Matthew Garber, MD, FAAP
Paul D. Hain, MD, FAAP
Brian K. Alverson, MD, FAAP
Erin R. Stucky Fisher, MD, FAAP
Daniel A. Rauch, MD, FAAP, Special Consultant/Committee on Hospital Care
Elena Aragona, MD, Liaison, Section on Medical Students, Residents, and Fellowship Trainees
S. Niccole Alexander, MPP,Manager, Division of Hospital and Surgical Services Ruth Trailer, BGS, Coordinator, Division of Hospital and Surgical Services
Report From the Section
Ricardo Quinonez, MD, FAAP
I often think of pediatric hospitalists as agents of clarity and reason. Evidence-based medicine, quality improvement, outcomes research and comparative effectiveness research are just some of the tools that hospitalists use in an effort to make sense of complex problems where conjecture sometimes clouds reason. Such is the case with the ongoing debate about pediatric readmissions. In adult medicine, unplanned readmissions are accepted surrogates for poor quality, though even this view has been challenged.1 For some adult conditions, readmissions are tied to decreased Medicare reimbursement. Are pediatric readmissions a reflection on the quality of care received by hospitalized children? Pediatric hospitalists are beginning to answer this question.
Original research articles and commentaries in the seminal journals Pediatrics and JAMA recently addressed this issue with pediatric hospitalists leading the charge.2–4 We are learning that a one size fits all approach to readmissions is unlikely to work for children. Pediatric readmissions are low in number (much lower than adults), frequently planned, rarely preventable (with little consensus that the small portion of possibly preventable readmissions actually are preventable) and affect certain patient populations disproportionately, ie, children with medical complexity, who may have different patterns of healthcare utilization, eg, using Children’s Hospitals rather than community hospitals. Additionally, the factors affecting readmission are complex and often outside the purview of the hospitalist. In other words, if the emerging evidence continues to point in the same direction, pediatric readmissions are unlikely to be good proxies for assessing quality.
Readmissions are just one part of the much bigger topic of “transitions of care” for the hospitalized patient. The AAP Section on Hospital Medicine and the Value in Inpatient Pediatrics Network (a program of the AAP Quality Improvement and Innovation Networks) recently co-sponsored a meeting of pediatric hospitalists, researchers, quality improvement experts, and government and private insurance industry stakeholders. The primary goal of this meeting was to summarize work done to date and begin the coordination of future efforts related to transitions of care for hospitalized children. This group, which met at AAP headquarters and was led by Dr. Mark Shen, was aptly named Seamless Transitions and Avoidable Readmissions Network (STARNet). STARNet will soon engage the rest of the pediatric hospital medicine community with the goal to speak in a unified voice to policy makers about readmissions and other issues related to transitions of care.
SOHM will continue to support its members who aim to coordinate efforts of pediatric hospitalists, and thus, produce much more meaningful and generalizable outcomes. STARNet is just one such example. It is our expectation that, with SOHM’s support, pediatric hospitalists will drive the conversation and help create meaningful policies that link quality of care to compensation and reimbursement. The sentiment “if we don’t do it, someone will do it for us” certainly applies here. As agents of clarity and reason, pediatric hospitalists are answering the call and speaking first.
PEDIATRICS HOSPITAL MEDICINE CONFERENCE EXPERIENCES
The AAP SOHM was pleased to provide four travel grants to attend the Pediatric Hospital Medicine (PHM) Conference held in July 2012. The unprecedented attendance at last year’s conference was reflected by a record number of applications. Awardees had the opportunity to meet AAP SOHM Past Chairperson, Dr. Daniel Rauch. The blurbs below demonstrate their positive overall experiences at the conference.
Dr. Eric R. Coon, University of Texas Southwestern Austin
For me, the measure of a conference is how inspired I feel afterward to think about things in a different way and to take on new challenges. PHM is the most invigorating medical conference I have attended. Sessions on research on a shoestring budget and manuscript writing gave me insight on a research project and got me fired up to finish it. Discussions with fellows and program directors of fellowships helped me narrow my focus about where to apply and made me really excited about the prospects of those programs. I feel so much more aware of the national scene and its players and am thankful for the opportunity to share in the enormous enthusiasm of this group.
Dr. Carolyn Shook, Seattle Children’s Hospital
I appreciated both the breadth and depth of topics that covered my range of interests from health services research to clinical care of children with medical complexity. I was welcomed as a resident, and appreciated that the small group leaders acknowledged that regardless of standing, everyone was trying to learn with different experiences. Additionally, the larger sessions covering current care practices helped place into context the variation in care and attempts at creating more consistent, coherent approaches to care across the country.
Dr. Clota Snow, Hasbro Children’s Hospital
Overall, the conference was a very inspiring experience. I went into the weekend knowing I wanted to pursue hospital medicine, but I came away feeling energized and enthusiastic about my career choice. I was struck by the passion I observed during conference sessions, particularly ones that addressed controversial clinical topics. The camaraderie and spirit among the attendees was nice to see, and it’s a community I can envision myself being a part of for years to come. I met people from around the country, from fellow residents to attending physicians who are leaders in the field. I was particularly inspired by the research poster presentations; I have limited personal experience with research, and I am now eager to explore how I can incorporate research into my own career. I came away from the weekend anxious to put what I’ve learned into practice and to continue to be a part of this growing and evolving specialty.
Dr. Elena Aragona, Children’s National Medical Center
The PHM conference continues to exceed my expectations. Each year, the conference seems to reflect the growth in the field of pediatric hospital medicine. The breadth of topics covered is impressive; I was particularly happy with the number of hands-on sessions available, with offerings that simulated chronic care emergencies and high acuity sedation events. As always, it is both remarkable and inspiring to attend sessions detailing the different aspects of research and quality improvement that are given by leaders in the respective fields, and to learn from the experiences that other conference attendees have had. Perhaps most impressive was the discussion about the future of the field of hospital medicine and the transparency with which the pros and cons of the different paths available were examined. I look forward to following this debate on the listserv and in pediatric hospitalist publications.
SEVEN DAYS OF RED TEAM
Lisa M. Clewner, MD
Pediatric Hospitalist at Dell Children’s Medical Center of Central Texas
Assistant Professor UTSW Program at Austin
On the first day of rounds my team presented to me
Bad pneumonia status post VATS.
On the second day of rounds my team presented to me
And weird Strep endocarditis.
On the third day of rounds my team presented to me
And ESBL E. coli UTI.
On the fourth day of rounds my team presented to me
And Landau-Kleffner Epilepsy.
On the fifth day of rounds my team presented to me
Failure to thrive,
After heart transplant,
And Zoster with meningitis.
On the sixth day of rounds my team presented to me
Complex febrile seizure,
Acute on chronic pain,
Bone pain with limp
And end rounds with team debriefing☹
On the seventh day of rounds my team presented to me
Girl with Moya-Moya
Has new dysphagia
Is it a stroke?
Lots of Flu,
And Myasthenia Gravis.
On the eighth day I sat down and took a deep breath
Case reports and posters to come…
- Copyright © 2013 by the American Academy of Pediatrics