that maintains safety and improves sleep in hospitalized children.

Understanding pediatric palliative care within interdisciplinary palliative programs: a qualitative study

PurposeTo describe the process of delivery of pediatric palliative care from the perspective of a pediatric interdisciplinary team and the children’s parents.MethodsA qualitative descriptive case study was conducted. Purposeful sampling took place within a specialized pediatric palliative care Unit in Madrid (Spain), located at the Niño Jesus Hospital. The study participants included a specialized pediatric palliative care team from Madrid's pediatric palliative care program, other professional teams involved in interdisciplinary care and parents of children under pediatric palliative care. Data were collected via semi-structured interviews, focus groups and researchers’ field notes. A thematic analysis was performed.ResultsThis study included 28 participants (20 women, 8 men), of whom 18 were professionals who belonged to the pediatric palliative care interdisciplinary team, 4 professionals were from other units that collaborated with the pediatric palliative care, and 6 were parents (5 women, 1 man). The mean age of the pediatric palliative care members was 38.2 years (SD ± 7.9), that of the collaborating professionals was 40.5 (SD ± 6.8), and that of the parents was 44.2 (SD ± 5.4). Two main themes emerged: a) Pediatric palliative care has a distinct identity, associated with life. It represents the provision of special care in highly complex children, in the context of the home, far from the hospital environment; b) The team is key: its interdisciplinary organization provides a more comprehensive view of the child and their family, fosters communication among professionals, and improves coordination with other services involved in the care of children. The mindset shift experienced by ID-PPC professionals towards a palliative approach makes them more sensitive to the needs of their patients and leads them to develop specific skills in areas such as communication, decision-making, and adaptability that were identified as differentiating aspects of pediatric palliative care.ConclusionsDescribing pediatric palliative care from the professional and parental perspective helps to establish realistic and comprehensive goals for the care of children and their parents. The findings of this study may help with the establishment of a pediatric palliative care team, as a necessary organizational change in a health care system that cares for children with complex and life-threatening conditions. Promoting training in pediatric palliative care, prioritizing more horizontal organizations, providing tools and spaces for coordination and communication between professionals from different services, together with the creation of a position of case coordinator in the care process of children could enhance the understanding of pediatric palliative care services.

Pyomyositis associated with abscess formation caused by streptococcus pneumoniae in children: a case report and review of literature

BackgroundPyomyositis is an unusual bacterial infection but potential severe in children. Staphylococcus Aureus is the main caused of this disease (70–90%), following by Streptococcus Pyogenes (4–16%). Streptococcus Pneumoniae rarely caused invasive muscular infections. We describe a case of pyomyositis caused by Streptococcus Pneumonia in an adolescent 12-year-old female.Case presentationI.L. referred to our hospital for high fever associated with right hip and abdominal pain. The blood exams showed increase of leukocytes with prevalence of neutrophils with high level of inflammatory markers (CRP 46,17 mg/dl; Procalcitonin 25,8 ng/ml). The abdomen ultrasonography was unremarkable. The CT and MRI of the abdomen and right hip revealed pyomyositis of the iliopsoas, piriformis and internal shutter associated with collection of pus between the muscular planes (Fig. 1). The patient was admitted to our paediatric care unit, and she was initially treatment with intravenous Ceftriaxone (100 mg/kg/day) and Vancomycin (60 mg/kg/day). On day 2, a pansensitive Streptococcus Pneumoniae was isolated from the blood culture, and the antibiotic treatment was changed to only IV Ceftriaxone. She was successively treated with IV Ceftriaxone for 3 weeks, then continued with oral Amoxicillin for a total of 6 weeks of therapy. The follow up showed a complete resolution of the pyomyositis and psoas abscess after 2 months.ConclusionPyomyositis associate with abscess is a rare and very dangerous disease in children. The clinical presentation can mimic symptoms of other pathologies like osteomyelitis or septic arthritis, so many times is hard to identify. The main risk factors include story of recent trauma and immunodeficiency, not present in our case report. The therapy involves the antibiotics and, if possible, abscess drainage. In literature there is much discussion about duration of antibiotic therapy.

