Quality improvement

...and the world of pediatric emergency medicine

Over a week ago I let you know that I was headed out for a number of important medical society and continuing education meetings.

I was planning to write at least every other day or night to share what I was learning and doing; to give you a behind-the-scenes view of how some of these organizations work and what they do. I am sad to report that I have been so busy, and so tired I neglected this blog in favor of more meetings, sweet dinners with old friends, and sleep, when I could manage to get some. Now, as I sit in the airport lounge waiting to make my last connection before I arrive in Roanoke, I finally have a few minutes to catch my breath and catch you up on the week's activities.

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celebration of quality and patient safety

I was honored today to be invited to share in the celebration of quality in the Carilion Clinic Children's Hospital's Neonatal Intensive Care Unit (NICU). This is the 60-bed unit that provides care to our most vulnerable patients. It is the largest intensive care unit in our hospital, and is the third largest such unit in the State of Virginia (Inova Fairfax NICU has 72 beds in Northern Virginia, and Children's Hospital of the Kings Daughters (CHKD) has 62 beds.

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pediatric asthma; a real challenge in management

Asthma is the most common chronic disease of childhood. Continuing on a theme we started yesterday, talking about children with chronic disease, I was very interested to read an  article by Kevin Dubrowski and colleagues from this month's edition of Pediatrics about one way to follow children with this disease, called spirometry.

I have asked my colleague, Dr. Andre Muelenaer, head of the Carilion Clinic Children's Hospital section of pediatric pulmonology and allergy, to comment on this article. Here is what he has to say:

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optimal care for children in the emergency department

Did you know that of the approximately 119 million visits to an emergency department (ED) each year, nearly 20% are made by children? That means that nearly 24 million children are seen in EDs each year. There are nearly 4000 EDs in the US, and only a minority of those are in children's hospitals, or hospitals with pediatric training programs, or clearly identified pediatric ED's. Emergency care for children was identified by the institute of medicine (IOM) in 2003 as woefully in need of improvement. The IOM found that EDs often lack the expertise and equipment needed to provide appropriate care for childre during emergencies.

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a family member is not a visitor

On Friday I wrote about issues in patient safety, and I will continue in that vein today

. One big focus of the Children's hospital over the last two years, has been the introduction and development of patient and family centered care (PFCC). There are many aspects to health care that make it patient and family centered. One major aspect is acknowledging the role that families play in the lives  of patients, and recognizing that respect for families is an important part of how we care for patients.

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our healthcare system is like an autumnal mountainside

This morning as I awoke with the sun coming up over the mountain, I was struck with the similarity of the autumnal changes of the mountain, and the changes we are now seeing in our health care system.

If you look at the side of a mountain as a whole, the change appears to be gradual. Slowly the variegated green of summer turns into a quilt of reds, organges, yellows and browns. But have you noticed that some of the trees actually turned bright red weeks ago? And after all the leaves have turned color and eventually fallen to the forest floor, there will be some patches of green left on that mountainside, created by those trees whose colors will never change.

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confessions about patient harm

A couple of days ago, Nancy Agee, president of Carilion Clinic's hospital division, distributed a sobering article from the Reader's Digest about the importance of patient safety http://www.rd.com/living-healthy/doctors-confess-their-fatal-mistakes/article185422.html. It is moving, because it consists of a number of "confessions" of doctors, nurses, and pharmacists who inadvertently caused harm to patients, and have lived with the knowledge of this harm for the rest of their careers. Such experiences happen to EVERY HEALTH CARE PROVIDER at some time in their careers, and are responsible for unnecessary harm to patients and unnecessary cost to our health care system.

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at the AAP NCE meeting

Yesterday was a day of uneventful travel from Roanoke to San Francisco.

Today I started performing the "work" of attending this meeting.  At 7:30 am I was among a small group of  pediatric subspecialists that met with the leadership of the American Board of Pediatrics to discuss issues related to maintenance of certification in the pediatric subspecialties.

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