Introduction

Research is a rapidly growing aspect of inpatient medicine. The practice of evidence-based medicine and the acute need for more evidence on inpatient conditions require that pediatric hospitalists understand and participate in research related activities. Pediatric hospitalists’ role in research will vary depending on their setting and job description. This role may include many facets, from reviewing relevant patient-based articles, to participating in multi-institutional studies requiring enrollment of patients, to leading local or national studies. Pediatric hospitalists should have a basic understanding of research methods and processes in order to participate in and benefit from research. Pediatric hospitalists are well positioned to promote research to patients, the family/caregivers, colleagues, and other healthcare providers and through this, to contribute to the effective care of hospitalized patients.

Pediatric hospitalists should be able to:

• Compare and contrast the advantages and disadvantages of experimental (such as randomized control trials) and observational (such as descriptive, cohort, or case control) study designs, including meta-analyses and systematic reviews.
• Define common sources of bias, including information bias, selection bias, and uncontrolled confounding, and describe how each may impact a study.
• Define basic statistical terms such as sample, discrete and continuous data variables, measures of central tendency (mean, median, and mode), and variability (variance, standard deviation, range).
• List resources available to access current or proposed studies including The Pediatric Health Information System (PHIS), the Healthcare Cost and Utilization Project (HCUP), the Kids’ Inpatient Database (KID), clinicaltrials.gov, and others.
• Name potential research funding sources, such as the Agency for Healthcare Research and Quality (AHRQ), the National Institutes of Health (NIH), the Patient-Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation, local and state funding sources, and others.
• Summarize the goals of pediatric hospital medicine-specific research networks, including the Pediatric Research in the Inpatient Setting (PRIS) network and the Value in Pediatrics (VIP) network.
• Discuss the basic resources commonly required to support research components, including data collection, data analysis, abstract and manuscript preparation, grant funding, and others.
• Review the aspects of the research process that relate to protection of participants, including informed consent and/or assent, the institutional review boards (IRB) review, and HIPAA (Health Insurance Portability and Accountability Act) forms.
• Discuss special protections needed when conducting research with vulnerable populations.
• Define “minimal risk” for a healthy child and for a child with an illness.
• Discuss why common training that addresses ethics, vulnerable populations, consenting, data safety, and other items is required prior to participating as a research team member for a research study.
• Compare and contrast the goals, intent, study focus, and IRB requirements for quality improvement studies from those of traditional clinical research.
• Cite the steps needed to obtain approval for a QI study within the local context.
• Compare and contrast the goals, intent, study focus, and IRB requirements for education studies to those of traditional clinical research.
• Cite the steps needed to obtain approval for a study focused on educational outcomes.
• List common barriers to implementation of clinical studies and describe the pediatric hospitalist’s role in overcoming these barriers.

Pediatric hospitalists should be able to:

• Utilize a format such as PICO (Population, Intervention, Comparison, Outcome) to generate an answerable patient-centered clinical question that is relevant to improving patient care.
• Demonstrate proficiency in systematic searching of the primary medical literature using online search engines.
• Perform critical appraisal of the literature, including identifying threats to study validity, determining if study subjects were similar to local patients, and determining if all clinically important outcomes were considered.
• Apply and integrate the results of studies to clinical practice.
• Determine if the likely benefits noted in a treatment study are worth the potential harm and cost.
• Determine whether a test noted in a diagnostic study is available, affordable, accurate, and precise in the present clinical setting and determine whether the results of the test will change the management of patients being treated.
• Determine if the magnitude of risk warrants an attempt to stop the exposure for a given study on harm.
• Identify if the results of a given study on disease prognosis will lead directly to selecting therapy and/or are useful for counseling patients.
• Participate in educating learners and junior faculty about research and research methodologies, within the local context.
• Determine the relevance of potential research studies with regards to impact on patient care.
• Perform effective informed consent or assent for patients participating in research studies, as appropriate.
• Identify and resolve conflict of interest or potential conflict of interest when participating in research studies.
• Demonstrate basic skills in acquiring, managing, and sharing data collected for research purposes in a responsible and professional manner.
• Adhere to standards for protecting confidentiality, avoiding unjustified exclusions, sharing data, and adhering to copyright law.
• Perform peer-review of a manuscript, abstract, or other research-based work, in collaboration with colleagues as appropriate.
• Demonstrate basic skills in communicating about research opportunities with patients and the family/caregivers within the local context.

Pediatric hospitalists should be able to:

• Recognize the value of seeking the research that supports clinical care decisions and how research fills knowledge gaps and challenges the field to advance.
• Realize the importance of informed consent for patient participation in clinical research.
• Reflect on the importance of patient assent, even in the presence of legal guardian informed consent, when involving children in clinical research.
• Exemplify highly ethical behaviors when promoting or participating in research studies.
• Realize the value of and exemplify a willingness to perform journal-requested peer review of manuscripts, conference abstracts, or other research-based work.
• Reflect on and provide support and education for patients and the family/caregivers on the benefits of research for hospitalized children.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in interdisciplinary initiatives to develop and sustain participation of interdisciplinary teams in performance of research.
• Collaborate with colleagues, hospital administration, and community leaders for thoughtful application of research findings to improve systems of healthcare delivery.
• Lead, coordinate, or participate in national multi-center research efforts that improve the evidence base in inpatient pediatrics, within local context.
• Collaborate with leaders in the university department of pediatrics and school of medicine, hospital administration, and medical staff to encourage local hospital participation in national multi-center research efforts.
• Collaborate with research team members to educate colleagues, hospital staff, and others on the importance of research in improving child health outcomes.

Introduction

Research is a rapidly growing aspect of inpatient medicine. The practice of evidence-based medicine and the acute need for more evidence on inpatient conditions require that pediatric hospitalists understand and participate in research related activities. Pediatric hospitalists’ role in research will vary depending on their setting and job description. This role may include many facets, from reviewing relevant patient-based articles, to participating in multi-institutional studies requiring enrollment of patients, to leading local or national studies. Pediatric hospitalists should have a basic understanding of research methods and processes in order to participate in and benefit from research. Pediatric hospitalists are well positioned to promote research to patients, the family/caregivers, colleagues, and other healthcare providers and through this, to contribute to the effective care of hospitalized patients.

Pediatric hospitalists should be able to:

• Compare and contrast the advantages and disadvantages of experimental (such as randomized control trials) and observational (such as descriptive, cohort, or case control) study designs, including meta-analyses and systematic reviews.
• Define common sources of bias, including information bias, selection bias, and uncontrolled confounding, and describe how each may impact a study.
• Define basic statistical terms such as sample, discrete and continuous data variables, measures of central tendency (mean, median, and mode), and variability (variance, standard deviation, range).
• List resources available to access current or proposed studies including The Pediatric Health Information System (PHIS), the Healthcare Cost and Utilization Project (HCUP), the Kids’ Inpatient Database (KID), clinicaltrials.gov, and others.
• Name potential research funding sources, such as the Agency for Healthcare Research and Quality (AHRQ), the National Institutes of Health (NIH), the Patient-Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation, local and state funding sources, and others.
• Summarize the goals of pediatric hospital medicine-specific research networks, including the Pediatric Research in the Inpatient Setting (PRIS) network and the Value in Pediatrics (VIP) network.
• Discuss the basic resources commonly required to support research components, including data collection, data analysis, abstract and manuscript preparation, grant funding, and others.
• Review the aspects of the research process that relate to protection of participants, including informed consent and/or assent, the institutional review boards (IRB) review, and HIPAA (Health Insurance Portability and Accountability Act) forms.
• Discuss special protections needed when conducting research with vulnerable populations.
• Define “minimal risk” for a healthy child and for a child with an illness.
• Discuss why common training that addresses ethics, vulnerable populations, consenting, data safety, and other items is required prior to participating as a research team member for a research study.
• Compare and contrast the goals, intent, study focus, and IRB requirements for quality improvement studies from those of traditional clinical research.
• Cite the steps needed to obtain approval for a QI study within the local context.
• Compare and contrast the goals, intent, study focus, and IRB requirements for education studies to those of traditional clinical research.
• Cite the steps needed to obtain approval for a study focused on educational outcomes.
• List common barriers to implementation of clinical studies and describe the pediatric hospitalist’s role in overcoming these barriers.

Pediatric hospitalists should be able to:

• Utilize a format such as PICO (Population, Intervention, Comparison, Outcome) to generate an answerable patient-centered clinical question that is relevant to improving patient care.
• Demonstrate proficiency in systematic searching of the primary medical literature using online search engines.
• Perform critical appraisal of the literature, including identifying threats to study validity, determining if study subjects were similar to local patients, and determining if all clinically important outcomes were considered.
• Apply and integrate the results of studies to clinical practice.
• Determine if the likely benefits noted in a treatment study are worth the potential harm and cost.
• Determine whether a test noted in a diagnostic study is available, affordable, accurate, and precise in the present clinical setting and determine whether the results of the test will change the management of patients being treated.
• Determine if the magnitude of risk warrants an attempt to stop the exposure for a given study on harm.
• Identify if the results of a given study on disease prognosis will lead directly to selecting therapy and/or are useful for counseling patients.
• Participate in educating learners and junior faculty about research and research methodologies, within the local context.
• Determine the relevance of potential research studies with regards to impact on patient care.
• Perform effective informed consent or assent for patients participating in research studies, as appropriate.
• Identify and resolve conflict of interest or potential conflict of interest when participating in research studies.
• Demonstrate basic skills in acquiring, managing, and sharing data collected for research purposes in a responsible and professional manner.
• Adhere to standards for protecting confidentiality, avoiding unjustified exclusions, sharing data, and adhering to copyright law.
• Perform peer-review of a manuscript, abstract, or other research-based work, in collaboration with colleagues as appropriate.
• Demonstrate basic skills in communicating about research opportunities with patients and the family/caregivers within the local context.

Pediatric hospitalists should be able to:

• Recognize the value of seeking the research that supports clinical care decisions and how research fills knowledge gaps and challenges the field to advance.
• Realize the importance of informed consent for patient participation in clinical research.
• Reflect on the importance of patient assent, even in the presence of legal guardian informed consent, when involving children in clinical research.
• Exemplify highly ethical behaviors when promoting or participating in research studies.
• Realize the value of and exemplify a willingness to perform journal-requested peer review of manuscripts, conference abstracts, or other research-based work.
• Reflect on and provide support and education for patients and the family/caregivers on the benefits of research for hospitalized children.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in interdisciplinary initiatives to develop and sustain participation of interdisciplinary teams in performance of research.
• Collaborate with colleagues, hospital administration, and community leaders for thoughtful application of research findings to improve systems of healthcare delivery.
• Lead, coordinate, or participate in national multi-center research efforts that improve the evidence base in inpatient pediatrics, within local context.
• Collaborate with leaders in the university department of pediatrics and school of medicine, hospital administration, and medical staff to encourage local hospital participation in national multi-center research efforts.
• Collaborate with research team members to educate colleagues, hospital staff, and others on the importance of research in improving child health outcomes.

Introduction

Research is a rapidly growing aspect of inpatient medicine. The practice of evidence-based medicine and the acute need for more evidence on inpatient conditions require that pediatric hospitalists understand and participate in research related activities. Pediatric hospitalists’ role in research will vary depending on their setting and job description. This role may include many facets, from reviewing relevant patient-based articles, to participating in multi-institutional studies requiring enrollment of patients, to leading local or national studies. Pediatric hospitalists should have a basic understanding of research methods and processes in order to participate in and benefit from research. Pediatric hospitalists are well positioned to promote research to patients, the family/caregivers, colleagues, and other healthcare providers and through this, to contribute to the effective care of hospitalized patients.

Pediatric hospitalists should be able to:

• Compare and contrast the advantages and disadvantages of experimental (such as randomized control trials) and observational (such as descriptive, cohort, or case control) study designs, including meta-analyses and systematic reviews.
• Define common sources of bias, including information bias, selection bias, and uncontrolled confounding, and describe how each may impact a study.
• Define basic statistical terms such as sample, discrete and continuous data variables, measures of central tendency (mean, median, and mode), and variability (variance, standard deviation, range).
• List resources available to access current or proposed studies including The Pediatric Health Information System (PHIS), the Healthcare Cost and Utilization Project (HCUP), the Kids’ Inpatient Database (KID), clinicaltrials.gov, and others.
• Name potential research funding sources, such as the Agency for Healthcare Research and Quality (AHRQ), the National Institutes of Health (NIH), the Patient-Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation, local and state funding sources, and others.
• Summarize the goals of pediatric hospital medicine-specific research networks, including the Pediatric Research in the Inpatient Setting (PRIS) network and the Value in Pediatrics (VIP) network.
• Discuss the basic resources commonly required to support research components, including data collection, data analysis, abstract and manuscript preparation, grant funding, and others.
• Review the aspects of the research process that relate to protection of participants, including informed consent and/or assent, the institutional review boards (IRB) review, and HIPAA (Health Insurance Portability and Accountability Act) forms.
• Discuss special protections needed when conducting research with vulnerable populations.
• Define “minimal risk” for a healthy child and for a child with an illness.
• Discuss why common training that addresses ethics, vulnerable populations, consenting, data safety, and other items is required prior to participating as a research team member for a research study.
• Compare and contrast the goals, intent, study focus, and IRB requirements for quality improvement studies from those of traditional clinical research.
• Cite the steps needed to obtain approval for a QI study within the local context.
• Compare and contrast the goals, intent, study focus, and IRB requirements for education studies to those of traditional clinical research.
• Cite the steps needed to obtain approval for a study focused on educational outcomes.
• List common barriers to implementation of clinical studies and describe the pediatric hospitalist’s role in overcoming these barriers.

Pediatric hospitalists should be able to:

• Utilize a format such as PICO (Population, Intervention, Comparison, Outcome) to generate an answerable patient-centered clinical question that is relevant to improving patient care.
• Demonstrate proficiency in systematic searching of the primary medical literature using online search engines.
• Perform critical appraisal of the literature, including identifying threats to study validity, determining if study subjects were similar to local patients, and determining if all clinically important outcomes were considered.
• Apply and integrate the results of studies to clinical practice.
• Determine if the likely benefits noted in a treatment study are worth the potential harm and cost.
• Determine whether a test noted in a diagnostic study is available, affordable, accurate, and precise in the present clinical setting and determine whether the results of the test will change the management of patients being treated.
• Determine if the magnitude of risk warrants an attempt to stop the exposure for a given study on harm.
• Identify if the results of a given study on disease prognosis will lead directly to selecting therapy and/or are useful for counseling patients.
• Participate in educating learners and junior faculty about research and research methodologies, within the local context.
• Determine the relevance of potential research studies with regards to impact on patient care.
• Perform effective informed consent or assent for patients participating in research studies, as appropriate.
• Identify and resolve conflict of interest or potential conflict of interest when participating in research studies.
• Demonstrate basic skills in acquiring, managing, and sharing data collected for research purposes in a responsible and professional manner.
• Adhere to standards for protecting confidentiality, avoiding unjustified exclusions, sharing data, and adhering to copyright law.
• Perform peer-review of a manuscript, abstract, or other research-based work, in collaboration with colleagues as appropriate.
• Demonstrate basic skills in communicating about research opportunities with patients and the family/caregivers within the local context.

Pediatric hospitalists should be able to:

• Recognize the value of seeking the research that supports clinical care decisions and how research fills knowledge gaps and challenges the field to advance.
• Realize the importance of informed consent for patient participation in clinical research.
• Reflect on the importance of patient assent, even in the presence of legal guardian informed consent, when involving children in clinical research.
• Exemplify highly ethical behaviors when promoting or participating in research studies.
• Realize the value of and exemplify a willingness to perform journal-requested peer review of manuscripts, conference abstracts, or other research-based work.
• Reflect on and provide support and education for patients and the family/caregivers on the benefits of research for hospitalized children.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in interdisciplinary initiatives to develop and sustain participation of interdisciplinary teams in performance of research.
• Collaborate with colleagues, hospital administration, and community leaders for thoughtful application of research findings to improve systems of healthcare delivery.
• Lead, coordinate, or participate in national multi-center research efforts that improve the evidence base in inpatient pediatrics, within local context.
• Collaborate with leaders in the university department of pediatrics and school of medicine, hospital administration, and medical staff to encourage local hospital participation in national multi-center research efforts.
• Collaborate with research team members to educate colleagues, hospital staff, and others on the importance of research in improving child health outcomes.

Introduction

Quality Improvement (QI) in healthcare involves planning, implementation, and ongoing assessment of care to proactively improve healthcare outcomes. Hospitals use QI programs to optimize care, streamline systems operations, meet regulatory requirements, and enhance customer service quality. Since the publication of Crossing the Quality Chasm decades ago by the Institutes of Medicine (now the National Academies of Medicine), even greater attention has been focused on improving use and assessing outcomes of evidence-based practices. Proving that “quality of care” and healthcare “value” (quality achieved relative to cost) has been achieved is critical for individual hospitals as well as the national healthcare system. The challenge is to maintain fiscal viability while delivering appropriate healthcare. Healthcare leaders therefore consider QI programs integral to system operations as a means to assure that resources are used wisely and delivery of consistent outcomes that improve the health of the populations served occurs. Pediatric hospitalists work on the front lines of clinical care and are aware of opportunities to improve acute care management, address gaps in chronic care needs, and identify opportunities for system-wide enhancements. Pediatric hospitalists are well positioned to act as influential change agents to promote, champion, and lead QI projects to ensure the highest value of healthcare for hospitalized children.