The new Italian registry of infantile thrombosis (RITI): A reflection on its journey, challenges and pitfalls.

Thrombotic events in neonates and children represent a rare although severe occurrence in view of the associated risk of mortality and sequelae. Quality evidence is limited in this field, and registry studies provide an essential base for research. The aim of this paper is to present the new Italian Registry of Infantile Thrombosis (RITI), set it into the scene of international thrombosis and stroke registries, and provide some insight on the challenges associated with registry management. We present the detailed structure and content of the new RITI registry, a brief overview of its main data, and a reflection on its features, pitfalls and the main challenges related to its management. The RITI, initially started in 2007 and officially re-launched in 2017 after structural modifications, is a non-interventional retrospective and prospective registry study collecting data on neonatal and pediatric patients (0-18 years) who experienced a systemic or cerebral thrombotic event in Italy. The RITI is managed by a multidisciplinary team with expertise in pediatric thrombosis, and participation is open to all Italian physicians, on a voluntary basis. The overall aim of the registry is to acquire new evidence to better characterize the population of children with thrombotic events and improve their management and outcome. 48 Italian pediatric and intensive care units are actively involved in the RITI, including 85 medical doctors from 16 Italian regions. A total of 1,001 neonates and children affected by cerebral or systemic thrombosis have been enrolled. The RITI is one of the largest available European registries of neonatal and pediatric thrombosis. National registries like the RITI represent a model for the study of rare conditions based on multidisciplinary and multicenter collaboration, aimed at overcoming the limitations due to small populations of patients, and creating a network of experts for patient referral and continuous education. Moreover, registry studies have a pivotal role in the research on pediatric thrombosis, due to the limited feasibility of high-quality studies. In our experience, the main critical stages, pitfalls and challenges in registry management include adequate registry designing, diffusion, data completeness and quality control.

Home care needs of paediatric palliative patients perceived by professionals: A grounded theory

ObjectiveTo explore the elements involved in the process of paediatric palliative home care in the Spanish context according to the opinion of professionals. MethodQualitative study based on Grounded Theory, adjusted to COREQ standards, using theoretical sampling with in-depth interviews (June 2021–February 2022) with paediatricians, paediatric nurses and social workers from paediatric palliative care units in Spain, excluding professionals with less than 1 years’ experience. Interviews were recorded and transcribed literally for coding and categorisation through a constant comparative process of code co-occurrence until data saturation using Atlas-Ti®. The anonymity of the informants has been guaranteed by using pseudonyms after approval by the Research Ethics Committee of the Hospital Universitario de Gran Canaria Doctor Negrín (Las Palmas, Canary Islands) with registration number 2021-403-1. Results18 interviews were conducted and 990 quotes were grouped into 22 categories of analysis and structured into four thematic groups (care, environment, patient and family, and professionals). The findings showed a holistic view emphasising the need to organise and integrate the factors involved in the home-based approach to paediatric palliative home care. ConclusionsIn our context, the home environment meets appropriate conditions for the development of paediatric palliative care. The categories of analysis identified establish a starting point for further deepening the approach from the thematic areas involved: care, the environment, the patient and family, and professionals.

Practical guideline for setting up a comprehensive pediatric care unit for critical care delivery at district hospitals and medical colleges under ECRP-II

Pediatric critical care is highly sophisticated and precise and is possible only in specialized areas such as pediatric intensive care units (PICUs) or high dependency units equipped with round-the-clock monitoring facilities, skilled and trained staff, and treatment equipment. The need for critical care beds was sharply felt during the COVID-19 pandemic and the Government of India launched the COVID-19 emergency response and health system preparedness package: phase II (ECRP-II) with a hub and spoke model to strengthen pediatric critical care delivery at district level under the skilled supervision of state-level PICUs of the identified center of excellence (CoE). The CoEs will have well-equipped PICUs providing tele-ICU service, mentoring, and technical hand-holding to the district pediatric unit. This model was envisioned to be extended to critically ill children with nonCOVID illnesses after the pandemic abates. For achieving the proposed objectives under the ECRP-II scheme, this guideline aims to provide a practical framework for setting up comprehensive pediatric care units at district hospitals and medical colleges (spoke) well connected with a CoE (hub) for teleconsultation, knowledge exchange, referral, and back referral between hub and spokes.

