Are You In or Are You Out? Provider Note Sharing in Pediatrics

From Rady Children’s in San Diego, an accounting of their experience going to default note sharing across most of the enterprise, including inpatient and specialty care. Main thrust of the article is that an opt-in strategy for providers does not result in much charing of notes, but opt-out does, and they know of no major issues with the practice.

Bourgeois 2018 (Pediatrics)

The Illusion of Catch-up Growth in Premature Infants: Use of the Growth Index and Age Correction

The corrected growth data of appropriate-for-gestational-age children approximated normal expected growth, whereas small-for-gestational-age children still demonstrated subnormal growth at 29 months of age, despite correction. In both appropriate-for-gestational-age and small-for-gestational-age children, catch-up growth appears to be a statistical illusion created by charting growth of premature infants using chronological age rather than the more appropriate corrected age. 

Karnisky W 1987 (AJDC) | PubMed 3578164 | Author Search

Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits

One concern about the use of telehealth in pediatrics is whether the care is the same as it would be for in-person visits. Given the real or perceived parental desire for antibiotics for viral illnesses, it’s legitimate to wonder if telehealth visits for minor viral infections would produce more prescriptions for antibiotics. This study of claims data compared a number of telehealth visits (n = 4604) to a much larger collection of urgent-care visits (n = 38,408) and primary-care provider visits (n = 485,201). Antibiotic prescribing was somewhat higher for visits (52%, vs. 42% urgent care and 31% PCP). This study raises the question of whether expectations of parents are different under telehealth conditions. If expectations of antibiotic prescribing are higher using telehealth, it remains to be studied whether this is real or simply perceived by providers.

[su_cite_pediatrics url_fragment=”143/5/e20182491″ author=”Ray” year=”2019″] | PubMed 30962253 | Author Search

Distinct Newborn Identification Requirement

From the Joint Commission, about a National Patient Safety Goal (NPSG.01.01.01) that goes into effect 1/1/19, on more distinguishable newborn naming conventions, for example, using the mother’s first and last names and the newborn’s gender (plus added letters for multiple births) to create a temporary name. (R3 Report. June 25, 2018;7:1-2).

TJC 2018 (Link)

An Estimation of Costs of a Pediatric Telemedicine Practice in Public Schools

The objective of this study was to estimate the costs of providing 386 telemedicine clinical consults at 10 school clinics during the 1999-2000 school year. The average costs of a telemedicine consult ranged from a high of $7328.17 when only one consult was done to a low of $173.13 when 129 consults were completed. At 165 consults, the average costs of a telemedicine consult and a medical center pediatric ambulatory consult were approximately equal. At 200 consults, telemedicine was estimated to be equal to or less costly than conventional ambulatory care visits by some 9.5%.

Doolittle 2003 (Link) | PubMed 12544547 | Author Search

Evaluation of Medication Dose Alerts in Pediatric Inpatients

A categorization of alerts generated from inpatient orders at a medium-sized pediatric hospital in 2010 using a vendor-provided computerized provider order entry software with a custom-developed set of 13,530 alerts, 89% of which were maximum-dose alerts. Over the year of data collection there were 182,308 orders for 1092 medications. 6.1% of orders produced an alert. 73.4% of those were dose-range alerts, which users complied with only 8.5% of the time. Overall, providers disregarded 92.4% of alerts of all types.

Scharnweber 2013 (Link) (Int J Med Inform) | PubMed 23643148 | Author Search

Computer-Aided Recognition of Facial Attributes for Fetal Alcohol Spectrum Disorders

Comparison of computer-based facial recognition software of facial images against standard, manual examination in fetal alcohol spectrum disorders. Areas-under-the-curve values for individual receiver-operating characteristic curves revealed the computer-aided system to be comparable to the manual method in detecting patients with FASD. Cases of alcohol-related neurodevelopmental disorder were identified more efficiently by the computer-aided system in comparison to the manual method.

[su_cite_pediatrics url_fragment = ‘140/6/e20162028’ author = ‘Valentine’ year = ‘2017’] | PubMed 12345678 | Author Search

Autism Screening With Online Decision Support by Primary Care Pediatricians Aided by M-CHAT/F

An evaluation of the Modified Checklist for Autism in Toddlers (M-CHAT) With Follow-up Interview (M-CHAT/F) as administered by primary-care pediatricians during typical checkups. Comparing the PCP performance to that of trained research assistants, sensitivity, specificity, positive predictive value (PPV), and overall accuracy for M-CHAT/F showed significant equivalence.

[su_cite_pediatrics url_fragment = ‘138/3/e20153036’ author = ‘Sturner’ year = ‘2016’] | PubMed 27542847 | Author Search