Pediatric hospitalists should be able to:

• Compare and contrast between Quality Assurance (focus on individual compliance with standards) and Quality Improvement (proactive systems improvement via integration of best practices).
• Define the “Model for Improvement.”
• Summarize the steps of the Shewart-Deming Plan Do Study Act (PDSA) cycle of improvement.
• Explain the value of demonstrating small gains and identifying failures for correction through rapid cycle improvement.
• Describe how lean methodology attempts to eliminate waste and Six Sigma attempts to reduce variation and defects within a process.
• Define commonly used QI tools and terms such as common cause and special cause variation, run charts, cumulative proportion charts, process map, and others.
• Cite examples of structure, process, outcome, and balancing metrics, attending to areas such as clinical, financial, resource use, and perceptions of care improvement.
• Summarize how QI supports effective development of care standardization, best practices, and practice guidelines in order to improve clinical outcomes.
• Discuss the importance of integrating evidence-based medicine into the planning stage of QI projects affecting patient care.
• Explain how QI can be effectively used for both clinical and system operations improvements using examples such as clinical care guidelines and hospital procedures.
• Describe the business case for quality and review why quality should drive cost and resource allocation.
• Define the role of the patient and family in QI and illustrate how their involvement or perspectives are central to QI project success.
• Discuss how interprofessional teams and a culture of commitment to QI impact the success of QI Programs.
• Explain the role of human factors in implementing healthcare improvements.
• List the attributes necessary to moderate, facilitate, and lead QI initiatives and discuss the importance of team building methods.
• Summarize how regulatory, accrediting, advocacy, research funders, and insurers impact QI initiatives and outcomes reporting for hospitalized children, attending to the Centers for Medicare and Medicaid, The Joint Commission, Agency for Healthcare Research and Quality, Leapfrog, and the National Quality Forum.
• Discuss the value of national, state, and local comparative quality data reporting and the clinical, educational, and research utility of national sources such as the Pediatric Health Information Dataset (PHIS).
• Review how reporting quality outcomes to external sources and posting on local hospital websites can affect the patient experience and community trust.
• Summarize the value of continuous participation in QI activities, noting the expectations from medical school through American Board of Pediatrics initial and ongoing certification.

Pediatric hospitalists should be able to:

• Identify processes in need of improvement and engage the appropriate personnel to gain approval for a QI project.
• Demonstrate proficiency in performing each step in a basic QI project.
• Demonstrate proficiency in utilizing basic QI tools such as a process map, key driver diagram, and fishbone diagram.
• Perform review of quality data, including basic data analysis, interpretation, and development of recommendations from the data.
• Serve as a liaison between physician staff and hospital administrative staff when interpreting physician-specific information and clinical care outliers.
• Utilize communication and leadership skills to participate effectively on an interdisciplinary team.
• Educate trainees, nursing staff, ancillary staff, and peers on the basic principles of QI.
• Assist with development of practice guidelines to assure delivery of standardized high value care in the hospital setting.
• Use best practice guidelines effectively and consistently.
• Demonstrate facility with the use of common computer applications, including spreadsheet and database management for information retrieval and analysis.

Pediatric hospitalists should be able to:

• Realize the value of leading as an “early adopter” and “change agent” by building an awareness of and consensus for changes needed to make patient care quality a high priority.
• Recognize the importance of team building, leadership, and family centeredness in performing effective QI.
• Acknowledge the importance of collaboration with healthcare providers critical to QI efforts, such as clinical team members, information technology staff, data analysts, and others.
• Seek opportunities to initiate or actively participate in QI projects.
• Work collaboratively to help create and maintain a QI culture within the institution.
• Exemplify professional behavior when reviewing and interpreting data.
• Recognize how value is defined by the patient and family/caregivers and support QI efforts to increase this value.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Engage hospital, medical group, and medical staff leadership in creating, implementing, and sustaining short- and long-term QI goals that add value for all customers.
• Participate on QI committees and seek opportunities to serve as QI officers or consultants.
• Advocate for the necessary information systems and other infrastructure to secure accurate data and assure success in the QI process.

Introduction

Quality Improvement (QI) in healthcare involves planning, implementation, and ongoing assessment of care to proactively improve healthcare outcomes. Hospitals use QI programs to optimize care, streamline systems operations, meet regulatory requirements, and enhance customer service quality. Since the publication of Crossing the Quality Chasm decades ago by the Institutes of Medicine (now the National Academies of Medicine), even greater attention has been focused on improving use and assessing outcomes of evidence-based practices. Proving that “quality of care” and healthcare “value” (quality achieved relative to cost) has been achieved is critical for individual hospitals as well as the national healthcare system. The challenge is to maintain fiscal viability while delivering appropriate healthcare. Healthcare leaders therefore consider QI programs integral to system operations as a means to assure that resources are used wisely and delivery of consistent outcomes that improve the health of the populations served occurs. Pediatric hospitalists work on the front lines of clinical care and are aware of opportunities to improve acute care management, address gaps in chronic care needs, and identify opportunities for system-wide enhancements. Pediatric hospitalists are well positioned to act as influential change agents to promote, champion, and lead QI projects to ensure the highest value of healthcare for hospitalized children.

Pediatric hospitalists should be able to:

• Compare and contrast between Quality Assurance (focus on individual compliance with standards) and Quality Improvement (proactive systems improvement via integration of best practices).
• Define the “Model for Improvement.”
• Summarize the steps of the Shewart-Deming Plan Do Study Act (PDSA) cycle of improvement.
• Explain the value of demonstrating small gains and identifying failures for correction through rapid cycle improvement.
• Describe how lean methodology attempts to eliminate waste and Six Sigma attempts to reduce variation and defects within a process.
• Define commonly used QI tools and terms such as common cause and special cause variation, run charts, cumulative proportion charts, process map, and others.
• Cite examples of structure, process, outcome, and balancing metrics, attending to areas such as clinical, financial, resource use, and perceptions of care improvement.
• Summarize how QI supports effective development of care standardization, best practices, and practice guidelines in order to improve clinical outcomes.
• Discuss the importance of integrating evidence-based medicine into the planning stage of QI projects affecting patient care.
• Explain how QI can be effectively used for both clinical and system operations improvements using examples such as clinical care guidelines and hospital procedures.
• Describe the business case for quality and review why quality should drive cost and resource allocation.
• Define the role of the patient and family in QI and illustrate how their involvement or perspectives are central to QI project success.
• Discuss how interprofessional teams and a culture of commitment to QI impact the success of QI Programs.
• Explain the role of human factors in implementing healthcare improvements.
• List the attributes necessary to moderate, facilitate, and lead QI initiatives and discuss the importance of team building methods.
• Summarize how regulatory, accrediting, advocacy, research funders, and insurers impact QI initiatives and outcomes reporting for hospitalized children, attending to the Centers for Medicare and Medicaid, The Joint Commission, Agency for Healthcare Research and Quality, Leapfrog, and the National Quality Forum.
• Discuss the value of national, state, and local comparative quality data reporting and the clinical, educational, and research utility of national sources such as the Pediatric Health Information Dataset (PHIS).
• Review how reporting quality outcomes to external sources and posting on local hospital websites can affect the patient experience and community trust.
• Summarize the value of continuous participation in QI activities, noting the expectations from medical school through American Board of Pediatrics initial and ongoing certification.

Pediatric hospitalists should be able to:

• Identify processes in need of improvement and engage the appropriate personnel to gain approval for a QI project.
• Demonstrate proficiency in performing each step in a basic QI project.
• Demonstrate proficiency in utilizing basic QI tools such as a process map, key driver diagram, and fishbone diagram.
• Perform review of quality data, including basic data analysis, interpretation, and development of recommendations from the data.
• Serve as a liaison between physician staff and hospital administrative staff when interpreting physician-specific information and clinical care outliers.
• Utilize communication and leadership skills to participate effectively on an interdisciplinary team.
• Educate trainees, nursing staff, ancillary staff, and peers on the basic principles of QI.
• Assist with development of practice guidelines to assure delivery of standardized high value care in the hospital setting.
• Use best practice guidelines effectively and consistently.
• Demonstrate facility with the use of common computer applications, including spreadsheet and database management for information retrieval and analysis.

Pediatric hospitalists should be able to:

• Realize the value of leading as an “early adopter” and “change agent” by building an awareness of and consensus for changes needed to make patient care quality a high priority.
• Recognize the importance of team building, leadership, and family centeredness in performing effective QI.
• Acknowledge the importance of collaboration with healthcare providers critical to QI efforts, such as clinical team members, information technology staff, data analysts, and others.
• Seek opportunities to initiate or actively participate in QI projects.
• Work collaboratively to help create and maintain a QI culture within the institution.
• Exemplify professional behavior when reviewing and interpreting data.
• Recognize how value is defined by the patient and family/caregivers and support QI efforts to increase this value.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Engage hospital, medical group, and medical staff leadership in creating, implementing, and sustaining short- and long-term QI goals that add value for all customers.
• Participate on QI committees and seek opportunities to serve as QI officers or consultants.
• Advocate for the necessary information systems and other infrastructure to secure accurate data and assure success in the QI process.

Introduction

Quality Improvement (QI) in healthcare involves planning, implementation, and ongoing assessment of care to proactively improve healthcare outcomes. Hospitals use QI programs to optimize care, streamline systems operations, meet regulatory requirements, and enhance customer service quality. Since the publication of Crossing the Quality Chasm decades ago by the Institutes of Medicine (now the National Academies of Medicine), even greater attention has been focused on improving use and assessing outcomes of evidence-based practices. Proving that “quality of care” and healthcare “value” (quality achieved relative to cost) has been achieved is critical for individual hospitals as well as the national healthcare system. The challenge is to maintain fiscal viability while delivering appropriate healthcare. Healthcare leaders therefore consider QI programs integral to system operations as a means to assure that resources are used wisely and delivery of consistent outcomes that improve the health of the populations served occurs. Pediatric hospitalists work on the front lines of clinical care and are aware of opportunities to improve acute care management, address gaps in chronic care needs, and identify opportunities for system-wide enhancements. Pediatric hospitalists are well positioned to act as influential change agents to promote, champion, and lead QI projects to ensure the highest value of healthcare for hospitalized children.

Pediatric hospitalists should be able to:

• Compare and contrast between Quality Assurance (focus on individual compliance with standards) and Quality Improvement (proactive systems improvement via integration of best practices).
• Define the “Model for Improvement.”
• Summarize the steps of the Shewart-Deming Plan Do Study Act (PDSA) cycle of improvement.
• Explain the value of demonstrating small gains and identifying failures for correction through rapid cycle improvement.
• Describe how lean methodology attempts to eliminate waste and Six Sigma attempts to reduce variation and defects within a process.
• Define commonly used QI tools and terms such as common cause and special cause variation, run charts, cumulative proportion charts, process map, and others.
• Cite examples of structure, process, outcome, and balancing metrics, attending to areas such as clinical, financial, resource use, and perceptions of care improvement.
• Summarize how QI supports effective development of care standardization, best practices, and practice guidelines in order to improve clinical outcomes.
• Discuss the importance of integrating evidence-based medicine into the planning stage of QI projects affecting patient care.
• Explain how QI can be effectively used for both clinical and system operations improvements using examples such as clinical care guidelines and hospital procedures.
• Describe the business case for quality and review why quality should drive cost and resource allocation.
• Define the role of the patient and family in QI and illustrate how their involvement or perspectives are central to QI project success.
• Discuss how interprofessional teams and a culture of commitment to QI impact the success of QI Programs.
• Explain the role of human factors in implementing healthcare improvements.
• List the attributes necessary to moderate, facilitate, and lead QI initiatives and discuss the importance of team building methods.
• Summarize how regulatory, accrediting, advocacy, research funders, and insurers impact QI initiatives and outcomes reporting for hospitalized children, attending to the Centers for Medicare and Medicaid, The Joint Commission, Agency for Healthcare Research and Quality, Leapfrog, and the National Quality Forum.
• Discuss the value of national, state, and local comparative quality data reporting and the clinical, educational, and research utility of national sources such as the Pediatric Health Information Dataset (PHIS).
• Review how reporting quality outcomes to external sources and posting on local hospital websites can affect the patient experience and community trust.
• Summarize the value of continuous participation in QI activities, noting the expectations from medical school through American Board of Pediatrics initial and ongoing certification.

Pediatric hospitalists should be able to:

• Identify processes in need of improvement and engage the appropriate personnel to gain approval for a QI project.
• Demonstrate proficiency in performing each step in a basic QI project.
• Demonstrate proficiency in utilizing basic QI tools such as a process map, key driver diagram, and fishbone diagram.
• Perform review of quality data, including basic data analysis, interpretation, and development of recommendations from the data.
• Serve as a liaison between physician staff and hospital administrative staff when interpreting physician-specific information and clinical care outliers.
• Utilize communication and leadership skills to participate effectively on an interdisciplinary team.
• Educate trainees, nursing staff, ancillary staff, and peers on the basic principles of QI.
• Assist with development of practice guidelines to assure delivery of standardized high value care in the hospital setting.
• Use best practice guidelines effectively and consistently.
• Demonstrate facility with the use of common computer applications, including spreadsheet and database management for information retrieval and analysis.

Pediatric hospitalists should be able to:

• Realize the value of leading as an “early adopter” and “change agent” by building an awareness of and consensus for changes needed to make patient care quality a high priority.
• Recognize the importance of team building, leadership, and family centeredness in performing effective QI.
• Acknowledge the importance of collaboration with healthcare providers critical to QI efforts, such as clinical team members, information technology staff, data analysts, and others.
• Seek opportunities to initiate or actively participate in QI projects.
• Work collaboratively to help create and maintain a QI culture within the institution.
• Exemplify professional behavior when reviewing and interpreting data.
• Recognize how value is defined by the patient and family/caregivers and support QI efforts to increase this value.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Engage hospital, medical group, and medical staff leadership in creating, implementing, and sustaining short- and long-term QI goals that add value for all customers.
• Participate on QI committees and seek opportunities to serve as QI officers or consultants.
• Advocate for the necessary information systems and other infrastructure to secure accurate data and assure success in the QI process.

Introduction

Patient safety is defined as freedom from accidental injury caused by medical care, such as harm or death attributable to adverse drug events, patient misidentifications, or health care-acquired infections. In 1999 the Institute of Medicine (IOM; now the National Academy of Medicine) published the “To Err is Human” report, which challenged United States healthcare systems and providers to recognize, report, and mitigate error and harm to patients. Children, as a vulnerable population, are at particular risk for medical errors and specifically medication errors. Pediatric hospitalists work in the acute care hospital setting where high-risk diagnostic decision-making, transitions of care, medication safety, and handoffs are commonly performed. Pediatric hospitalists therefore have a duty to promote patient safety and help develop and implement systems to reduce both error and harm to hospitalized children.

Pediatric hospitalists should be able to:

• Review the basic principles of patient safety, including systems redesign and the prevention, identification, and mitigation of preventable adverse events.
• Review the difference between error and harm including different types of errors.
• Cite the key components of a culture of safety.
• Review the fundamental components of a “Just Culture” and describe how organizations can achieve them.
• Discuss why errors are multifactorial and more often the result of systems failures rather than individual failures.
• Define the concept of “second victim” and review steps to support colleagues, trainees, and other providers when they become a second victim.
• Define common features of a “High Reliability Organization” and explain how high reliability principles apply to clinical care and work on patient safety initiatives.
• Review common patient safety interventions to reduce errors, including electronic order sets, practice guidelines, checklists, clinical decision support, double checks, bar coding, lock-out drawers, and others.
• Discuss factors unique to children that lead to increased risk for medication errors.
• Describe how using structured communication techniques, such as standardized handoffs, closed loop communication, active listening, and critical language are critical to safety.
• Describe the role of patient/family engagement in patient safety.
• Describe the safety components of hospital accreditation and how pediatric hospitalists can help ensure these standards are met.
• Describe common types of cognitive biases, such as premature closure, anchoring, and others, and review how they contribute to diagnostic error.
• Discuss the goals of national safety collaboratives, such as Solutions for Patient Safety (SPS) and describe safety bundles for common hospital-acquired conditions (HACs).
• Review the role of pediatric hospitalists in maintaining national safety goals required by common key accrediting organizations, such as The Joint Commission (TJC) and others.

Pediatric hospitalists should be able to:

• Demonstrate skill in creating an environment that reflects a high reliability organization.
• Facilitate safe and efficient hospital admissions and discharges.
• Identify and order the level of nursing care needed for safe patient care.
• Engage and educate patients and the family/caregivers on their role in ensuring patient safety.
• Utilize and participate in optimizing patient safety features of health information technology.
• Educate trainees, colleagues, and other healthcare providers on basic safety principles.
• Demonstrate proficiency in reporting errors using safety reporting systems.
• Work effectively and collaboratively with patient safety teams.
• Engage in patient safety event reviews, including (root) causal analyses, Morbidity and Mortality committees, and sentinel event reviews.
• Disclose medical errors clearly, concisely, and completely to patients and the family/caregivers.
• Participate in continuous readiness for accreditation agencies by consistently adhering to patient safety practices.

Pediatric hospitalists should be able to:

• Reflect on the importance of creating and sustaining a culture of patient safety.
• Role model behaviors that exemplify a “Just Culture,” accountability, and learning from failure.
• Recognize that patient safety improvements come from consistently reporting near misses as well as medical errors.
• Promote an awareness of the need for and will for change to make patient safety a high and consistent priority.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in multidisciplinary broad strategies to positively impact patient safety in the organization.
• Collaborate with hospital administration and community leaders for the necessary information systems and other infrastructure to ensure success with pediatric patient safety initiatives.
• Lead, coordinate, or participate in multidisciplinary initiatives to develop and implement patient safety interventions where possible.