Increasing capacity in acute day care settings: patients' experiences of a pop-up day care unit

The unit operated fortnightly between December 2020 and March 2021. Family feedback on the service was collated via an online survey. 72 respondents found NHB acceptable; 70 (97%) would be happy to return; 63 (90.3%) preferred the NHB to attending Bristol Royal Hospital for Children or had no preference for their appointments. Positive comments focused on service organisation and clinical environment. Families valued the availability of the close, free parking. The minimal negative comments related to travel directions, lack of catering facilities and the small number of toilets. The pop-up service model was highly acceptable to families. This highlights the need for appropriate hospital services to explore similar initiatives beyond traditional healthcare settings in order to ensure that the provision of equitable health care is in line with the NHS Long Term Plan.

Methylene Blue Use in Pediatrics

AbstractCatecholamine-resistant shock, also known as vasoplegia, is a challenging entity with a significant risk of mortality. We seek to provide further data on the safety and effectiveness of methylene blue (MB) for vasoplegic shock in the pediatric population. We conducted a retrospective observational study of pediatric patients admitted to the pediatric intensive care unit or pediatric cardiac intensive care unit at Mount Sinai Kravis Children's Hospital from 2011 to 2021 who received MB for refractory shock. A list of patients was obtained by performing a pharmaceutical query from 2011 to 2021 for “MB.” Chart review was performed to determine indication for use and to collect demographic and clinical data. There were 33 MB administrations: 18 administrations (16 unique patients) for vasoplegic shock, 11 for surgical dye, and 4 for methemoglobinemia. The median age was 5 years (interquartile range [IQR]: 0.08, 13). Ten patients required MB following congenital cardiac repair (62.5%); one administration for myocarditis, septic shock, postcardiac arrest, high output chylothorax, scoliosis repair, and one multisystem inflammatory syndrome in children. No patients experienced hemolytic anemia or serotonin syndrome following administration. The median dose of MB was 1 mg/kg. Vasoactive-inotrope score (VIS) improved in 4 out of 18 administrations at 1 hour. Mean arterial pressure (MAP) improved in 10 out of 18 administrations at 1 hour. Systolic blood pressure (SBP) improved in 8 out of 18 administrations at 1 hour. VIS, MAP, and SBP improved in 8 out of 18 administrations at 6 hours. MB may be safely considered as rescue therapy in catecholamine-resistant shock in pediatrics.

Retinopathy of Prematurity: Risk Factors, Recent Trends of Screening and Outcome of Treatment in a Tertiary Care Eye Hospital of Bangladesh

Objectives: To determine the associated risk factors, current methods of screening and treatment outcome of ROP in a tertiarylevel eye hospital in Bangladesh. Methods: A prospective longitudinal study was conducted in the OPD, Pediatric care unit of a tertiary eye hospital, among 167 babies from October 2014 to June 2019. The initial examination was done either at four weeks of birth or 31 weeks post-conceptually, whichever was earlier. After taking consent, a detailed history was taken. Before the fundus examination, mydriasis was achieved, and indirect ophthalmoscopy was done under topical anesthesia. In favorable cases, staging of ROP was done with subsequent follow-up. As per ETROP indication, either laser photocoagulation or anti-vascular endothelial growth factor (anti-VEGF) injection or both were given for treatment. Later these babies were followed up to see the outcome. Results: Out of 167 babies, we had two groups after the 1st screening; 76 babies (45.5%) fell in the ROP group and 91 babies in the No ROP group. On subsequent screening, 28 babies had spontaneously regressed ROP, leaving 48 in the ROP group who required treatment. The male gender was predominant in both groups (52.6% and 56.04%, respectively). Type 1 ROP was the most prevalent. Oxygen therapy (93.4%) of variable duration and neonatal jaundice (52.6%) were the top two risk factors of ROP in this study. Sixty-five babies (38.9%) fell into a group of birth weight 1000-1500 grams, and 81 (48.5%) had a gestational age of 28-32 weeks. As a treatment, the majority with ROP (21 cases) received laser therapy. In the final follow-up, refractive errors are the most common outcome after treatment of ROP. Conclusion: The available care for ROP varies, and visual disability is mainly preventable when detected and treated in time. With limited resources and expertise, the screening and treatment of ROP implemented in Bangladesh showed some satisfactory outcomes; a longer follow-up would give a more detailed evaluation of the impact of this treatment on the visual status.

