Faculty Bibliography

BACKGROUND AND OBJECTIVES/OBJECTIVE:Family physicians contribute significantly to the pediatric workforce, but little is known about their pediatric training during residency, specifically in the inpatient setting. Our objective was to gather data on the inpatient pediatric training of family medicine residents from the perspective of pediatric faculty. METHODS:We created a survey about inpatient pediatric training of family medicine residents, including pediatric rotation characteristics, ward team structure, educational resources, and faculty involvement. The Association of Pediatric Program Directors (APPD) accepted the survey for distribution to pediatric residency associate program directors. Demographic data about respondents were provided by APPD. Data were collected between January and February 2024. We performed descriptive analysis of survey responses. RESULTS:We received 74 responses from 190 institutions, for a response rate of 39%. Of the respondents, 81% provided training to family medicine residents. We found wide variability in the structure of this training. Only 7% of sites reported having curricula specific to training family medicine residents in inpatient pediatric care. Inpatient pediatricians (76%) are often tasked with creating rotation structure and curricula for training family medicine residents. CONCLUSIONS:In the view provided by our limited survey population, we found variability in the training structure and content of pediatric inpatient experiences; few family medicine-specific curricular tools are being used for this training, with little to no family medicine faculty involvement in this training. An opportunity may be available for collaboration between pediatric and family medicine faculty to establish a foundation for future curricula.

INTRODUCTION/UNASSIGNED:In August 2020, residents and nurses lacked awareness and knowledge of the pediatric early warning system (PEWS). Residents and nurses infrequently performed interdisciplinary bedside huddles for patients with critical scores, and residents did not document assessments and plans despite these patients being at higher risk for clinical deterioration. We aimed to increase the mean rate of documented huddles from 0% to 50% within 4 months. METHODS/UNASSIGNED:We piloted this quality improvement project on 1 floor of a pediatric hospital and included patients admitted to the pediatric hospital medicine service. Key drivers included buy-in and trust in PEWS, understanding of critical scores, a reliable scoring algorithm, and a culture where interdisciplinary communication is routine. Interventions included physician and nurse education, improving the scoring algorithm, and promoting a shared understanding of PEWS. Our outcome measure was the percentage of documented huddle notes for each patient with a critical score, a proxy for huddles occurring. We entered data into a control chart and analyzed it for changes in response to interventions. RESULTS/UNASSIGNED:The mean baseline rate of note completion was 0%. After 4 months, the mean increased to 100%, associated with multiple educational interventions and efforts to improve the scoring algorithm. CONCLUSIONS/UNASSIGNED:Implementing multimodal interventions was associated with an increased rate of documented huddles. Scoring algorithm changes and personalized education galvanized physician and nurse support for PEWS. Institutions can use the lessons we have learned to implement PEWS and promote huddles and interdisciplinary communication.

BACKGROUND AND OBJECTIVE:In 2014, the Accreditation Council for Graduate Medical Education (ACGME) implemented numeric requirements for family medicine (FM) pediatric patient encounters. Impact on residency programs is unclear. We aimed to identify any difficulties faced by FM program directors (PDs) meeting these numeric requirements. METHODS:Questions about pediatric training in family medicine residencies were included in a survey of PDs conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA). We performed univariate analysis of the demographic and program characteristics. We then used χ2 tests of independence to test for bivariate associations between these characteristics and our primary outcome: the most difficult ACGME pediatric care requirement to meet. RESULTS:Most programs reported the hospital as the primary location of training (n=131, 46%) and their family medicine practice (FMP) patient population consisted of over 20% pediatric patients (n=153, 56%). Over 80% of program directors reported challenges meeting FM requirements for the care of children. Challenges meeting pediatric requirements were associated with fewer than 20% FMP patients under 19 years of age (P<.0001), fewer than 50% of core FM faculty caring for sick children (P=.0128), and primary location of pediatric training in a family health center (P=.0006). CONCLUSION:Difficulty meeting ACGME requirements for the care of children in FM residency programs is common, especially for programs with fewer than 20% FMP patients under 19 years of age. Further research is needed to determine how best to assure FM resident competencies in the care of children and adolescents.