• Actively participate in hospital-wide safety committees and seek to become leaders in pediatric patient safety in their institutions.

Introduction

Patient safety is defined as freedom from accidental injury caused by medical care, such as harm or death attributable to adverse drug events, patient misidentifications, or health care-acquired infections. In 1999 the Institute of Medicine (IOM; now the National Academy of Medicine) published the “To Err is Human” report, which challenged United States healthcare systems and providers to recognize, report, and mitigate error and harm to patients. Children, as a vulnerable population, are at particular risk for medical errors and specifically medication errors. Pediatric hospitalists work in the acute care hospital setting where high-risk diagnostic decision-making, transitions of care, medication safety, and handoffs are commonly performed. Pediatric hospitalists therefore have a duty to promote patient safety and help develop and implement systems to reduce both error and harm to hospitalized children.

Pediatric hospitalists should be able to:

• Review the basic principles of patient safety, including systems redesign and the prevention, identification, and mitigation of preventable adverse events.
• Review the difference between error and harm including different types of errors.
• Cite the key components of a culture of safety.
• Review the fundamental components of a “Just Culture” and describe how organizations can achieve them.
• Discuss why errors are multifactorial and more often the result of systems failures rather than individual failures.
• Define the concept of “second victim” and review steps to support colleagues, trainees, and other providers when they become a second victim.
• Define common features of a “High Reliability Organization” and explain how high reliability principles apply to clinical care and work on patient safety initiatives.
• Review common patient safety interventions to reduce errors, including electronic order sets, practice guidelines, checklists, clinical decision support, double checks, bar coding, lock-out drawers, and others.
• Discuss factors unique to children that lead to increased risk for medication errors.
• Describe how using structured communication techniques, such as standardized handoffs, closed loop communication, active listening, and critical language are critical to safety.
• Describe the role of patient/family engagement in patient safety.
• Describe the safety components of hospital accreditation and how pediatric hospitalists can help ensure these standards are met.
• Describe common types of cognitive biases, such as premature closure, anchoring, and others, and review how they contribute to diagnostic error.
• Discuss the goals of national safety collaboratives, such as Solutions for Patient Safety (SPS) and describe safety bundles for common hospital-acquired conditions (HACs).
• Review the role of pediatric hospitalists in maintaining national safety goals required by common key accrediting organizations, such as The Joint Commission (TJC) and others.

Pediatric hospitalists should be able to:

• Demonstrate skill in creating an environment that reflects a high reliability organization.
• Facilitate safe and efficient hospital admissions and discharges.
• Identify and order the level of nursing care needed for safe patient care.
• Engage and educate patients and the family/caregivers on their role in ensuring patient safety.
• Utilize and participate in optimizing patient safety features of health information technology.
• Educate trainees, colleagues, and other healthcare providers on basic safety principles.
• Demonstrate proficiency in reporting errors using safety reporting systems.
• Work effectively and collaboratively with patient safety teams.
• Engage in patient safety event reviews, including (root) causal analyses, Morbidity and Mortality committees, and sentinel event reviews.
• Disclose medical errors clearly, concisely, and completely to patients and the family/caregivers.
• Participate in continuous readiness for accreditation agencies by consistently adhering to patient safety practices.

Pediatric hospitalists should be able to:

• Reflect on the importance of creating and sustaining a culture of patient safety.
• Role model behaviors that exemplify a “Just Culture,” accountability, and learning from failure.
• Recognize that patient safety improvements come from consistently reporting near misses as well as medical errors.
• Promote an awareness of the need for and will for change to make patient safety a high and consistent priority.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in multidisciplinary broad strategies to positively impact patient safety in the organization.
• Collaborate with hospital administration and community leaders for the necessary information systems and other infrastructure to ensure success with pediatric patient safety initiatives.
• Lead, coordinate, or participate in multidisciplinary initiatives to develop and implement patient safety interventions where possible.

• Actively participate in hospital-wide safety committees and seek to become leaders in pediatric patient safety in their institutions.

Introduction

Patient safety is defined as freedom from accidental injury caused by medical care, such as harm or death attributable to adverse drug events, patient misidentifications, or health care-acquired infections. In 1999 the Institute of Medicine (IOM; now the National Academy of Medicine) published the “To Err is Human” report, which challenged United States healthcare systems and providers to recognize, report, and mitigate error and harm to patients. Children, as a vulnerable population, are at particular risk for medical errors and specifically medication errors. Pediatric hospitalists work in the acute care hospital setting where high-risk diagnostic decision-making, transitions of care, medication safety, and handoffs are commonly performed. Pediatric hospitalists therefore have a duty to promote patient safety and help develop and implement systems to reduce both error and harm to hospitalized children.

Pediatric hospitalists should be able to:

• Review the basic principles of patient safety, including systems redesign and the prevention, identification, and mitigation of preventable adverse events.
• Review the difference between error and harm including different types of errors.
• Cite the key components of a culture of safety.
• Review the fundamental components of a “Just Culture” and describe how organizations can achieve them.
• Discuss why errors are multifactorial and more often the result of systems failures rather than individual failures.
• Define the concept of “second victim” and review steps to support colleagues, trainees, and other providers when they become a second victim.
• Define common features of a “High Reliability Organization” and explain how high reliability principles apply to clinical care and work on patient safety initiatives.
• Review common patient safety interventions to reduce errors, including electronic order sets, practice guidelines, checklists, clinical decision support, double checks, bar coding, lock-out drawers, and others.
• Discuss factors unique to children that lead to increased risk for medication errors.
• Describe how using structured communication techniques, such as standardized handoffs, closed loop communication, active listening, and critical language are critical to safety.
• Describe the role of patient/family engagement in patient safety.
• Describe the safety components of hospital accreditation and how pediatric hospitalists can help ensure these standards are met.
• Describe common types of cognitive biases, such as premature closure, anchoring, and others, and review how they contribute to diagnostic error.
• Discuss the goals of national safety collaboratives, such as Solutions for Patient Safety (SPS) and describe safety bundles for common hospital-acquired conditions (HACs).
• Review the role of pediatric hospitalists in maintaining national safety goals required by common key accrediting organizations, such as The Joint Commission (TJC) and others.

Pediatric hospitalists should be able to:

• Demonstrate skill in creating an environment that reflects a high reliability organization.
• Facilitate safe and efficient hospital admissions and discharges.
• Identify and order the level of nursing care needed for safe patient care.
• Engage and educate patients and the family/caregivers on their role in ensuring patient safety.
• Utilize and participate in optimizing patient safety features of health information technology.
• Educate trainees, colleagues, and other healthcare providers on basic safety principles.
• Demonstrate proficiency in reporting errors using safety reporting systems.
• Work effectively and collaboratively with patient safety teams.
• Engage in patient safety event reviews, including (root) causal analyses, Morbidity and Mortality committees, and sentinel event reviews.
• Disclose medical errors clearly, concisely, and completely to patients and the family/caregivers.
• Participate in continuous readiness for accreditation agencies by consistently adhering to patient safety practices.

Pediatric hospitalists should be able to:

• Reflect on the importance of creating and sustaining a culture of patient safety.
• Role model behaviors that exemplify a “Just Culture,” accountability, and learning from failure.
• Recognize that patient safety improvements come from consistently reporting near misses as well as medical errors.
• Promote an awareness of the need for and will for change to make patient safety a high and consistent priority.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in multidisciplinary broad strategies to positively impact patient safety in the organization.
• Collaborate with hospital administration and community leaders for the necessary information systems and other infrastructure to ensure success with pediatric patient safety initiatives.
• Lead, coordinate, or participate in multidisciplinary initiatives to develop and implement patient safety interventions where possible.

• Actively participate in hospital-wide safety committees and seek to become leaders in pediatric patient safety in their institutions.

Introduction

Risk Management is a discipline commonly perceived to be the domain of institutional personnel and committees who are called upon to address adverse events that have already occurred. However, consequence management is far from the most effective utilization of such resources, as they are most efficiently and ethically deployed in preventive programs. Risk management therefore prospectively draws upon the disciplines of patient safety, performance improvement, systems management (including engineering and technology), ethics, and human factors in addition to medicine, in an effort to eliminate or ameliorate the undesirable consequences of delivering healthcare services. Hospitalized children are a highly vulnerable population due to social dependencies and developmental needs and have unique legal regulations that may impact care delivery. Pediatric hospitalists deliver care in this acute, high-risk healthcare environment and should be knowledgeable about legal and regulatory requirements, prevention strategies, and ways in which to collaborate with other professionals in management of hospitalized children.

Pediatric hospitalists should be able to:

• Summarize the role of common entities that accredit and license organizations, including The Joint Commission (TJC), the Centers for Medicare and Medicaid Services (CMS), and state health departments.
• Cite examples of how interfacility transfer of patients may be affected by the Emergency Medical Treatment and Active Labor Act (EMTALA).
• Summarize the basic regulatory and legal stipulations that may impact pediatric hospitalist contracting and practice, as noted in the anti-kickback regulations (Stark Rules) and anti-trust regulations (Sherman Act).
• Discuss the importance of fraud and abuse regulations for billing, coding, documentation, collections, utilization review, and managed care operations.
• Describe the common features of privacy regulations, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Review the role of physician licensing and oversight agencies such as the state Medical Board, National Practitioner Data Bank, and Drug Enforcement Agency.
• Define “medical liability,” “standard of practice,” and “negligence” and discuss the role of state malpractice statutes of limitation for children.
• Discuss the role of behavior and attitudes in generating patient and family/caregiver complaints.
• Describe the behavioral and physical characteristics of the impaired practitioner, including fatigue, substance abuse, and disruptive behavior.
• Summarize the role of the hospital medical staff in granting clinical privileges and initiating disciplinary actions through peer review process.
• List responsibilities associated with maintaining malpractice insurance, including documentation and disclosure requirements.
• Define the terms “assent” and “consent” and describe the circumstances in which informed assent or consent is needed.
• Give an example of legal issues that can arise in various clinical scenarios, such as end of life care, “no code” discussions (do-not-resuscitate or allow-natural-death), organ donation, guardianship, and newborn resuscitation.
• Describe the role of pediatric hospitalists in appropriate and timely notification to risk management or hospital counsel when medical errors or preventable events occur.
• Describe the role of pediatric hospitalists in recognizing and reporting family violence for the child, spouse, or elder.
• Provide examples of potential errors related to devices and technology, including Electronic Health Record (EHR) data entry, use, and documentation, privacy, device alert fatigue, and others.
• Review the relationship between human factors, design factors, risk management, patient safety, and quality improvement.

Pediatric hospitalists should be able to:

• Obtain informed assent and/or consent from patients and/or the family/caregivers.
• Disclose medical errors clearly, concisely, and completely to patients and the family/caregivers.
• Communicate in difficult situations and when delivering sensitive information, with compassion and a professional attitude.
• Support and communicate end-of-life decisions and planning.
• Transfer patient information concisely and precisely to other healthcare providers during all transitions of care.
• Prescribe treatments using safe medication prescribing practices.
• Document in the medical record with accuracy and appropriate detail.
• Identify when legal and risk management notification and/or expert consultation is indicated and initiate the escalation process.
• Demonstrate basic skills in utilizing risk reduction strategies, in partnership with local legal and risk management experts.

Pediatric hospitalists should be able to:

• Role model professional behavior.
• Recognize the importance of responding to complaints in a compassionate and sensitive manner.
• Reflect on the importance of collaborating with legal and risk management experts to learn and practice risk reduction strategies, such as failure modes and effects analysis (FMEA) and others.
• Reflect on and provide support and education for trainees in discussions on the importance of communication and documentation from the legal and risk management perspective.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in organizational risk management efforts and promote risk prevention by active participation in appropriate hospital committees.
• Collaborate with hospital administration and other colleagues to advocate for and modify systems and processes that help risk reduction.
• Lead, coordinate, or participate in healthcare information systems related initiatives that enhance the ease and accuracy of documentation and prescribing.
• Lead, coordinate, or participate in efforts to create a comprehensive risk reduction program encompassing education for hospital staff, medical staff, and trainees.

Introduction

Risk Management is a discipline commonly perceived to be the domain of institutional personnel and committees who are called upon to address adverse events that have already occurred. However, consequence management is far from the most effective utilization of such resources, as they are most efficiently and ethically deployed in preventive programs. Risk management therefore prospectively draws upon the disciplines of patient safety, performance improvement, systems management (including engineering and technology), ethics, and human factors in addition to medicine, in an effort to eliminate or ameliorate the undesirable consequences of delivering healthcare services. Hospitalized children are a highly vulnerable population due to social dependencies and developmental needs and have unique legal regulations that may impact care delivery. Pediatric hospitalists deliver care in this acute, high-risk healthcare environment and should be knowledgeable about legal and regulatory requirements, prevention strategies, and ways in which to collaborate with other professionals in management of hospitalized children.

Pediatric hospitalists should be able to:

• Summarize the role of common entities that accredit and license organizations, including The Joint Commission (TJC), the Centers for Medicare and Medicaid Services (CMS), and state health departments.
• Cite examples of how interfacility transfer of patients may be affected by the Emergency Medical Treatment and Active Labor Act (EMTALA).
• Summarize the basic regulatory and legal stipulations that may impact pediatric hospitalist contracting and practice, as noted in the anti-kickback regulations (Stark Rules) and anti-trust regulations (Sherman Act).
• Discuss the importance of fraud and abuse regulations for billing, coding, documentation, collections, utilization review, and managed care operations.
• Describe the common features of privacy regulations, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Review the role of physician licensing and oversight agencies such as the state Medical Board, National Practitioner Data Bank, and Drug Enforcement Agency.
• Define “medical liability,” “standard of practice,” and “negligence” and discuss the role of state malpractice statutes of limitation for children.
• Discuss the role of behavior and attitudes in generating patient and family/caregiver complaints.
• Describe the behavioral and physical characteristics of the impaired practitioner, including fatigue, substance abuse, and disruptive behavior.
• Summarize the role of the hospital medical staff in granting clinical privileges and initiating disciplinary actions through peer review process.
• List responsibilities associated with maintaining malpractice insurance, including documentation and disclosure requirements.
• Define the terms “assent” and “consent” and describe the circumstances in which informed assent or consent is needed.
• Give an example of legal issues that can arise in various clinical scenarios, such as end of life care, “no code” discussions (do-not-resuscitate or allow-natural-death), organ donation, guardianship, and newborn resuscitation.
• Describe the role of pediatric hospitalists in appropriate and timely notification to risk management or hospital counsel when medical errors or preventable events occur.
• Describe the role of pediatric hospitalists in recognizing and reporting family violence for the child, spouse, or elder.
• Provide examples of potential errors related to devices and technology, including Electronic Health Record (EHR) data entry, use, and documentation, privacy, device alert fatigue, and others.
• Review the relationship between human factors, design factors, risk management, patient safety, and quality improvement.

Pediatric hospitalists should be able to:

• Obtain informed assent and/or consent from patients and/or the family/caregivers.
• Disclose medical errors clearly, concisely, and completely to patients and the family/caregivers.
• Communicate in difficult situations and when delivering sensitive information, with compassion and a professional attitude.
• Support and communicate end-of-life decisions and planning.
• Transfer patient information concisely and precisely to other healthcare providers during all transitions of care.
• Prescribe treatments using safe medication prescribing practices.
• Document in the medical record with accuracy and appropriate detail.
• Identify when legal and risk management notification and/or expert consultation is indicated and initiate the escalation process.
• Demonstrate basic skills in utilizing risk reduction strategies, in partnership with local legal and risk management experts.

Pediatric hospitalists should be able to:

• Role model professional behavior.
• Recognize the importance of responding to complaints in a compassionate and sensitive manner.
• Reflect on the importance of collaborating with legal and risk management experts to learn and practice risk reduction strategies, such as failure modes and effects analysis (FMEA) and others.
• Reflect on and provide support and education for trainees in discussions on the importance of communication and documentation from the legal and risk management perspective.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in organizational risk management efforts and promote risk prevention by active participation in appropriate hospital committees.
• Collaborate with hospital administration and other colleagues to advocate for and modify systems and processes that help risk reduction.
• Lead, coordinate, or participate in healthcare information systems related initiatives that enhance the ease and accuracy of documentation and prescribing.
• Lead, coordinate, or participate in efforts to create a comprehensive risk reduction program encompassing education for hospital staff, medical staff, and trainees.

Introduction

Risk Management is a discipline commonly perceived to be the domain of institutional personnel and committees who are called upon to address adverse events that have already occurred. However, consequence management is far from the most effective utilization of such resources, as they are most efficiently and ethically deployed in preventive programs. Risk management therefore prospectively draws upon the disciplines of patient safety, performance improvement, systems management (including engineering and technology), ethics, and human factors in addition to medicine, in an effort to eliminate or ameliorate the undesirable consequences of delivering healthcare services. Hospitalized children are a highly vulnerable population due to social dependencies and developmental needs and have unique legal regulations that may impact care delivery. Pediatric hospitalists deliver care in this acute, high-risk healthcare environment and should be knowledgeable about legal and regulatory requirements, prevention strategies, and ways in which to collaborate with other professionals in management of hospitalized children.