Do young adults complete health care proxies before anesthesia?

BackgroundHealth care proxy (HCP) completion rates by older adults are relatively low; however, not much is known about proxy completion rates by younger adults. ObjectivesThis study aimed to identify HCP completion rates amongst 18–21 year old young adults without intellectual disabilities admitted to a pediatric hospital peri-anesthesia care unit (PACU) and determine whether there was an association with any demographic factors. MethodsRetrospective chart review was performed to describe demographic variables, presence of HCP, and relationship to proxy. The relationship between demographic groups and HCP completion was analyzed by chi-square analysis for categorical variables and student t-test for continuous variables. ResultsOverall, 31.4 % (128/408) of patients completed an HCP, and younger patients were more likely to have done so. Analysis showed no statistically significant relationship between other demographic variables and HCP completion. A majority of patients identified a parent as their proxy. ConclusionLess than one third of young adult patients admitted to a children’s hospital perioperative care unit completed a health care proxy. Other than age, there was no statistically significant difference in demographic variables between those who completed and did not complete a health care proxy. Further research is needed to validate these findings in other clinical settings and drive targeted initiatives to increase advance care planning among young adult patients.

Anxiety, Depression, Perceived Social Support, and Life Satisfaction in Mothers with Children in the Pediatric Cardiac Care Unit After Heart Surgery

Anxiety, Depression, Perceived Social Support, and Life Satisfaction in Mothers with Children in the Pediatric Cardiac Care Unit After Heart Surgery

Measuring Success of Patient Safety Initiatives: The 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade

Measuring Success of Patient Safety Initiatives: The 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade

Nurses’ Perceptions of a Novel Rooming-in Program for Infants With Critical Congenital Heart Disease

The transition to home for infants who require complex care can be overwhelming for caregivers. Infants with critical congenital heart disease (CCHD) require advanced care management, so their caregivers must acquire extensive training before the infants are discharged home. Rooming-in programs have improved patient outcomes in other settings, such as the postpartum period. However, little research has examined a rooming-in program in a pediatric cardiac acute care setting. To describe nurses' perceptions of a novel rooming-in program implemented in a pediatric cardiac acute care unit. A qualitative descriptive research design was used to describe nurses' perceptions of the rooming-in program for infants with CCHD. Three focus groups were conducted with a convenience sample of 13 registered nurses who cared for infants with CCHD during the rooming-in program. Four trained independent coders performed qualitative thematic analysis. Nurses provided critical insight into the rooming-in program. Three themes were identified: improved nursing and family outcomes, leading the way through collaboration, and room for improvement. Infants with CCHD have complex needs, and caregivers must acquire advanced skills to adequately care for these infants. This study is the first to explore nurses' perceptions of a rooming-in program for infants with CCHD. The findings could improve rooming-in programs in the pediatric acute care setting, which can translate to better patient outcomes.

Prevalence of work-related musculoskeletal disorders among pediatric long-term ventilatory care unit nurses: Descriptive cross-sectional study