BACKGROUND AND OBJECTIVES:Written discharge instructions help to bridge hospital-to-home transitions for patients and families, though substantial variation in discharge instruction quality exists. We aimed to assess the association between participation in an Institute for Healthcare Improvement Virtual Breakthrough Series collaborative and the quality of pediatric written discharge instructions across 8 US hospitals. METHODS:We conducted a multicenter, interrupted time-series analysis of a medical records-based quality measure focused on written discharge instruction content (0-100 scale, higher scores reflect better quality). Data were from random samples of pediatric patients (N = 5739) discharged from participating hospitals between September 2015 and August 2016, and between December 2017 and January 2020. These periods consisted of 3 phases: 1. a 14-month precollaborative phase; 2. a 12-month quality improvement collaborative phase when hospitals implemented multiple rapid cycle tests of change and shared improvement strategies; and 3. a 12-month postcollaborative phase. Interrupted time-series models assessed the association between study phase and measure performance over time, stratified by baseline hospital performance, adjusting for seasonality and hospital fixed effects. RESULTS:Among hospitals with high baseline performance, measure scores increased during the quality improvement collaborative phase beyond the expected precollaborative trend (+0.7 points/month; 95% confidence interval, 0.4-1.0; P < .001). Among hospitals with low baseline performance, measure scores increased but at a lower rate than the expected precollaborative trend (-0.5 points/month; 95% confidence interval, -0.8 to -0.2; P < .01). CONCLUSIONS:Participation in this 8-hospital Institute for Healthcare Improvement Virtual Breakthrough Series collaborative was associated with improvement in the quality of written discharge instructions beyond precollaborative trends only for hospitals with high baseline performance.

PURPOSE:Anterior vertebral body tethering (VBT) is a non-fusion surgical treatment for Adolescent Idiopathic Scoliosis requiring chest tube(s) (CT). We sought to assess the efficacy of post-op intravenous tranexamic acid (IV TXA) in reducing CT drainage and retention. METHODS:35 VBT patients received 24 h of post-op IV TXA (2 mg/kg/h) were compared to 49 who did not. Group comparisons were performed using Wilcoxon rank-sum and chi-squared tests. Multivariate linear regression analysis was used to assess the relationships between TXA and both CT drainage and retention time. RESULTS:There were no group differences at baseline (Table). CTs placed for thoracic (T) and thoracolumbar (TL) curves were assessed separately. For TH CT, there was less total CT drainage in the TXA group (TXA 569.4 ± 337.4 mL vs. Non-TXA 782.5 ± 338.9 mL; p = 0.003) and shorter CT retention time (TXA 3.0 ± 1.3 vs. Non-TXA 3.9 ± 1.4 days; p = 0.003). For TL CT, there was less total CT drainage in the TXA group (TXA 206.8 ± 152.2 mL vs. Non-TXA 395.7 ± 196.1 mL; p = 0.003) and shorter CT retention time (TXA 1.7 ± 1.3 vs. Non-TXA 2.7 ± 1.0 days; p = 0.001). Following multivariate analysis, use of TXA was the only significant predictor of both drainage in T and TL CTs (p = 0.012 and p = 0.002, respectively) as well as T and TL CT retention time (p = 0.008 and p = 0.009, respectively). There were no differences in LOS (p = 0.863) or ICU stay (p = 0.290). CONCLUSION:IV TXA results in a significant decrease in CT drainage and retention time. CT retention is decreased by 1 day for those that receive TXA. LEVEL OF EVIDENCE:III.

OBJECTIVES:The number of hospitalized coronavirus disease 2019 patients in March 2020 to April 2020 in our New York City hospital required increased physician staffing, including deployment of pediatricians to adult care. To improve the deployment process, we sought to understand the mindset, preparations for, and experience during deployment of pediatric faculty in our institution. METHODS:test were used to compare groups. Free-text responses were categorized by topic. Survey responses were shared with leadership in real time and adjustments to the deployment process made. RESULTS:= 16). Dissemination of details about schedules and role clarification before deployment were areas for improvement. CONCLUSIONS:Pediatric faculty facing deployment to adult care have concerns about the process of deployment as well as the work itself. Specific information distributed in advance, along with consistent and frequent communication, may help mitigate these fears.