Pediatric hospitalists should be able to:

• Summarize the role of common entities that accredit and license organizations, including The Joint Commission (TJC), the Centers for Medicare and Medicaid Services (CMS), and state health departments.
• Cite examples of how interfacility transfer of patients may be affected by the Emergency Medical Treatment and Active Labor Act (EMTALA).
• Summarize the basic regulatory and legal stipulations that may impact pediatric hospitalist contracting and practice, as noted in the anti-kickback regulations (Stark Rules) and anti-trust regulations (Sherman Act).
• Discuss the importance of fraud and abuse regulations for billing, coding, documentation, collections, utilization review, and managed care operations.
• Describe the common features of privacy regulations, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Review the role of physician licensing and oversight agencies such as the state Medical Board, National Practitioner Data Bank, and Drug Enforcement Agency.
• Define “medical liability,” “standard of practice,” and “negligence” and discuss the role of state malpractice statutes of limitation for children.
• Discuss the role of behavior and attitudes in generating patient and family/caregiver complaints.
• Describe the behavioral and physical characteristics of the impaired practitioner, including fatigue, substance abuse, and disruptive behavior.
• Summarize the role of the hospital medical staff in granting clinical privileges and initiating disciplinary actions through peer review process.
• List responsibilities associated with maintaining malpractice insurance, including documentation and disclosure requirements.
• Define the terms “assent” and “consent” and describe the circumstances in which informed assent or consent is needed.
• Give an example of legal issues that can arise in various clinical scenarios, such as end of life care, “no code” discussions (do-not-resuscitate or allow-natural-death), organ donation, guardianship, and newborn resuscitation.
• Describe the role of pediatric hospitalists in appropriate and timely notification to risk management or hospital counsel when medical errors or preventable events occur.
• Describe the role of pediatric hospitalists in recognizing and reporting family violence for the child, spouse, or elder.
• Provide examples of potential errors related to devices and technology, including Electronic Health Record (EHR) data entry, use, and documentation, privacy, device alert fatigue, and others.
• Review the relationship between human factors, design factors, risk management, patient safety, and quality improvement.

Pediatric hospitalists should be able to:

• Obtain informed assent and/or consent from patients and/or the family/caregivers.
• Disclose medical errors clearly, concisely, and completely to patients and the family/caregivers.
• Communicate in difficult situations and when delivering sensitive information, with compassion and a professional attitude.
• Support and communicate end-of-life decisions and planning.
• Transfer patient information concisely and precisely to other healthcare providers during all transitions of care.
• Prescribe treatments using safe medication prescribing practices.
• Document in the medical record with accuracy and appropriate detail.
• Identify when legal and risk management notification and/or expert consultation is indicated and initiate the escalation process.
• Demonstrate basic skills in utilizing risk reduction strategies, in partnership with local legal and risk management experts.

Pediatric hospitalists should be able to:

• Role model professional behavior.
• Recognize the importance of responding to complaints in a compassionate and sensitive manner.
• Reflect on the importance of collaborating with legal and risk management experts to learn and practice risk reduction strategies, such as failure modes and effects analysis (FMEA) and others.
• Reflect on and provide support and education for trainees in discussions on the importance of communication and documentation from the legal and risk management perspective.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in organizational risk management efforts and promote risk prevention by active participation in appropriate hospital committees.
• Collaborate with hospital administration and other colleagues to advocate for and modify systems and processes that help risk reduction.
• Lead, coordinate, or participate in healthcare information systems related initiatives that enhance the ease and accuracy of documentation and prescribing.
• Lead, coordinate, or participate in efforts to create a comprehensive risk reduction program encompassing education for hospital staff, medical staff, and trainees.

Introduction

Healthcare is complex and dynamic. As such, it requires leaders who understand its multiple components, including highly technical professions, longstanding institutions of care and education, third-party payers, and large supporting industries. Regulatory frameworks, fragmented incentives, and multidimensional determinants of health serve to further complicate healthcare processes. Leadership is a broad construct that involves individuals, interactions, and change. Leaders motivate and influence others using a combination of virtuous behavior and process-oriented management of change. Pediatric hospitalists are required to be leaders on a daily basis, in communication, interprofessional practice, high-performing teams, operational efficiency, quality improvement efforts, and family centered care. They often are involved in administration, where additional competencies in business and strategy are also useful. Pediatric hospitalists work in the most complex and expensive part of the healthcare system and are therefore well positioned to lead at the bedside, in programs, and in the larger healthcare system.

Pediatric hospitalists should be able to:

• Identify some common models or styles of leadership, such as transformational, transactional, autocratic, laissez-faire, task-oriented, and relationship-oriented leadership.
• Review the impact that differing leadership styles may have on quality improvement and patient safety efforts.
• Compare and contrast leadership styles with communication styles.
• Illustrate how utilizing leadership skills enhances performance when working clinically at the bedside, as well as when leading projects, programs, or other larger efforts.
• Identify the key aspects of a high-performing healthcare system, attending to continuous learning, equity, cost, patient experience, access, clinical quality, and patient safety.
• Identify the key aspects of a high-performing team, attending to mutual respect, recognition, communication, cohesion, mutual support, and situational awareness.
• Describe the importance of task and role clarity in team performance.
• List factors that impact team dynamics.
• Explain how respecting dignity and embracing cultural diversity in the context of family centered and interprofessional health care is central to effective leadership.
• Compare and contrast between leadership and management.
• Explain the importance of setting vision and strategy in leadership.
• List examples of commonly used group decision-making techniques, such as brainstorming, nominal group, Delphi, and dialectical inquiry.
• Define “change management” and review the role of leaders as change agents for projects and quality improvement processes.
• Discuss the impact of effective leadership of interprofessional teams on hospital daily operational efficiency and throughput.
• Describe the impact of effective leadership on quality improvement efforts, patient safety, high value care, hospital business, and population health outcomes.

Pediatric hospitalists should be able to:

• Demonstrate effective leadership skills in communication, de-escalation and conflict resolution and management of team dynamic problems.
• Lead family centered rounds with an interprofessional team.
• Execute efficient operations, such as hospital throughput, in collaboration with hospital administrative initiatives.
• Collaborate in interprofessional improvement initiatives.
• Demonstrate basic skills in leading an effective meeting that results in a specific outcome, decision, or action.

Pediatric hospitalists should be able to:

• Realize the value of cultural and professional diversity in interprofessional practice and family centered care.
• Model self-awareness, ethical behavior, integrity, and inclusiveness.
• Reflect on the importance of leadership as a journey of self-development.
• Exemplify effective delivery and receipt of constructive feedback.
• Recognize the interaction between business performance, healthcare delivery, and clinical outcomes in an evolving health care landscape.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate or participate in efforts to expand education and mentorship in leadership skills in pediatric hospital medicine.
• Participate and lead where appropriate in division, department or group, and hospital level committees to advocate for care of hospitalized children.
• Collaborate with and actively participate and lead where appropriate in medical staff related activities.

Introduction

Healthcare is complex and dynamic. As such, it requires leaders who understand its multiple components, including highly technical professions, longstanding institutions of care and education, third-party payers, and large supporting industries. Regulatory frameworks, fragmented incentives, and multidimensional determinants of health serve to further complicate healthcare processes. Leadership is a broad construct that involves individuals, interactions, and change. Leaders motivate and influence others using a combination of virtuous behavior and process-oriented management of change. Pediatric hospitalists are required to be leaders on a daily basis, in communication, interprofessional practice, high-performing teams, operational efficiency, quality improvement efforts, and family centered care. They often are involved in administration, where additional competencies in business and strategy are also useful. Pediatric hospitalists work in the most complex and expensive part of the healthcare system and are therefore well positioned to lead at the bedside, in programs, and in the larger healthcare system.

Pediatric hospitalists should be able to:

• Identify some common models or styles of leadership, such as transformational, transactional, autocratic, laissez-faire, task-oriented, and relationship-oriented leadership.
• Review the impact that differing leadership styles may have on quality improvement and patient safety efforts.
• Compare and contrast leadership styles with communication styles.
• Illustrate how utilizing leadership skills enhances performance when working clinically at the bedside, as well as when leading projects, programs, or other larger efforts.
• Identify the key aspects of a high-performing healthcare system, attending to continuous learning, equity, cost, patient experience, access, clinical quality, and patient safety.
• Identify the key aspects of a high-performing team, attending to mutual respect, recognition, communication, cohesion, mutual support, and situational awareness.
• Describe the importance of task and role clarity in team performance.
• List factors that impact team dynamics.
• Explain how respecting dignity and embracing cultural diversity in the context of family centered and interprofessional health care is central to effective leadership.
• Compare and contrast between leadership and management.
• Explain the importance of setting vision and strategy in leadership.
• List examples of commonly used group decision-making techniques, such as brainstorming, nominal group, Delphi, and dialectical inquiry.
• Define “change management” and review the role of leaders as change agents for projects and quality improvement processes.
• Discuss the impact of effective leadership of interprofessional teams on hospital daily operational efficiency and throughput.
• Describe the impact of effective leadership on quality improvement efforts, patient safety, high value care, hospital business, and population health outcomes.

Pediatric hospitalists should be able to:

• Demonstrate effective leadership skills in communication, de-escalation and conflict resolution and management of team dynamic problems.
• Lead family centered rounds with an interprofessional team.
• Execute efficient operations, such as hospital throughput, in collaboration with hospital administrative initiatives.
• Collaborate in interprofessional improvement initiatives.
• Demonstrate basic skills in leading an effective meeting that results in a specific outcome, decision, or action.

Pediatric hospitalists should be able to:

• Realize the value of cultural and professional diversity in interprofessional practice and family centered care.
• Model self-awareness, ethical behavior, integrity, and inclusiveness.
• Reflect on the importance of leadership as a journey of self-development.
• Exemplify effective delivery and receipt of constructive feedback.
• Recognize the interaction between business performance, healthcare delivery, and clinical outcomes in an evolving health care landscape.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate or participate in efforts to expand education and mentorship in leadership skills in pediatric hospital medicine.
• Participate and lead where appropriate in division, department or group, and hospital level committees to advocate for care of hospitalized children.
• Collaborate with and actively participate and lead where appropriate in medical staff related activities.

Introduction

Healthcare is complex and dynamic. As such, it requires leaders who understand its multiple components, including highly technical professions, longstanding institutions of care and education, third-party payers, and large supporting industries. Regulatory frameworks, fragmented incentives, and multidimensional determinants of health serve to further complicate healthcare processes. Leadership is a broad construct that involves individuals, interactions, and change. Leaders motivate and influence others using a combination of virtuous behavior and process-oriented management of change. Pediatric hospitalists are required to be leaders on a daily basis, in communication, interprofessional practice, high-performing teams, operational efficiency, quality improvement efforts, and family centered care. They often are involved in administration, where additional competencies in business and strategy are also useful. Pediatric hospitalists work in the most complex and expensive part of the healthcare system and are therefore well positioned to lead at the bedside, in programs, and in the larger healthcare system.

Pediatric hospitalists should be able to:

• Identify some common models or styles of leadership, such as transformational, transactional, autocratic, laissez-faire, task-oriented, and relationship-oriented leadership.
• Review the impact that differing leadership styles may have on quality improvement and patient safety efforts.
• Compare and contrast leadership styles with communication styles.
• Illustrate how utilizing leadership skills enhances performance when working clinically at the bedside, as well as when leading projects, programs, or other larger efforts.
• Identify the key aspects of a high-performing healthcare system, attending to continuous learning, equity, cost, patient experience, access, clinical quality, and patient safety.
• Identify the key aspects of a high-performing team, attending to mutual respect, recognition, communication, cohesion, mutual support, and situational awareness.
• Describe the importance of task and role clarity in team performance.
• List factors that impact team dynamics.
• Explain how respecting dignity and embracing cultural diversity in the context of family centered and interprofessional health care is central to effective leadership.
• Compare and contrast between leadership and management.
• Explain the importance of setting vision and strategy in leadership.
• List examples of commonly used group decision-making techniques, such as brainstorming, nominal group, Delphi, and dialectical inquiry.
• Define “change management” and review the role of leaders as change agents for projects and quality improvement processes.
• Discuss the impact of effective leadership of interprofessional teams on hospital daily operational efficiency and throughput.
• Describe the impact of effective leadership on quality improvement efforts, patient safety, high value care, hospital business, and population health outcomes.

Pediatric hospitalists should be able to:

• Demonstrate effective leadership skills in communication, de-escalation and conflict resolution and management of team dynamic problems.
• Lead family centered rounds with an interprofessional team.
• Execute efficient operations, such as hospital throughput, in collaboration with hospital administrative initiatives.
• Collaborate in interprofessional improvement initiatives.
• Demonstrate basic skills in leading an effective meeting that results in a specific outcome, decision, or action.

Pediatric hospitalists should be able to:

• Realize the value of cultural and professional diversity in interprofessional practice and family centered care.
• Model self-awareness, ethical behavior, integrity, and inclusiveness.
• Reflect on the importance of leadership as a journey of self-development.
• Exemplify effective delivery and receipt of constructive feedback.
• Recognize the interaction between business performance, healthcare delivery, and clinical outcomes in an evolving health care landscape.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate or participate in efforts to expand education and mentorship in leadership skills in pediatric hospital medicine.
• Participate and lead where appropriate in division, department or group, and hospital level committees to advocate for care of hospitalized children.
• Collaborate with and actively participate and lead where appropriate in medical staff related activities.

Introduction

Infections are one of the most common causes of hospitalization, morbidity, and mortality among children. Infections due to antibiotic resistant bacteria are an increasing burden on public health. Antibiotic exposure in both the ambulatory and hospital settings is a prime driver for development of antibiotic resistance and is a risk factor for developing infections which are increasingly due to multi-drug resistant organisms (MDROs). As the number of children surviving with significant medical complexity grows, the incidence of device-associated infections and of hospital-acquired (nosocomial) infections (HAI) is also rising. In addition, children are often more severely impacted when community outbreaks of infectious diseases occur, requiring rapid identification, containment, and treatment while limiting unnecessary antibiotic exposure. Pediatric hospitalists play a vital role in minimizing antimicrobial treatment risks to children through the judicious use of antimicrobials and participation in antimicrobial stewardship programs and practices.

Pediatric hospitalists should be able to:

• Describe common infection prevention measures used to reduce the spread of infection, including vaccinations, hand hygiene, and the use of personal protective equipment (PPE).
• Define commonly used infection control terms for precautions, such as standard, contact, droplet, airborne, protective (reverse) isolation, and transmission-based, and give an example of each.
• Explain the difference between community-acquired and hospital-acquired infections.
• Explain why antibiotic exposure is a prime driver of antibiotic resistance.
• Cite examples of commonly used daily practices that are integral to antimicrobial stewardship, such as judicious initiation of antimicrobials, appropriate use and interpretation of diagnostic microbiology, and narrowing the spectrum or discontinuation of antimicrobials.
• Delineate the risk for and types of infections associated with commonly used temporary medical devices, such as urinary catheters, intravenous access lines, chest tubes, nasogastric tubes, and others.
• Delineate the risk for and types of infections associated with common chronic medical devices, such as tracheostomy tubes, ventriculoperitoneal shunts, and others.
• Distinguish between empirical and definitive antimicrobial prescribing.
• Review the risks of repeated antimicrobial empiric therapy use for children with chronic medical complexity, attending to antimicrobial resistance for the host and community, antimicrobial side effects, and drug-drug interactions that may limit antimicrobial effectiveness.
• List common adverse effects of frequently prescribed antibiotics and antivirals for children hospitalized with routine infections, such as pneumonia, cellulitis, and fever in the infant, and discuss how antimicrobial stewardship and infection control practices may minimize these risks.
• List common strategies used by antimicrobial stewardship programs to optimize appropriate antimicrobial use, including prospective audit and feedback, formulary restrictions, automated stop dates for prescribed antibiotics, and 48-hour timeouts.
• Summarize common infection control practices used to minimize the risk of HAIs, including catheter-related bloodstream infections, urinary catheter infections, and others.
• List common multiple-drug resistant organisms (MDROs) and distinguish between infection control practices for these organisms compared to other infectious organisms.
• Review the clinical presentation of Clostridium difficile infection in children and discuss risk factors for it, including antibiotic exposure.
• Describe the relationship between antimicrobial stewardship, patient safety, and quality improvement, including clinical practice guidelines.
• Discuss how the hospital may be a potential venue for initial recognition of a community infectious disease outbreak and review the role that pediatric hospitalists can play in patient triage, admission decision-making, management, and hospital flow, attending to local context and resources.
• Review the relationship between community infection outbreaks and vaccination rates and discuss the role pediatric hospitalists can play in vaccination of hospitalized children.
• List which communicable diseases are mandatory to report to the local or state Department of Health.

Pediatric hospitalists should be able to:

• Demonstrate skills in recognizing the need for and ordering appropriate isolation precautions for children hospitalized with acute infection symptoms.
• Determine the need for and order appropriate contact precautions for children hospitalized with a history of MDRO infection, including methicillin-resistant Staphylococcus aureus (MRSA) and multi-drug resistant gram-negative bacteria.
• Select and order appropriate diagnostic studies for commonly encountered infections, including serologies, polymerase chain reaction (PCR) tests, cultures and sensitivities for varied organisms (including bacterial, viral, and fungal), and other rapid diagnostic testing for pathogens as available in the local context.
• Interpret diagnostic testing results efficiently and initiate appropriate treatment based on the results.
• Interpret diagnostic testing performed related to medical devices, distinguishing between infection and colonization, and initiate or change treatment based on the results.
• Participate actively in infection prevention and control programs.
• Utilize antimicrobial best practices that are embedded in local clinical pathways.
• Identify common signs and symptoms of possible device-associated infection.
• Interpret a hospital antibiogram to guide selection of antibiotic therapy.
• Identify opportunities to limit antimicrobial exposure among hospitalized children receiving empirical antibiotic therapy and initiate action for a given patient or population of patients.
• Develop and execute antibiotic treatment plans that maximize the safety of antibiotic use, including transitions to oral antibiotics when appropriate, limiting treatment duration, and discontinuing antibiotics.
• Communicate and educate patient and the family/caregivers regarding the risks and benefits of antimicrobial treatment and the importance of adhering to infection control practices, including rules regarding visitation during infectious seasons or outbreaks.