PurposePrevalence of musculoskeletal disorders (MSD) is widely reported among nurses but not specific to nurses working in pediatric long-term ventilatory care (PLTVC) units. The purpose of this study is to determine the prevalence of MSD among nurses working in PLTVC settings. Design and methodsCross-sectional descriptive design. Using the Extended Nordic Musculoskeletal Questionnaire, 127 nurses working in PLTVC units were recruited to examine the prevalence of single-site, two-site, and multi-site MSDs in nine body parts. Results90.6% of participants reported a lifetime prevalence of MSD in single site, 95% CI [84.21, 94.51]; 53.5% in two-sites, 95% CI [44.89, 61.99]; 46% in multi-sites, CI [28.38, 44.87]. The most common pain site was lower back (55.1%) followed by neck (35.4%), shoulder (33.9%), upper back (29.1%), wrist/hand (17.3%), ankle/ft (15.7%), knee (15%), hips/thighs (11.8%), and elbow (7.9%). There was a statistically significant difference in participants' years of experience in PLTVC among those reporting multi-site pain (M = 6.10, SD = 5.58) and the rest (M = 3.77, SD = 3.84) of the group reporting no pain or pain in one or two sites; t = (2.77), p = .006, 95% CI [0.66, 3.98]. ConclusionsThere is a high prevalence of MSD among PLTVC nurses. There seems to be a relationship between years of experience in PLTVC settings and multi-site pain. Practice implicationsPLTVC nurses must take additional precautions, since working in this environment increases the possibility of developing pain in multiple sites, particularly if they have been working for more than six years.

Nursing staff communication with pediatric patients and families in a pediatric transitional care unit: a best practice implementation project.

The objective of this project was to promote evidence-based practices regarding nursing communication with pediatric patients/families. Effective communication between healthcare providers and patients/families is an essential component of patient care and plays a vital role in patient outcomes. Ineffective communication among the healthcare team and patient families has been described as a significant factor contributing to adverse events and poor health outcomes. The project used JBI's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for encouraging evidence-based practices. A baseline audit was conducted, followed by the implementation of targeted strategies. The project was completed with a follow-up audit to determine change in practice. Three evidence-based practices were utilized as audit criteria for the project. The baseline audit on the three audit criteria revealed an average compliance of 30%. After providing communication skills training to nursing staff and education and visual aids to patients/families and nursing staff regarding the use of white boards, follow-up audits revealed an average compliance of 62%, an increase of 32%. These implementation strategies will continue to be utilized on the unit and will be implemented in other areas of the hospital to further improve communication between patients/families and their healthcare team.

Learning from the COVID-19 pandemic: IMCU as a more efficient model of pediatric critical care organization

BackgroundA significant proportion of children with SARs-CoV-2-related illnesses have been admitted to the Pediatric intensive care unit (ICU), although often for closer monitoring or concerns related to comorbidities or young age. This may have resulted in inappropriate ICU admissions, waste of resources, ICU overcrowding, and stress for young patients and caregivers.The Pediatric Intermediate Care Unit (IMCU) may represent an appropriate setting for the care of children whose monitoring and treatment needs are beyond the resources of a general pediatric ward, but who do not qualify for critical care.However, research on pediatric IMCUs and data on their performance is very limited. MethodsWe conducted a single-center retrospective study including all patients aged 0–18 with acute COVID-19 or multisystem inflammatory syndrome in children (MIS-C), admitted to a newly established stand-alone 12-bed pediatric IMCU at Gaslini Hospital, Genoa, Italy, between 1 March 2020 and 31 January 2022.Each IMCU room has a multiparameter monitor connected to a control station and can be equipped as an ICU room in case of need for escalation of care, up to ECMO support. IMCU and ICU are adjacent and located on the same floor, allowing a timely escalation from intermediate to critical care in the IMCU, with staff changes without the need for patient transfer. ResultsAmong 550 patients hospitalized for acute COVID-19 or MIS-C, 106 (19.2%, 80 with acute COVID-19, and 26 MIS-C) were admitted to IMCU. Three of them (2.8%) required escalation to critical care due to the worsening of their conditions. Forty-seven patients (44%) were discharged home from the IMCU, while the remaining 57 (55%) were transferred to low-intensity care units after clinical improvement. ConclusionsIn our study, the need for pediatric ICU admission was low for both acute COVID-19 patients (0.8%) and MIS-C patients (3.1%) compared to the literature data. The IMCU represented an adequate setting for children with COVID-19-related illness who need a higher level of care, but lack strict indications for ICU admission, thus preventing ICU overcrowding and wasting of economic and logistical resources. Further studies are needed to better assess the impact of an IMCU on hospital costs, ICU activity, and long-term psychological sequelae on children and their families.