Pediatric hospitalists should be able to:

• Recognize that infection control practices are a primary means of reducing the risk of harm to hospitalized children.
• Reflect on the importance of collaboration with infectious diseases specialists and pharmacists to improve the judicious use of antibiotics.
• Role model infection control practices at the bedside including appropriate empirical and definitive antibiotic therapy practices.
• Reflect on the impact that infection control practices may have on patients and the family/caregivers.
• Recognize how adhering to infection control practices and antimicrobial stewardship for a given patient influences risks for the patient and the larger community.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with hospital staff, infection prevention specialists, hospital epidemiologists, microbiology laboratory, and others in multidisciplinary initiatives to monitor and prevent community-acquired and nosocomial infections.
• Coordinate or participate in the local antimicrobial stewardship program to develop and implement evidence-based guidelines for antimicrobial use.
• Lead, coordinate, or participate in the local program to reduce the incidence of hospital-acquired infections.
• Lead, coordinate, or participate in efforts to educate staff, trainees, patients, and the family/caregivers on the importance of infection control and antimicrobial stewardship.

Introduction

Infections are one of the most common causes of hospitalization, morbidity, and mortality among children. Infections due to antibiotic resistant bacteria are an increasing burden on public health. Antibiotic exposure in both the ambulatory and hospital settings is a prime driver for development of antibiotic resistance and is a risk factor for developing infections which are increasingly due to multi-drug resistant organisms (MDROs). As the number of children surviving with significant medical complexity grows, the incidence of device-associated infections and of hospital-acquired (nosocomial) infections (HAI) is also rising. In addition, children are often more severely impacted when community outbreaks of infectious diseases occur, requiring rapid identification, containment, and treatment while limiting unnecessary antibiotic exposure. Pediatric hospitalists play a vital role in minimizing antimicrobial treatment risks to children through the judicious use of antimicrobials and participation in antimicrobial stewardship programs and practices.

Pediatric hospitalists should be able to:

• Describe common infection prevention measures used to reduce the spread of infection, including vaccinations, hand hygiene, and the use of personal protective equipment (PPE).
• Define commonly used infection control terms for precautions, such as standard, contact, droplet, airborne, protective (reverse) isolation, and transmission-based, and give an example of each.
• Explain the difference between community-acquired and hospital-acquired infections.
• Explain why antibiotic exposure is a prime driver of antibiotic resistance.
• Cite examples of commonly used daily practices that are integral to antimicrobial stewardship, such as judicious initiation of antimicrobials, appropriate use and interpretation of diagnostic microbiology, and narrowing the spectrum or discontinuation of antimicrobials.
• Delineate the risk for and types of infections associated with commonly used temporary medical devices, such as urinary catheters, intravenous access lines, chest tubes, nasogastric tubes, and others.
• Delineate the risk for and types of infections associated with common chronic medical devices, such as tracheostomy tubes, ventriculoperitoneal shunts, and others.
• Distinguish between empirical and definitive antimicrobial prescribing.
• Review the risks of repeated antimicrobial empiric therapy use for children with chronic medical complexity, attending to antimicrobial resistance for the host and community, antimicrobial side effects, and drug-drug interactions that may limit antimicrobial effectiveness.
• List common adverse effects of frequently prescribed antibiotics and antivirals for children hospitalized with routine infections, such as pneumonia, cellulitis, and fever in the infant, and discuss how antimicrobial stewardship and infection control practices may minimize these risks.
• List common strategies used by antimicrobial stewardship programs to optimize appropriate antimicrobial use, including prospective audit and feedback, formulary restrictions, automated stop dates for prescribed antibiotics, and 48-hour timeouts.
• Summarize common infection control practices used to minimize the risk of HAIs, including catheter-related bloodstream infections, urinary catheter infections, and others.
• List common multiple-drug resistant organisms (MDROs) and distinguish between infection control practices for these organisms compared to other infectious organisms.
• Review the clinical presentation of Clostridium difficile infection in children and discuss risk factors for it, including antibiotic exposure.
• Describe the relationship between antimicrobial stewardship, patient safety, and quality improvement, including clinical practice guidelines.
• Discuss how the hospital may be a potential venue for initial recognition of a community infectious disease outbreak and review the role that pediatric hospitalists can play in patient triage, admission decision-making, management, and hospital flow, attending to local context and resources.
• Review the relationship between community infection outbreaks and vaccination rates and discuss the role pediatric hospitalists can play in vaccination of hospitalized children.
• List which communicable diseases are mandatory to report to the local or state Department of Health.

Pediatric hospitalists should be able to:

• Demonstrate skills in recognizing the need for and ordering appropriate isolation precautions for children hospitalized with acute infection symptoms.
• Determine the need for and order appropriate contact precautions for children hospitalized with a history of MDRO infection, including methicillin-resistant Staphylococcus aureus (MRSA) and multi-drug resistant gram-negative bacteria.
• Select and order appropriate diagnostic studies for commonly encountered infections, including serologies, polymerase chain reaction (PCR) tests, cultures and sensitivities for varied organisms (including bacterial, viral, and fungal), and other rapid diagnostic testing for pathogens as available in the local context.
• Interpret diagnostic testing results efficiently and initiate appropriate treatment based on the results.
• Interpret diagnostic testing performed related to medical devices, distinguishing between infection and colonization, and initiate or change treatment based on the results.
• Participate actively in infection prevention and control programs.
• Utilize antimicrobial best practices that are embedded in local clinical pathways.
• Identify common signs and symptoms of possible device-associated infection.
• Interpret a hospital antibiogram to guide selection of antibiotic therapy.
• Identify opportunities to limit antimicrobial exposure among hospitalized children receiving empirical antibiotic therapy and initiate action for a given patient or population of patients.
• Develop and execute antibiotic treatment plans that maximize the safety of antibiotic use, including transitions to oral antibiotics when appropriate, limiting treatment duration, and discontinuing antibiotics.
• Communicate and educate patient and the family/caregivers regarding the risks and benefits of antimicrobial treatment and the importance of adhering to infection control practices, including rules regarding visitation during infectious seasons or outbreaks.

Pediatric hospitalists should be able to:

• Recognize that infection control practices are a primary means of reducing the risk of harm to hospitalized children.
• Reflect on the importance of collaboration with infectious diseases specialists and pharmacists to improve the judicious use of antibiotics.
• Role model infection control practices at the bedside including appropriate empirical and definitive antibiotic therapy practices.
• Reflect on the impact that infection control practices may have on patients and the family/caregivers.
• Recognize how adhering to infection control practices and antimicrobial stewardship for a given patient influences risks for the patient and the larger community.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with hospital staff, infection prevention specialists, hospital epidemiologists, microbiology laboratory, and others in multidisciplinary initiatives to monitor and prevent community-acquired and nosocomial infections.
• Coordinate or participate in the local antimicrobial stewardship program to develop and implement evidence-based guidelines for antimicrobial use.
• Lead, coordinate, or participate in the local program to reduce the incidence of hospital-acquired infections.
• Lead, coordinate, or participate in efforts to educate staff, trainees, patients, and the family/caregivers on the importance of infection control and antimicrobial stewardship.

Introduction

Infections are one of the most common causes of hospitalization, morbidity, and mortality among children. Infections due to antibiotic resistant bacteria are an increasing burden on public health. Antibiotic exposure in both the ambulatory and hospital settings is a prime driver for development of antibiotic resistance and is a risk factor for developing infections which are increasingly due to multi-drug resistant organisms (MDROs). As the number of children surviving with significant medical complexity grows, the incidence of device-associated infections and of hospital-acquired (nosocomial) infections (HAI) is also rising. In addition, children are often more severely impacted when community outbreaks of infectious diseases occur, requiring rapid identification, containment, and treatment while limiting unnecessary antibiotic exposure. Pediatric hospitalists play a vital role in minimizing antimicrobial treatment risks to children through the judicious use of antimicrobials and participation in antimicrobial stewardship programs and practices.

Pediatric hospitalists should be able to:

• Describe common infection prevention measures used to reduce the spread of infection, including vaccinations, hand hygiene, and the use of personal protective equipment (PPE).
• Define commonly used infection control terms for precautions, such as standard, contact, droplet, airborne, protective (reverse) isolation, and transmission-based, and give an example of each.
• Explain the difference between community-acquired and hospital-acquired infections.
• Explain why antibiotic exposure is a prime driver of antibiotic resistance.
• Cite examples of commonly used daily practices that are integral to antimicrobial stewardship, such as judicious initiation of antimicrobials, appropriate use and interpretation of diagnostic microbiology, and narrowing the spectrum or discontinuation of antimicrobials.
• Delineate the risk for and types of infections associated with commonly used temporary medical devices, such as urinary catheters, intravenous access lines, chest tubes, nasogastric tubes, and others.
• Delineate the risk for and types of infections associated with common chronic medical devices, such as tracheostomy tubes, ventriculoperitoneal shunts, and others.
• Distinguish between empirical and definitive antimicrobial prescribing.
• Review the risks of repeated antimicrobial empiric therapy use for children with chronic medical complexity, attending to antimicrobial resistance for the host and community, antimicrobial side effects, and drug-drug interactions that may limit antimicrobial effectiveness.
• List common adverse effects of frequently prescribed antibiotics and antivirals for children hospitalized with routine infections, such as pneumonia, cellulitis, and fever in the infant, and discuss how antimicrobial stewardship and infection control practices may minimize these risks.
• List common strategies used by antimicrobial stewardship programs to optimize appropriate antimicrobial use, including prospective audit and feedback, formulary restrictions, automated stop dates for prescribed antibiotics, and 48-hour timeouts.
• Summarize common infection control practices used to minimize the risk of HAIs, including catheter-related bloodstream infections, urinary catheter infections, and others.
• List common multiple-drug resistant organisms (MDROs) and distinguish between infection control practices for these organisms compared to other infectious organisms.
• Review the clinical presentation of Clostridium difficile infection in children and discuss risk factors for it, including antibiotic exposure.
• Describe the relationship between antimicrobial stewardship, patient safety, and quality improvement, including clinical practice guidelines.
• Discuss how the hospital may be a potential venue for initial recognition of a community infectious disease outbreak and review the role that pediatric hospitalists can play in patient triage, admission decision-making, management, and hospital flow, attending to local context and resources.
• Review the relationship between community infection outbreaks and vaccination rates and discuss the role pediatric hospitalists can play in vaccination of hospitalized children.
• List which communicable diseases are mandatory to report to the local or state Department of Health.

Pediatric hospitalists should be able to:

• Demonstrate skills in recognizing the need for and ordering appropriate isolation precautions for children hospitalized with acute infection symptoms.
• Determine the need for and order appropriate contact precautions for children hospitalized with a history of MDRO infection, including methicillin-resistant Staphylococcus aureus (MRSA) and multi-drug resistant gram-negative bacteria.
• Select and order appropriate diagnostic studies for commonly encountered infections, including serologies, polymerase chain reaction (PCR) tests, cultures and sensitivities for varied organisms (including bacterial, viral, and fungal), and other rapid diagnostic testing for pathogens as available in the local context.
• Interpret diagnostic testing results efficiently and initiate appropriate treatment based on the results.
• Interpret diagnostic testing performed related to medical devices, distinguishing between infection and colonization, and initiate or change treatment based on the results.
• Participate actively in infection prevention and control programs.
• Utilize antimicrobial best practices that are embedded in local clinical pathways.
• Identify common signs and symptoms of possible device-associated infection.
• Interpret a hospital antibiogram to guide selection of antibiotic therapy.
• Identify opportunities to limit antimicrobial exposure among hospitalized children receiving empirical antibiotic therapy and initiate action for a given patient or population of patients.
• Develop and execute antibiotic treatment plans that maximize the safety of antibiotic use, including transitions to oral antibiotics when appropriate, limiting treatment duration, and discontinuing antibiotics.
• Communicate and educate patient and the family/caregivers regarding the risks and benefits of antimicrobial treatment and the importance of adhering to infection control practices, including rules regarding visitation during infectious seasons or outbreaks.

Pediatric hospitalists should be able to:

• Recognize that infection control practices are a primary means of reducing the risk of harm to hospitalized children.
• Reflect on the importance of collaboration with infectious diseases specialists and pharmacists to improve the judicious use of antibiotics.
• Role model infection control practices at the bedside including appropriate empirical and definitive antibiotic therapy practices.
• Reflect on the impact that infection control practices may have on patients and the family/caregivers.
• Recognize how adhering to infection control practices and antimicrobial stewardship for a given patient influences risks for the patient and the larger community.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with hospital staff, infection prevention specialists, hospital epidemiologists, microbiology laboratory, and others in multidisciplinary initiatives to monitor and prevent community-acquired and nosocomial infections.
• Coordinate or participate in the local antimicrobial stewardship program to develop and implement evidence-based guidelines for antimicrobial use.
• Lead, coordinate, or participate in the local program to reduce the incidence of hospital-acquired infections.
• Lead, coordinate, or participate in efforts to educate staff, trainees, patients, and the family/caregivers on the importance of infection control and antimicrobial stewardship.

Introduction

Value in healthcare is defined as quality achieved relative to cost. Quality encompasses individual patient and population health outcomes, safety, and experience while cost includes resource utilization and opportunity costs. In order to operationalize high value care (HVC), the Centers for Medicare and Medicaid chose to apply the Institute of Healthcare Improvement’s Triple Aim framework – improving the patient experience, improving the health of populations, and reducing the cost of health care. Pediatric hospitalists are well positioned to promote high value care by decreasing costs, increasing safety, enhancing the patient experience, improving efficiency of care delivery, and improving clinical outcomes. Pediatric hospitalists should deliver healthcare in a manner that optimizes value to the patient, patient populations, and the healthcare system.

Pediatric hospitalists should be able to:

• Discuss how providing “the right care at the right time in the right place” is necessary to optimize value to the patient and the system.
• Summarize the basic structure of the patient-centered health care delivery system, including the macro system (national and regional systems), the mesosystem (integrated inpatient and outpatient settings), and the microsystem (front line care between physician and patient).
• Summarize the National Academy of Medicine’s (formerly Institute of Medicine) six aims of healthcare: Safe, Timely, Efficient, Equitable, Effective, and Patient-centered care.
• State the importance of defining healthcare value as the ratio of quality over cost and compare and contrast value for a single episode of care for one patient versus for a population over time.
• Discuss how coordinated management of complex chronic diseases and development of integrated delivery systems can impact healthcare value for patients, the family/caregivers, and the healthcare system.
• Cite examples of how failure to coordinate and align care in and across each of the above systems can fragment healthcare delivery.
• Compare and contrast the definition of healthcare quality from the perspectives of different stakeholders, including the government, other payors, healthcare systems, hospital and medical staff, and patients and family/caregivers.
• Define the terms “overuse,” “over-diagnosis,” “over-testing,” and “over-treatment” and review how these may impact patient safety, the patient experience, and costs of care.
• Using evidence-based medicine principles, describe how best practices and streamlined clinical care result in increased healthcare value.
• Explain why hospitalists should have a working knowledge of the risks, benefits, harms, pretest probability, and relative costs of commonly performed healthcare tests and treatments.
• Review the goals of shared decision-making discussions and cite how healthcare value should reflect the patients’ and family/caregivers’ unique perspectives on goals of care .
• Provide examples of hospital care costs under control of the hospitalist and review how controlling costs for a single patient or population of patients impacts the value equation.
• Illustrate the importance of local considerations when prescribing a treatment plan, such as total cost, compliance, pediatric formulation, and insurance formulary lists.
• Summarize the relationship between patient safety, quality improvement, and high value care.

Pediatric hospitalists should be able to:

• Demonstrate skills in communicating indications for tests, procedures, and medications, with patients, the family/caregivers, consultants, and the healthcare team.
• Provide education and information to patients and the family/caregivers that assists them in understanding and choosing care that is supported by evidence.
• Identify costs to patients (including time, anxiety, expense, and clinical harm) and the healthcare system (including time, resources, and expense).
• Educate trainees on the definition of healthcare value and importance of cost considerations of medical care.
• Demonstrate proficiency in adhering to best practice protocols and guidelines.
• Identify interventions that provide no benefit to overall clinical health outcome and/or may be harmful and participate in abating or eliminating these practices.
• Participate in developing, utilizing, or reviewing performance reports to improve delivery of value-based care.
• Apply the concept of “Right patient, right place, right time” in practice, to maximize value to the patient and the healthcare system.
• Work effectively and collaboratively to integrate hospital discharge and post discharge care.

Pediatric hospitalists should be able to:

• Recognize the importance of providing preventive healthcare as part of a high value care.
• Role model resource utilization stewardship by allocating resources that result in high-value and evidence-based care.
• Realize the value of working collaboratively with other stakeholders to continuously improve health care outcomes in a patient centered and cost-effective manner.
• Demonstrate leadership and professionalism by proactively seeking feedback on clinical practice patterns to identify actions viewed as low-value or harmful to patients.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with hospital administration, colleagues, and other hospital staff to identify and share information about costs of care, including drugs, medical imaging, devices, procedures, and consultations.
• Support healthcare system efforts to gather and disseminate cost, quality, and safety data for use in monitoring quality and business improvement efforts.
• Promote standardization of clinical care based on local pathways or protocols and national clinical practice guidelines as tangible ways to improve adherence to best practices and increase value.
• Collaborate with hospital administrators to determine and direct policies that impact healthcare utilization.
• Provide leadership to affect change on a systemic level by identifying opportunities to improve outcomes, minimize harm, and reduce health care waste.

Introduction

Value in healthcare is defined as quality achieved relative to cost. Quality encompasses individual patient and population health outcomes, safety, and experience while cost includes resource utilization and opportunity costs. In order to operationalize high value care (HVC), the Centers for Medicare and Medicaid chose to apply the Institute of Healthcare Improvement’s Triple Aim framework – improving the patient experience, improving the health of populations, and reducing the cost of health care. Pediatric hospitalists are well positioned to promote high value care by decreasing costs, increasing safety, enhancing the patient experience, improving efficiency of care delivery, and improving clinical outcomes. Pediatric hospitalists should deliver healthcare in a manner that optimizes value to the patient, patient populations, and the healthcare system.

Pediatric hospitalists should be able to:

• Discuss how providing “the right care at the right time in the right place” is necessary to optimize value to the patient and the system.
• Summarize the basic structure of the patient-centered health care delivery system, including the macro system (national and regional systems), the mesosystem (integrated inpatient and outpatient settings), and the microsystem (front line care between physician and patient).
• Summarize the National Academy of Medicine’s (formerly Institute of Medicine) six aims of healthcare: Safe, Timely, Efficient, Equitable, Effective, and Patient-centered care.
• State the importance of defining healthcare value as the ratio of quality over cost and compare and contrast value for a single episode of care for one patient versus for a population over time.
• Discuss how coordinated management of complex chronic diseases and development of integrated delivery systems can impact healthcare value for patients, the family/caregivers, and the healthcare system.
• Cite examples of how failure to coordinate and align care in and across each of the above systems can fragment healthcare delivery.
• Compare and contrast the definition of healthcare quality from the perspectives of different stakeholders, including the government, other payors, healthcare systems, hospital and medical staff, and patients and family/caregivers.
• Define the terms “overuse,” “over-diagnosis,” “over-testing,” and “over-treatment” and review how these may impact patient safety, the patient experience, and costs of care.
• Using evidence-based medicine principles, describe how best practices and streamlined clinical care result in increased healthcare value.
• Explain why hospitalists should have a working knowledge of the risks, benefits, harms, pretest probability, and relative costs of commonly performed healthcare tests and treatments.
• Review the goals of shared decision-making discussions and cite how healthcare value should reflect the patients’ and family/caregivers’ unique perspectives on goals of care .
• Provide examples of hospital care costs under control of the hospitalist and review how controlling costs for a single patient or population of patients impacts the value equation.
• Illustrate the importance of local considerations when prescribing a treatment plan, such as total cost, compliance, pediatric formulation, and insurance formulary lists.
• Summarize the relationship between patient safety, quality improvement, and high value care.

Pediatric hospitalists should be able to:

• Demonstrate skills in communicating indications for tests, procedures, and medications, with patients, the family/caregivers, consultants, and the healthcare team.
• Provide education and information to patients and the family/caregivers that assists them in understanding and choosing care that is supported by evidence.
• Identify costs to patients (including time, anxiety, expense, and clinical harm) and the healthcare system (including time, resources, and expense).
• Educate trainees on the definition of healthcare value and importance of cost considerations of medical care.
• Demonstrate proficiency in adhering to best practice protocols and guidelines.
• Identify interventions that provide no benefit to overall clinical health outcome and/or may be harmful and participate in abating or eliminating these practices.
• Participate in developing, utilizing, or reviewing performance reports to improve delivery of value-based care.
• Apply the concept of “Right patient, right place, right time” in practice, to maximize value to the patient and the healthcare system.
• Work effectively and collaboratively to integrate hospital discharge and post discharge care.

Pediatric hospitalists should be able to:

• Recognize the importance of providing preventive healthcare as part of a high value care.
• Role model resource utilization stewardship by allocating resources that result in high-value and evidence-based care.
• Realize the value of working collaboratively with other stakeholders to continuously improve health care outcomes in a patient centered and cost-effective manner.
• Demonstrate leadership and professionalism by proactively seeking feedback on clinical practice patterns to identify actions viewed as low-value or harmful to patients.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with hospital administration, colleagues, and other hospital staff to identify and share information about costs of care, including drugs, medical imaging, devices, procedures, and consultations.
• Support healthcare system efforts to gather and disseminate cost, quality, and safety data for use in monitoring quality and business improvement efforts.
• Promote standardization of clinical care based on local pathways or protocols and national clinical practice guidelines as tangible ways to improve adherence to best practices and increase value.
• Collaborate with hospital administrators to determine and direct policies that impact healthcare utilization.
• Provide leadership to affect change on a systemic level by identifying opportunities to improve outcomes, minimize harm, and reduce health care waste.

Introduction

Value in healthcare is defined as quality achieved relative to cost. Quality encompasses individual patient and population health outcomes, safety, and experience while cost includes resource utilization and opportunity costs. In order to operationalize high value care (HVC), the Centers for Medicare and Medicaid chose to apply the Institute of Healthcare Improvement’s Triple Aim framework – improving the patient experience, improving the health of populations, and reducing the cost of health care. Pediatric hospitalists are well positioned to promote high value care by decreasing costs, increasing safety, enhancing the patient experience, improving efficiency of care delivery, and improving clinical outcomes. Pediatric hospitalists should deliver healthcare in a manner that optimizes value to the patient, patient populations, and the healthcare system.

Pediatric hospitalists should be able to:

• Discuss how providing “the right care at the right time in the right place” is necessary to optimize value to the patient and the system.
• Summarize the basic structure of the patient-centered health care delivery system, including the macro system (national and regional systems), the mesosystem (integrated inpatient and outpatient settings), and the microsystem (front line care between physician and patient).
• Summarize the National Academy of Medicine’s (formerly Institute of Medicine) six aims of healthcare: Safe, Timely, Efficient, Equitable, Effective, and Patient-centered care.
• State the importance of defining healthcare value as the ratio of quality over cost and compare and contrast value for a single episode of care for one patient versus for a population over time.
• Discuss how coordinated management of complex chronic diseases and development of integrated delivery systems can impact healthcare value for patients, the family/caregivers, and the healthcare system.
• Cite examples of how failure to coordinate and align care in and across each of the above systems can fragment healthcare delivery.
• Compare and contrast the definition of healthcare quality from the perspectives of different stakeholders, including the government, other payors, healthcare systems, hospital and medical staff, and patients and family/caregivers.
• Define the terms “overuse,” “over-diagnosis,” “over-testing,” and “over-treatment” and review how these may impact patient safety, the patient experience, and costs of care.
• Using evidence-based medicine principles, describe how best practices and streamlined clinical care result in increased healthcare value.
• Explain why hospitalists should have a working knowledge of the risks, benefits, harms, pretest probability, and relative costs of commonly performed healthcare tests and treatments.
• Review the goals of shared decision-making discussions and cite how healthcare value should reflect the patients’ and family/caregivers’ unique perspectives on goals of care .
• Provide examples of hospital care costs under control of the hospitalist and review how controlling costs for a single patient or population of patients impacts the value equation.
• Illustrate the importance of local considerations when prescribing a treatment plan, such as total cost, compliance, pediatric formulation, and insurance formulary lists.
• Summarize the relationship between patient safety, quality improvement, and high value care.

Pediatric hospitalists should be able to:

• Demonstrate skills in communicating indications for tests, procedures, and medications, with patients, the family/caregivers, consultants, and the healthcare team.
• Provide education and information to patients and the family/caregivers that assists them in understanding and choosing care that is supported by evidence.
• Identify costs to patients (including time, anxiety, expense, and clinical harm) and the healthcare system (including time, resources, and expense).
• Educate trainees on the definition of healthcare value and importance of cost considerations of medical care.
• Demonstrate proficiency in adhering to best practice protocols and guidelines.
• Identify interventions that provide no benefit to overall clinical health outcome and/or may be harmful and participate in abating or eliminating these practices.
• Participate in developing, utilizing, or reviewing performance reports to improve delivery of value-based care.
• Apply the concept of “Right patient, right place, right time” in practice, to maximize value to the patient and the healthcare system.
• Work effectively and collaboratively to integrate hospital discharge and post discharge care.

Pediatric hospitalists should be able to:

• Recognize the importance of providing preventive healthcare as part of a high value care.
• Role model resource utilization stewardship by allocating resources that result in high-value and evidence-based care.
• Realize the value of working collaboratively with other stakeholders to continuously improve health care outcomes in a patient centered and cost-effective manner.
• Demonstrate leadership and professionalism by proactively seeking feedback on clinical practice patterns to identify actions viewed as low-value or harmful to patients.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Collaborate with hospital administration, colleagues, and other hospital staff to identify and share information about costs of care, including drugs, medical imaging, devices, procedures, and consultations.
• Support healthcare system efforts to gather and disseminate cost, quality, and safety data for use in monitoring quality and business improvement efforts.
• Promote standardization of clinical care based on local pathways or protocols and national clinical practice guidelines as tangible ways to improve adherence to best practices and increase value.
• Collaborate with hospital administrators to determine and direct policies that impact healthcare utilization.
• Provide leadership to affect change on a systemic level by identifying opportunities to improve outcomes, minimize harm, and reduce health care waste.

Introduction

Health information technology (Health IT) is comprised of a range of digital tools used within the health care systems to collect, store, analyze, and share medical data. In today’s healthcare systems, health IT is an invaluable component for delivery of high-quality and safe care. Recognizing the role of health IT, the Institute of Medicine (now the National Academies of Medicine), in 1999, issued reports highlighting the potential of the electronic health record (EHR) in reducing medical errors through electronic order entry, facilitating care coordination, and improving clinical efficiencies. Despite these benefits, hospitals were slow to adopt these technologies until Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009. Under this act, standards were set for ‘meaningful use’ of health IT and substantial resources and incentives were provided to eligible hospitals and providers to offset EHR implementation costs. The result over the past decade has been widespread adoption of the EHR across the United States, although children’s hospitals remain at the slower end of the adoption curve. Pediatric hospitalists use health IT systems for clinical care, education, quality improvement (QI), patient safety efforts, and for research and thus play a critical role in implementing and optimizing health IT use within hospital systems.

Pediatric hospitalists should be able to:

• Describe the unique role of health IT in providing care to hospitalized children and the importance of careful design and implementation of health IT systems within hospitals and hospital systems that care for children.
• Describe the impact of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule on health IT security and the importance of secure storage and retrieval of protected health information.
• Explain the value of clinical decision support in rendering patient care.
• Compare and contrast the influence of health IT systems on practice management, clinical decision-making, QI initiatives, safety initiatives, and research in the healthcare setting.
• List resources that can be accessed to address questions about information systems, such as local system super users, hospital IT support, vendor support lines, online access to other healthcare providers who use the system, and others.
• Delineate how staff dedicated to health IT support quality and safety efforts and data retrieval.
• List information resources and tools available to support life-long learning in dynamic health IT.
• Discuss the importance of pediatric hospitalists in developing, modifying, and evaluating changes to health IT systems on an ongoing basis to optimize workflow and patient care.
• Recognize that dependence on technology for some clinical tasks is an unintended consequence that has arisen since the institution of the EHR.
• Give examples of human errors that can occur when using an EHR, such as medication entry errors, documenting in the wrong patient record, and others.
• Identify problems of a poorly designed EHR and describe how pediatric hospitalists can partner with hospital systems to mitigate these problems.
• Cite common risks that may occur when utilizing an EHR designed for adult aged patients and review actions to mitigate these risks for pediatric patients.

Pediatric hospitalists should be able to:

• Demonstrate proficiency with the local EHR or computerized provider order entry system.
• Access and use web-based educational resources for continuing education and enrichment of trainee learning experiences.
• Utilize local health IT systems for clinical care, education, QI and patient safety initiatives, and research in an effective and efficient manner.
• Assist in or champion the creation, ongoing maintenance, and optimization of electronic order sets and documentation templates.
• Assess and assist with improving and optimizing clinical decision support tools, including rules and alerts, to meet the changing needs of the health care system and hospitalized children.
• Use hospital health IT system downtime procedures to provide safe continued medical care to patients in the event of a system failure or shutdown.
• Demonstrate best practices in use of the EHR, such as use of “navigators” and order sets, importing relevant medical records where available, and avoiding potentially risky practices such as copy-paste where appropriate.
• Educate trainees on correct use of the EHR and edit and attest to trainee notes as appropriate.

Pediatric hospitalists should be able to:

• Exemplify accountability by adhering to regulations around proper use of health IT.
• Acknowledge the value of collaboration with healthcare providers, patients and the family/caregivers, and hospital administration to ensure the successful functioning of health IT systems.
• Advocate for the proper alignment of health IT system choices with clinical needs, particularly for pediatric-specific needs in predominantly adult healthcare systems.
• Realize the importance of communicating effectively with health IT system managers and leaders.
• Recognize and respect patient confidentiality by using the security-directed features of information systems.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in appropriate hospital and health systems committees to assist in developing and optimizing health IT solutions to improve quality, safety, and workflow efficiencies.
• Partner with hospital leaders and administration to optimize use of the EHR to improve clinical documentation and develop performance measures and dashboards for the hospitalist practice and the hospital system.
• Collaborate with family advisory groups, hospital administration, healthcare providers, and community partners to support and enhance the use of the EHR by patients and the family/caregivers.
• Partner with hospital administration and healthcare providers to integrate new technologies that improve pediatric hospital medicine practice and care delivery to the hospitalized child, such as clinical decision support tools, telemedicine, health information exchange, registries, and others.
• Seek opportunities to improve the role of health IT in managing costs and supporting quality and clinical research, as applicable.

Introduction

Health information technology (Health IT) is comprised of a range of digital tools used within the health care systems to collect, store, analyze, and share medical data. In today’s healthcare systems, health IT is an invaluable component for delivery of high-quality and safe care. Recognizing the role of health IT, the Institute of Medicine (now the National Academies of Medicine), in 1999, issued reports highlighting the potential of the electronic health record (EHR) in reducing medical errors through electronic order entry, facilitating care coordination, and improving clinical efficiencies. Despite these benefits, hospitals were slow to adopt these technologies until Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009. Under this act, standards were set for ‘meaningful use’ of health IT and substantial resources and incentives were provided to eligible hospitals and providers to offset EHR implementation costs. The result over the past decade has been widespread adoption of the EHR across the United States, although children’s hospitals remain at the slower end of the adoption curve. Pediatric hospitalists use health IT systems for clinical care, education, quality improvement (QI), patient safety efforts, and for research and thus play a critical role in implementing and optimizing health IT use within hospital systems.

Pediatric hospitalists should be able to:

• Describe the unique role of health IT in providing care to hospitalized children and the importance of careful design and implementation of health IT systems within hospitals and hospital systems that care for children.
• Describe the impact of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule on health IT security and the importance of secure storage and retrieval of protected health information.
• Explain the value of clinical decision support in rendering patient care.
• Compare and contrast the influence of health IT systems on practice management, clinical decision-making, QI initiatives, safety initiatives, and research in the healthcare setting.
• List resources that can be accessed to address questions about information systems, such as local system super users, hospital IT support, vendor support lines, online access to other healthcare providers who use the system, and others.
• Delineate how staff dedicated to health IT support quality and safety efforts and data retrieval.
• List information resources and tools available to support life-long learning in dynamic health IT.
• Discuss the importance of pediatric hospitalists in developing, modifying, and evaluating changes to health IT systems on an ongoing basis to optimize workflow and patient care.
• Recognize that dependence on technology for some clinical tasks is an unintended consequence that has arisen since the institution of the EHR.
• Give examples of human errors that can occur when using an EHR, such as medication entry errors, documenting in the wrong patient record, and others.
• Identify problems of a poorly designed EHR and describe how pediatric hospitalists can partner with hospital systems to mitigate these problems.
• Cite common risks that may occur when utilizing an EHR designed for adult aged patients and review actions to mitigate these risks for pediatric patients.

Pediatric hospitalists should be able to:

• Demonstrate proficiency with the local EHR or computerized provider order entry system.
• Access and use web-based educational resources for continuing education and enrichment of trainee learning experiences.
• Utilize local health IT systems for clinical care, education, QI and patient safety initiatives, and research in an effective and efficient manner.
• Assist in or champion the creation, ongoing maintenance, and optimization of electronic order sets and documentation templates.
• Assess and assist with improving and optimizing clinical decision support tools, including rules and alerts, to meet the changing needs of the health care system and hospitalized children.
• Use hospital health IT system downtime procedures to provide safe continued medical care to patients in the event of a system failure or shutdown.
• Demonstrate best practices in use of the EHR, such as use of “navigators” and order sets, importing relevant medical records where available, and avoiding potentially risky practices such as copy-paste where appropriate.
• Educate trainees on correct use of the EHR and edit and attest to trainee notes as appropriate.

Pediatric hospitalists should be able to:

• Exemplify accountability by adhering to regulations around proper use of health IT.
• Acknowledge the value of collaboration with healthcare providers, patients and the family/caregivers, and hospital administration to ensure the successful functioning of health IT systems.
• Advocate for the proper alignment of health IT system choices with clinical needs, particularly for pediatric-specific needs in predominantly adult healthcare systems.
• Realize the importance of communicating effectively with health IT system managers and leaders.
• Recognize and respect patient confidentiality by using the security-directed features of information systems.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in appropriate hospital and health systems committees to assist in developing and optimizing health IT solutions to improve quality, safety, and workflow efficiencies.
• Partner with hospital leaders and administration to optimize use of the EHR to improve clinical documentation and develop performance measures and dashboards for the hospitalist practice and the hospital system.
• Collaborate with family advisory groups, hospital administration, healthcare providers, and community partners to support and enhance the use of the EHR by patients and the family/caregivers.
• Partner with hospital administration and healthcare providers to integrate new technologies that improve pediatric hospital medicine practice and care delivery to the hospitalized child, such as clinical decision support tools, telemedicine, health information exchange, registries, and others.
• Seek opportunities to improve the role of health IT in managing costs and supporting quality and clinical research, as applicable.

Introduction

Health information technology (Health IT) is comprised of a range of digital tools used within the health care systems to collect, store, analyze, and share medical data. In today’s healthcare systems, health IT is an invaluable component for delivery of high-quality and safe care. Recognizing the role of health IT, the Institute of Medicine (now the National Academies of Medicine), in 1999, issued reports highlighting the potential of the electronic health record (EHR) in reducing medical errors through electronic order entry, facilitating care coordination, and improving clinical efficiencies. Despite these benefits, hospitals were slow to adopt these technologies until Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009. Under this act, standards were set for ‘meaningful use’ of health IT and substantial resources and incentives were provided to eligible hospitals and providers to offset EHR implementation costs. The result over the past decade has been widespread adoption of the EHR across the United States, although children’s hospitals remain at the slower end of the adoption curve. Pediatric hospitalists use health IT systems for clinical care, education, quality improvement (QI), patient safety efforts, and for research and thus play a critical role in implementing and optimizing health IT use within hospital systems.

Pediatric hospitalists should be able to:

• Describe the unique role of health IT in providing care to hospitalized children and the importance of careful design and implementation of health IT systems within hospitals and hospital systems that care for children.
• Describe the impact of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule on health IT security and the importance of secure storage and retrieval of protected health information.
• Explain the value of clinical decision support in rendering patient care.
• Compare and contrast the influence of health IT systems on practice management, clinical decision-making, QI initiatives, safety initiatives, and research in the healthcare setting.
• List resources that can be accessed to address questions about information systems, such as local system super users, hospital IT support, vendor support lines, online access to other healthcare providers who use the system, and others.
• Delineate how staff dedicated to health IT support quality and safety efforts and data retrieval.
• List information resources and tools available to support life-long learning in dynamic health IT.
• Discuss the importance of pediatric hospitalists in developing, modifying, and evaluating changes to health IT systems on an ongoing basis to optimize workflow and patient care.
• Recognize that dependence on technology for some clinical tasks is an unintended consequence that has arisen since the institution of the EHR.
• Give examples of human errors that can occur when using an EHR, such as medication entry errors, documenting in the wrong patient record, and others.
• Identify problems of a poorly designed EHR and describe how pediatric hospitalists can partner with hospital systems to mitigate these problems.
• Cite common risks that may occur when utilizing an EHR designed for adult aged patients and review actions to mitigate these risks for pediatric patients.

Pediatric hospitalists should be able to:

• Demonstrate proficiency with the local EHR or computerized provider order entry system.
• Access and use web-based educational resources for continuing education and enrichment of trainee learning experiences.
• Utilize local health IT systems for clinical care, education, QI and patient safety initiatives, and research in an effective and efficient manner.
• Assist in or champion the creation, ongoing maintenance, and optimization of electronic order sets and documentation templates.
• Assess and assist with improving and optimizing clinical decision support tools, including rules and alerts, to meet the changing needs of the health care system and hospitalized children.
• Use hospital health IT system downtime procedures to provide safe continued medical care to patients in the event of a system failure or shutdown.
• Demonstrate best practices in use of the EHR, such as use of “navigators” and order sets, importing relevant medical records where available, and avoiding potentially risky practices such as copy-paste where appropriate.
• Educate trainees on correct use of the EHR and edit and attest to trainee notes as appropriate.

Pediatric hospitalists should be able to:

• Exemplify accountability by adhering to regulations around proper use of health IT.
• Acknowledge the value of collaboration with healthcare providers, patients and the family/caregivers, and hospital administration to ensure the successful functioning of health IT systems.
• Advocate for the proper alignment of health IT system choices with clinical needs, particularly for pediatric-specific needs in predominantly adult healthcare systems.
• Realize the importance of communicating effectively with health IT system managers and leaders.
• Recognize and respect patient confidentiality by using the security-directed features of information systems.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in appropriate hospital and health systems committees to assist in developing and optimizing health IT solutions to improve quality, safety, and workflow efficiencies.
• Partner with hospital leaders and administration to optimize use of the EHR to improve clinical documentation and develop performance measures and dashboards for the hospitalist practice and the hospital system.
• Collaborate with family advisory groups, hospital administration, healthcare providers, and community partners to support and enhance the use of the EHR by patients and the family/caregivers.
• Partner with hospital administration and healthcare providers to integrate new technologies that improve pediatric hospital medicine practice and care delivery to the hospitalized child, such as clinical decision support tools, telemedicine, health information exchange, registries, and others.
• Seek opportunities to improve the role of health IT in managing costs and supporting quality and clinical research, as applicable.

Introduction

Transitions of care are patient-centered events. They therefore describe when a patient moves from one level of care to another, from one institution to another, or from one system to another as occurs with pediatric to adult care transitions. One component of transitions of care is the patient handoff, which is a provider-centered event that also occurs outside of a patient transition, such as during shift change. Handoffs refer to the interaction between providers when responsibility for patient care is transferred from one provider to another. Ineffective transitions of care and handoffs jeopardize patient safety and may result in adverse events, increased healthcare utilization, and stress for patients or the family/caregivers. Thus, every transition of care and handoff should involve a set of actions designed to ensure that the transfer is safe, efficient, and effective. Pediatric hospitalists routinely utilize handoffs in daily work, are integral in patient transitions of care, and should be competent in both.

Pediatric hospitalists should be able to:

• Compare and contrast patient handoffs with transitions of care.
• Discuss the critical elements that should be communicated between providers at the time of a patient handoff and how these elements may vary depending on characteristics of the patient or the provider.
• Discuss the value of using available handoff aides such as communication patient safety acronyms, handoff tools, and checklists.
• Describe the benefits and risks of automated electronic medical record data integration into handoff aides.
• Discuss the value of using available discharge toolkits to integrate processes, checklists, education, and assessment of quality outcome metrics related to discharge transition of care.
• Compare and contrast the value of potential discharge transition of care metrics, such as patient experience, unplanned returns for care, post discharge planned visit adherence, retained understanding of medication and treatment plans, and others.
• List the relevant information that should be communicated during each transition of care to ensure patient safety and promote the continuum of care.
• Explain the benefits and risks of different modes of communication in the context of the various types of patient transfers.
• Differentiate between the available levels of care and determine the most appropriate option for each patient.
• Describe the impact of the Emergency Medical Treatment and Active Labor Act (EMTALA) on patient transfers.
• Summarize the care commonly available for children at post-acute care facilities, such as rehabilitation facilities.
• Review the steps needed to ensure safe hospital discharge transition of care for patients who will receive home care services, including collaborating with discharge planning staff, placing appropriate orders, securing a post-discharge responsible provider, and other steps.
• Discuss elements important to the safe transition of care at hospital discharge for the patient and family/caregivers, including use of teach-back, handouts, and other tools for patient and family/caregivers’ engagement and empowerment in care planning for the home environment.
• Cite the benefits of and barriers to ongoing discharge transition of care education from the time of admission for patients and the family/caregivers.
• Summarize the approach toward initiating transition of care discussions with the family/caregivers of adolescent patients with chronic conditions, attending to patient age, developmental status, empowerment, healthcare system barriers, and others within the local context.

Pediatric hospitalists should be able to:

• Prepare concise clinical summaries in preparation for patient handoffs or transitions of care, incorporating key elements as appropriate.
• Standardize handoffs to ensure accuracy and concise and complete transfer of information.
• Demonstrate skills in utilizing local handoff tools, acronyms, and checklists.
• Educate trainees on proper handoff communications.
• Utilize the most efficient and reliable mode of communication for each transition of care.
• Arrange safe and efficient transfers to, from, and within the hospital setting.
• Review the medical information received from referring providers and clarify any discrepancies when accepting a new patient.
• Anticipate needs prior to the time of discharge to begin discharge planning early in the hospitalization.
• Provide clear discharge instructions that consider the primary language and reading level of patients and the family/caregivers and include key components (such as diagnosis specific instructions, contingency plan, medications, follow up recommendations/appointments, information about available resources, and others).
• Communicate effectively with the primary care and other providers as necessary at the time of admission, discharge, and other transitions of care.
• Select and order appropriate post-acute care facilities and services within the local context.
• Accurately and completely reconcile medications during transitions of care.
• Coordinate care that ensures the future comprehensive review of patient data that was pending at the time of discharge.

Pediatric hospitalists should be able to:

• Recognize the impact of ineffective handoffs and transitions of care on patient safety and quality of care.
• Demonstrate respect for referring physicians and seek their input when developing protocols for communication during transitions of care.
• Recognize the impact of the transfer on patients and the family/caregivers and the importance of ensuring their goals and preferences are incorporated into the care plan at all stages of the transition of care.
• Exemplify responsible coordination of a multidisciplinary approach to patient and the family/caregiver education in preparation for the transition of care.
• Realize the need to provide support for patients, the family/caregivers, and healthcare providers after transitions of care should questions arise.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate with key stakeholders in the ongoing evaluation and improvement of the referral, admission, and discharge processes.
• Lead, coordinate, or participate in initiatives to develop and implement systems that promote timely and effective communication between providers during handoffs and transitions of care.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and referral centers for hospitalized patients and for those transitioning to adult healthcare systems.

Introduction

Transitions of care are patient-centered events. They therefore describe when a patient moves from one level of care to another, from one institution to another, or from one system to another as occurs with pediatric to adult care transitions. One component of transitions of care is the patient handoff, which is a provider-centered event that also occurs outside of a patient transition, such as during shift change. Handoffs refer to the interaction between providers when responsibility for patient care is transferred from one provider to another. Ineffective transitions of care and handoffs jeopardize patient safety and may result in adverse events, increased healthcare utilization, and stress for patients or the family/caregivers. Thus, every transition of care and handoff should involve a set of actions designed to ensure that the transfer is safe, efficient, and effective. Pediatric hospitalists routinely utilize handoffs in daily work, are integral in patient transitions of care, and should be competent in both.

Pediatric hospitalists should be able to:

• Compare and contrast patient handoffs with transitions of care.
• Discuss the critical elements that should be communicated between providers at the time of a patient handoff and how these elements may vary depending on characteristics of the patient or the provider.
• Discuss the value of using available handoff aides such as communication patient safety acronyms, handoff tools, and checklists.
• Describe the benefits and risks of automated electronic medical record data integration into handoff aides.
• Discuss the value of using available discharge toolkits to integrate processes, checklists, education, and assessment of quality outcome metrics related to discharge transition of care.
• Compare and contrast the value of potential discharge transition of care metrics, such as patient experience, unplanned returns for care, post discharge planned visit adherence, retained understanding of medication and treatment plans, and others.
• List the relevant information that should be communicated during each transition of care to ensure patient safety and promote the continuum of care.
• Explain the benefits and risks of different modes of communication in the context of the various types of patient transfers.
• Differentiate between the available levels of care and determine the most appropriate option for each patient.
• Describe the impact of the Emergency Medical Treatment and Active Labor Act (EMTALA) on patient transfers.
• Summarize the care commonly available for children at post-acute care facilities, such as rehabilitation facilities.
• Review the steps needed to ensure safe hospital discharge transition of care for patients who will receive home care services, including collaborating with discharge planning staff, placing appropriate orders, securing a post-discharge responsible provider, and other steps.
• Discuss elements important to the safe transition of care at hospital discharge for the patient and family/caregivers, including use of teach-back, handouts, and other tools for patient and family/caregivers’ engagement and empowerment in care planning for the home environment.
• Cite the benefits of and barriers to ongoing discharge transition of care education from the time of admission for patients and the family/caregivers.
• Summarize the approach toward initiating transition of care discussions with the family/caregivers of adolescent patients with chronic conditions, attending to patient age, developmental status, empowerment, healthcare system barriers, and others within the local context.

Pediatric hospitalists should be able to:

• Prepare concise clinical summaries in preparation for patient handoffs or transitions of care, incorporating key elements as appropriate.
• Standardize handoffs to ensure accuracy and concise and complete transfer of information.
• Demonstrate skills in utilizing local handoff tools, acronyms, and checklists.
• Educate trainees on proper handoff communications.
• Utilize the most efficient and reliable mode of communication for each transition of care.
• Arrange safe and efficient transfers to, from, and within the hospital setting.
• Review the medical information received from referring providers and clarify any discrepancies when accepting a new patient.
• Anticipate needs prior to the time of discharge to begin discharge planning early in the hospitalization.
• Provide clear discharge instructions that consider the primary language and reading level of patients and the family/caregivers and include key components (such as diagnosis specific instructions, contingency plan, medications, follow up recommendations/appointments, information about available resources, and others).
• Communicate effectively with the primary care and other providers as necessary at the time of admission, discharge, and other transitions of care.
• Select and order appropriate post-acute care facilities and services within the local context.
• Accurately and completely reconcile medications during transitions of care.
• Coordinate care that ensures the future comprehensive review of patient data that was pending at the time of discharge.

Pediatric hospitalists should be able to:

• Recognize the impact of ineffective handoffs and transitions of care on patient safety and quality of care.
• Demonstrate respect for referring physicians and seek their input when developing protocols for communication during transitions of care.
• Recognize the impact of the transfer on patients and the family/caregivers and the importance of ensuring their goals and preferences are incorporated into the care plan at all stages of the transition of care.
• Exemplify responsible coordination of a multidisciplinary approach to patient and the family/caregiver education in preparation for the transition of care.
• Realize the need to provide support for patients, the family/caregivers, and healthcare providers after transitions of care should questions arise.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate with key stakeholders in the ongoing evaluation and improvement of the referral, admission, and discharge processes.
• Lead, coordinate, or participate in initiatives to develop and implement systems that promote timely and effective communication between providers during handoffs and transitions of care.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and referral centers for hospitalized patients and for those transitioning to adult healthcare systems.

Introduction

Transitions of care are patient-centered events. They therefore describe when a patient moves from one level of care to another, from one institution to another, or from one system to another as occurs with pediatric to adult care transitions. One component of transitions of care is the patient handoff, which is a provider-centered event that also occurs outside of a patient transition, such as during shift change. Handoffs refer to the interaction between providers when responsibility for patient care is transferred from one provider to another. Ineffective transitions of care and handoffs jeopardize patient safety and may result in adverse events, increased healthcare utilization, and stress for patients or the family/caregivers. Thus, every transition of care and handoff should involve a set of actions designed to ensure that the transfer is safe, efficient, and effective. Pediatric hospitalists routinely utilize handoffs in daily work, are integral in patient transitions of care, and should be competent in both.

Pediatric hospitalists should be able to:

• Compare and contrast patient handoffs with transitions of care.
• Discuss the critical elements that should be communicated between providers at the time of a patient handoff and how these elements may vary depending on characteristics of the patient or the provider.
• Discuss the value of using available handoff aides such as communication patient safety acronyms, handoff tools, and checklists.
• Describe the benefits and risks of automated electronic medical record data integration into handoff aides.
• Discuss the value of using available discharge toolkits to integrate processes, checklists, education, and assessment of quality outcome metrics related to discharge transition of care.
• Compare and contrast the value of potential discharge transition of care metrics, such as patient experience, unplanned returns for care, post discharge planned visit adherence, retained understanding of medication and treatment plans, and others.
• List the relevant information that should be communicated during each transition of care to ensure patient safety and promote the continuum of care.
• Explain the benefits and risks of different modes of communication in the context of the various types of patient transfers.
• Differentiate between the available levels of care and determine the most appropriate option for each patient.
• Describe the impact of the Emergency Medical Treatment and Active Labor Act (EMTALA) on patient transfers.
• Summarize the care commonly available for children at post-acute care facilities, such as rehabilitation facilities.
• Review the steps needed to ensure safe hospital discharge transition of care for patients who will receive home care services, including collaborating with discharge planning staff, placing appropriate orders, securing a post-discharge responsible provider, and other steps.
• Discuss elements important to the safe transition of care at hospital discharge for the patient and family/caregivers, including use of teach-back, handouts, and other tools for patient and family/caregivers’ engagement and empowerment in care planning for the home environment.
• Cite the benefits of and barriers to ongoing discharge transition of care education from the time of admission for patients and the family/caregivers.
• Summarize the approach toward initiating transition of care discussions with the family/caregivers of adolescent patients with chronic conditions, attending to patient age, developmental status, empowerment, healthcare system barriers, and others within the local context.

Pediatric hospitalists should be able to:

• Prepare concise clinical summaries in preparation for patient handoffs or transitions of care, incorporating key elements as appropriate.
• Standardize handoffs to ensure accuracy and concise and complete transfer of information.
• Demonstrate skills in utilizing local handoff tools, acronyms, and checklists.
• Educate trainees on proper handoff communications.
• Utilize the most efficient and reliable mode of communication for each transition of care.
• Arrange safe and efficient transfers to, from, and within the hospital setting.
• Review the medical information received from referring providers and clarify any discrepancies when accepting a new patient.
• Anticipate needs prior to the time of discharge to begin discharge planning early in the hospitalization.
• Provide clear discharge instructions that consider the primary language and reading level of patients and the family/caregivers and include key components (such as diagnosis specific instructions, contingency plan, medications, follow up recommendations/appointments, information about available resources, and others).
• Communicate effectively with the primary care and other providers as necessary at the time of admission, discharge, and other transitions of care.
• Select and order appropriate post-acute care facilities and services within the local context.
• Accurately and completely reconcile medications during transitions of care.
• Coordinate care that ensures the future comprehensive review of patient data that was pending at the time of discharge.

Pediatric hospitalists should be able to:

• Recognize the impact of ineffective handoffs and transitions of care on patient safety and quality of care.
• Demonstrate respect for referring physicians and seek their input when developing protocols for communication during transitions of care.
• Recognize the impact of the transfer on patients and the family/caregivers and the importance of ensuring their goals and preferences are incorporated into the care plan at all stages of the transition of care.
• Exemplify responsible coordination of a multidisciplinary approach to patient and the family/caregiver education in preparation for the transition of care.
• Realize the need to provide support for patients, the family/caregivers, and healthcare providers after transitions of care should questions arise.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate with key stakeholders in the ongoing evaluation and improvement of the referral, admission, and discharge processes.
• Lead, coordinate, or participate in initiatives to develop and implement systems that promote timely and effective communication between providers during handoffs and transitions of care.
• Collaborate with hospital administration and community partners to develop and sustain referral networks between local facilities and referral centers for hospitalized patients and for those transitioning to adult healthcare systems.

Introduction

The National Academy of Medicine (NAM; previously the Institute of Medicine [IOM]), the American Academy of Pediatrics, and the Accreditation Council for Graduate Medical Education have all called for an increased emphasis on patient and family centered care. Family centered care (FCC) involves collaboration between patients, the family/caregivers, healthcare providers, and hospital administration to address the needs of individual patients, populations, and healthcare systems. It can inform policy, facility design, healthcare outcomes evaluation, and individual daily interactions. Thus, FCC is used to plan, deliver, and evaluate healthcare; conduct research; provide education; and improve healthcare quality. Pediatric hospitalists were first to lead national efforts to espouse family centered rounds (FCR), which is a cornerstone of a larger FCC program. Pediatric hospitalists promote high quality FCC by embedding it into daily interactions with patients and the family/caregivers, modeling and teaching it to trainees, and applying it to clinical care, medical education, research, quality improvement, hospital operations, and patient safety.

Pediatric hospitalists should be able to:

• Summarize the features of FCC, drawing upon existing frameworks from organizations such as the NAM, the Agency for Healthcare Research and Quality, and the Picker Institute.
• Describe the Picker Institute’s 8 Principles of Patient Centered Care: 1) respect for patient preferences, 2) coordination and integration of care, 3) information and education, 4) physical comfort, 5) emotional support, 6) involvement of family and friends, 7) continuity and transition, and 8) access to care.
• Summarize common components of a comprehensive healthcare system FCC program, attending to family involvement on advisory councils and boards, research committees, and electronic medical record groups, as well as healthcare system community partnerships and other relationships.
• Review the concept of “co-production”, which involves co-execution, co-planning, and civil discourse between patients, professionals, the healthcare system, and the community and society in order to achieve high-value healthcare and promote good health for all.
• Give examples of common best practices for FCR, including the family/caregivers speaking first, healthcare providers speaking in language understood by the family/caregivers, making plans and goal setting with the family/caregivers, asking open-ended questions, and assessing family/caregivers’ understanding.
• Describe the role of “patient activation” (patients attaining the confidence, knowledge, and skills to manage and maintain one’s health and healthcare needs) in promoting FCC in the inpatient setting.
• Discuss the steps of shared decision-making, including 1) seeking a patient’s participation, 2) helping a patient to explore and compare treatment options, 3) assessing a patient’s values and preferences, 4) reaching a decision with a patient, and 5) evaluating a patient’s decision.
• Discuss best practices of shared decision-making and give examples of where shared decision-making may be used inside and outside the setting of hospital rounds.
• Give examples of universal health literacy precautions use during communications with patients and the family/caregivers, including using plain language, minimizing unnecessary medical jargon, breaking down complex concepts into understandable pieces, bidirectional communication, and reinforcement with written or internet-based educational materials.
• Define implicit bias and review how unconscious, automatic stereotypes can affect understanding and decisions, leading to inconsistent management and healthcare outcome disparities.
• Discuss how differing experiences and views on race, ethnicity, sexual orientation, gender identity, religion, culture, immigration, disability, language, literacy, health literacy, and socioeconomic status may influence the approach toward and success of FCR and a comprehensive FCC program.

Pediatric hospitalists should be able to:

• Model, teach, and integrate FCC principles throughout the inpatient continuum of care delivery, from admission and medication reconciliation to rounds, transitions of care, and discharge planning.
• Demonstrate basic skills in co-production specific to hospital medicine including those affecting policy (co-commissioning), clinical care and education (co-design, co-delivery), and quality/safety/research (co-assessment) within the local context.
• Coordinate, lead, and adapt FCR to meet specific patient needs, such as low English proficiency (LEP) children, adolescents, caregivers, and family members.
• Educate trainees about the core elements of FCC.
• Utilize strategies to include nursing staff and other ancillary staff (such as pharmacists, social workers, care coordinators, and others) in FCC.
• Utilize strategies to activate patients and the family/caregivers.
• Demonstrate skills in shared decision-making.
• Integrate the consistent use of universal health literacy precautions into daily practice.
• Demonstrate culturally competent communication skills.
• Engage interpreters effectively for LEP patients.
• Identify and abate potential implicit biases.
• Demonstrate skill in using information technology, including electronic medical record portals, to promote patient engagement.

Pediatric hospitalists should be able to:

• Recognize the role that implicit bias plays in impeding FCC.
• Reflect on the importance of being respectful of religious, cultural, and personal preferences in communication and involvement in care.
• Realize the patient and family/caregivers’ important role in promoting health and partnering in care decisions, both in the hospital and after discharge.
• Consider that all patients and the family/caregivers benefit from clear communication and universal health literacy precautions.
• Recognize the unique roles of the patient and the family/caregivers as “vigilant partners” in care and in patient safety, including in safety promotion and safety reporting.
• Appreciate the unique needs of underserved and marginalized communities, including LEP patients, Lesbian Gay Bisexual Transgender (LGBT) youth, religious and ethnic minorities, and immigrants.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in interdisciplinary efforts to ensure effective patient and family engagement in hospital committees, research activities including prioritizing research questions, and hospital quality improvement initiatives.
• Work with hospital administration and other hospital leaders to create and sustain patient and family/caregiver involvement in safety reporting and safety promotion.
• Collaborate with graduate medical education leaders and other educators to create and sustain education around FCC for medical students, residents, faculty, and other healthcare providers.
• Collaborate with hospital administration and community leaders to engage patients and the family/caregivers in design and development of pediatric hospitals and healthcare systems, within local context.

Introduction

The National Academy of Medicine (NAM; previously the Institute of Medicine [IOM]), the American Academy of Pediatrics, and the Accreditation Council for Graduate Medical Education have all called for an increased emphasis on patient and family centered care. Family centered care (FCC) involves collaboration between patients, the family/caregivers, healthcare providers, and hospital administration to address the needs of individual patients, populations, and healthcare systems. It can inform policy, facility design, healthcare outcomes evaluation, and individual daily interactions. Thus, FCC is used to plan, deliver, and evaluate healthcare; conduct research; provide education; and improve healthcare quality. Pediatric hospitalists were first to lead national efforts to espouse family centered rounds (FCR), which is a cornerstone of a larger FCC program. Pediatric hospitalists promote high quality FCC by embedding it into daily interactions with patients and the family/caregivers, modeling and teaching it to trainees, and applying it to clinical care, medical education, research, quality improvement, hospital operations, and patient safety.

Pediatric hospitalists should be able to:

• Summarize the features of FCC, drawing upon existing frameworks from organizations such as the NAM, the Agency for Healthcare Research and Quality, and the Picker Institute.
• Describe the Picker Institute’s 8 Principles of Patient Centered Care: 1) respect for patient preferences, 2) coordination and integration of care, 3) information and education, 4) physical comfort, 5) emotional support, 6) involvement of family and friends, 7) continuity and transition, and 8) access to care.
• Summarize common components of a comprehensive healthcare system FCC program, attending to family involvement on advisory councils and boards, research committees, and electronic medical record groups, as well as healthcare system community partnerships and other relationships.
• Review the concept of “co-production”, which involves co-execution, co-planning, and civil discourse between patients, professionals, the healthcare system, and the community and society in order to achieve high-value healthcare and promote good health for all.
• Give examples of common best practices for FCR, including the family/caregivers speaking first, healthcare providers speaking in language understood by the family/caregivers, making plans and goal setting with the family/caregivers, asking open-ended questions, and assessing family/caregivers’ understanding.
• Describe the role of “patient activation” (patients attaining the confidence, knowledge, and skills to manage and maintain one’s health and healthcare needs) in promoting FCC in the inpatient setting.
• Discuss the steps of shared decision-making, including 1) seeking a patient’s participation, 2) helping a patient to explore and compare treatment options, 3) assessing a patient’s values and preferences, 4) reaching a decision with a patient, and 5) evaluating a patient’s decision.
• Discuss best practices of shared decision-making and give examples of where shared decision-making may be used inside and outside the setting of hospital rounds.
• Give examples of universal health literacy precautions use during communications with patients and the family/caregivers, including using plain language, minimizing unnecessary medical jargon, breaking down complex concepts into understandable pieces, bidirectional communication, and reinforcement with written or internet-based educational materials.
• Define implicit bias and review how unconscious, automatic stereotypes can affect understanding and decisions, leading to inconsistent management and healthcare outcome disparities.
• Discuss how differing experiences and views on race, ethnicity, sexual orientation, gender identity, religion, culture, immigration, disability, language, literacy, health literacy, and socioeconomic status may influence the approach toward and success of FCR and a comprehensive FCC program.

Pediatric hospitalists should be able to:

• Model, teach, and integrate FCC principles throughout the inpatient continuum of care delivery, from admission and medication reconciliation to rounds, transitions of care, and discharge planning.
• Demonstrate basic skills in co-production specific to hospital medicine including those affecting policy (co-commissioning), clinical care and education (co-design, co-delivery), and quality/safety/research (co-assessment) within the local context.
• Coordinate, lead, and adapt FCR to meet specific patient needs, such as low English proficiency (LEP) children, adolescents, caregivers, and family members.
• Educate trainees about the core elements of FCC.
• Utilize strategies to include nursing staff and other ancillary staff (such as pharmacists, social workers, care coordinators, and others) in FCC.
• Utilize strategies to activate patients and the family/caregivers.
• Demonstrate skills in shared decision-making.
• Integrate the consistent use of universal health literacy precautions into daily practice.
• Demonstrate culturally competent communication skills.
• Engage interpreters effectively for LEP patients.
• Identify and abate potential implicit biases.
• Demonstrate skill in using information technology, including electronic medical record portals, to promote patient engagement.

Pediatric hospitalists should be able to:

• Recognize the role that implicit bias plays in impeding FCC.
• Reflect on the importance of being respectful of religious, cultural, and personal preferences in communication and involvement in care.
• Realize the patient and family/caregivers’ important role in promoting health and partnering in care decisions, both in the hospital and after discharge.
• Consider that all patients and the family/caregivers benefit from clear communication and universal health literacy precautions.
• Recognize the unique roles of the patient and the family/caregivers as “vigilant partners” in care and in patient safety, including in safety promotion and safety reporting.
• Appreciate the unique needs of underserved and marginalized communities, including LEP patients, Lesbian Gay Bisexual Transgender (LGBT) youth, religious and ethnic minorities, and immigrants.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in interdisciplinary efforts to ensure effective patient and family engagement in hospital committees, research activities including prioritizing research questions, and hospital quality improvement initiatives.
• Work with hospital administration and other hospital leaders to create and sustain patient and family/caregiver involvement in safety reporting and safety promotion.
• Collaborate with graduate medical education leaders and other educators to create and sustain education around FCC for medical students, residents, faculty, and other healthcare providers.
• Collaborate with hospital administration and community leaders to engage patients and the family/caregivers in design and development of pediatric hospitals and healthcare systems, within local context.

Introduction

The National Academy of Medicine (NAM; previously the Institute of Medicine [IOM]), the American Academy of Pediatrics, and the Accreditation Council for Graduate Medical Education have all called for an increased emphasis on patient and family centered care. Family centered care (FCC) involves collaboration between patients, the family/caregivers, healthcare providers, and hospital administration to address the needs of individual patients, populations, and healthcare systems. It can inform policy, facility design, healthcare outcomes evaluation, and individual daily interactions. Thus, FCC is used to plan, deliver, and evaluate healthcare; conduct research; provide education; and improve healthcare quality. Pediatric hospitalists were first to lead national efforts to espouse family centered rounds (FCR), which is a cornerstone of a larger FCC program. Pediatric hospitalists promote high quality FCC by embedding it into daily interactions with patients and the family/caregivers, modeling and teaching it to trainees, and applying it to clinical care, medical education, research, quality improvement, hospital operations, and patient safety.

Pediatric hospitalists should be able to:

• Summarize the features of FCC, drawing upon existing frameworks from organizations such as the NAM, the Agency for Healthcare Research and Quality, and the Picker Institute.
• Describe the Picker Institute’s 8 Principles of Patient Centered Care: 1) respect for patient preferences, 2) coordination and integration of care, 3) information and education, 4) physical comfort, 5) emotional support, 6) involvement of family and friends, 7) continuity and transition, and 8) access to care.
• Summarize common components of a comprehensive healthcare system FCC program, attending to family involvement on advisory councils and boards, research committees, and electronic medical record groups, as well as healthcare system community partnerships and other relationships.
• Review the concept of “co-production”, which involves co-execution, co-planning, and civil discourse between patients, professionals, the healthcare system, and the community and society in order to achieve high-value healthcare and promote good health for all.
• Give examples of common best practices for FCR, including the family/caregivers speaking first, healthcare providers speaking in language understood by the family/caregivers, making plans and goal setting with the family/caregivers, asking open-ended questions, and assessing family/caregivers’ understanding.
• Describe the role of “patient activation” (patients attaining the confidence, knowledge, and skills to manage and maintain one’s health and healthcare needs) in promoting FCC in the inpatient setting.
• Discuss the steps of shared decision-making, including 1) seeking a patient’s participation, 2) helping a patient to explore and compare treatment options, 3) assessing a patient’s values and preferences, 4) reaching a decision with a patient, and 5) evaluating a patient’s decision.
• Discuss best practices of shared decision-making and give examples of where shared decision-making may be used inside and outside the setting of hospital rounds.
• Give examples of universal health literacy precautions use during communications with patients and the family/caregivers, including using plain language, minimizing unnecessary medical jargon, breaking down complex concepts into understandable pieces, bidirectional communication, and reinforcement with written or internet-based educational materials.
• Define implicit bias and review how unconscious, automatic stereotypes can affect understanding and decisions, leading to inconsistent management and healthcare outcome disparities.
• Discuss how differing experiences and views on race, ethnicity, sexual orientation, gender identity, religion, culture, immigration, disability, language, literacy, health literacy, and socioeconomic status may influence the approach toward and success of FCR and a comprehensive FCC program.

Pediatric hospitalists should be able to:

• Model, teach, and integrate FCC principles throughout the inpatient continuum of care delivery, from admission and medication reconciliation to rounds, transitions of care, and discharge planning.
• Demonstrate basic skills in co-production specific to hospital medicine including those affecting policy (co-commissioning), clinical care and education (co-design, co-delivery), and quality/safety/research (co-assessment) within the local context.
• Coordinate, lead, and adapt FCR to meet specific patient needs, such as low English proficiency (LEP) children, adolescents, caregivers, and family members.
• Educate trainees about the core elements of FCC.
• Utilize strategies to include nursing staff and other ancillary staff (such as pharmacists, social workers, care coordinators, and others) in FCC.
• Utilize strategies to activate patients and the family/caregivers.
• Demonstrate skills in shared decision-making.
• Integrate the consistent use of universal health literacy precautions into daily practice.
• Demonstrate culturally competent communication skills.
• Engage interpreters effectively for LEP patients.
• Identify and abate potential implicit biases.
• Demonstrate skill in using information technology, including electronic medical record portals, to promote patient engagement.

Pediatric hospitalists should be able to:

• Recognize the role that implicit bias plays in impeding FCC.
• Reflect on the importance of being respectful of religious, cultural, and personal preferences in communication and involvement in care.
• Realize the patient and family/caregivers’ important role in promoting health and partnering in care decisions, both in the hospital and after discharge.
• Consider that all patients and the family/caregivers benefit from clear communication and universal health literacy precautions.
• Recognize the unique roles of the patient and the family/caregivers as “vigilant partners” in care and in patient safety, including in safety promotion and safety reporting.
• Appreciate the unique needs of underserved and marginalized communities, including LEP patients, Lesbian Gay Bisexual Transgender (LGBT) youth, religious and ethnic minorities, and immigrants.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in interdisciplinary efforts to ensure effective patient and family engagement in hospital committees, research activities including prioritizing research questions, and hospital quality improvement initiatives.
• Work with hospital administration and other hospital leaders to create and sustain patient and family/caregiver involvement in safety reporting and safety promotion.
• Collaborate with graduate medical education leaders and other educators to create and sustain education around FCC for medical students, residents, faculty, and other healthcare providers.
• Collaborate with hospital administration and community leaders to engage patients and the family/caregivers in design and development of pediatric hospitals and healthcare systems, within local context.