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As the landscape of healthcare is shifting from volume-based to value-based practice, organizations are challenged to develop models that promote such changes with current resources while enriching the patient experience. A critical component to be successful, is utilizing an interprofessional team approach. An urban academic pediatric hospital developed such strategies by enhancing the use of Advanced Practice Providers (APPs) to optimize care. Through a series of tactics beginning with the strategic plan, results included an increase in volume, APP productivity, and enhanced satisfaction scores for both providers/patients, and an increase in access to pediatric specialty care.

Objective The purpose of this study was to determine if pediatric specialty pediatric team (SPT) interfacility–transported children from community emergency departments to a pediatric intensive care unit (PICU) have improved 48-hour mortality. Methods This is a multicenter, historic cohort analysis of the VPS, LLC PICU clinical database (VPS, LLC, Los Angeles, CA) for all PICU directly admitted pediatric patients ≤ 18 years of age from January 1, 2007, to March 31, 2009. Categoric variables were analyzed by the chi-square and Mann-Whitney tests for non-normally distributed continuous variables. The propensity score was determined by multiple logistic regression analysis. Nearest neighbor matching developed emergency medical services SPT pairs by similar propensity score. Multiple regression analyses of the matched pairs determined the association of SPT with 48-hour PICU mortality. P values Results This study included 3,795 PICU discharges from 12 hospitals. SPT-transported children were more severely ill, younger in age, and more likely to have a respiratory diagnosis ( P P = .0028). Multiple regressions adjusted for propensity score, illness severity, and PICU site showed no significant difference in 48-hour PICU mortality. Conclusion No significant difference in adjusted 48-hour PICU mortality for children transported by transport team type was discovered.

A quality improvement project intended to promote maintenance of normothermia through active prewarming was carried out at a pediatric specialty hospital. An alternative active, forced-air warming product (Bair Paws warming gowns) was trialed in place of the existing active warming product (Bair Hugger blankets). Converting to the new product was intended to improve patient and staff compliance with prewarming recommendations. The alternative forced air active warming product was favored by both staff and patients, and the rate of compliance with this practice nearly doubled following the change in product. Extensive interprofessional collaboration and problem solving were required to go from an idea to a fully implemented change. The project demonstrated the importance of collaboration among various disciplines and the positive impact interprofessional collaboration can have on compliance with practice changes.

Through Improve Care Now, a quality improvement and research collaborative for pediatric patients with inflammatory bowel disease, our clinic piloted the feasibility and acceptability of patient-facing electronic technology to enhance engagement. This article qualitatively describes our experience piloting the technology. Participants included 36 families. Tools included a Web-based report pushed to families before office visits explaining current and past results on key health metrics and a mobile app for tracking symptoms and concerns and previsit planning between scheduled office visits. Building technology into clinical care required more support than anticipated. The tools improved collaboration and were well received.

Neonatal and pediatric specialty transport teams provide an essential link between community referral centers and tertiary care children’s hospitals. These teams bring neonatal and pediatric critical care capabilities to the patient even before arrival at the destination hospital. Beyond the traditional expectations of interfacility transport teams such as intubation and vasoactive medications, many teams now perform advanced care transfers using mobile extracorporeal membrane oxygenation or have taken the leap to performing maternal-fetal transports. Finally, the skill sets and expertise of hospital-based transport team members may allow them to fulfill other roles within their organization, including participation on a rapid response team.

Objective The goal of this publication is to raise awareness of the impact of childhood obesity on the musculoskeletal health of children and its potential long-term implications. Methods Relevant articles dealing with musculoskeletal disorders either caused by or worsened by childhood obesity were reviewed through a Pub Med search. Efforts to recognize and combat the childhood obesity epidemic were also identified through Internet search engines. This case statement was then reviewed by the members of the pediatric specialty group of the US Bone and Joint Initiative, which represents an extensive number of organizations dealing with musculoskeletal health. Results Multiple musculoskeletal disorders are clearly caused by or worsened by childhood obesity. The review of the literature clearly demonstrates the increased frequency and severity of many childhood musculoskeletal disorders. Concerns about the long-term implications of these childhood onset disorders such as pain and degenerative changes into adulthood are clearly recognized by all the member organizations of the US Bone and Joint Initiative. Conclusions It is imperative to recognize the long-term implications of musculoskeletal disorders caused by or worsened by childhood obesity. It is also important to recognize that the ability to exercise comfortably is a key factor to developing a healthy lifestyle and maintaining a healthy body weight. Efforts to develop reasonable and acceptable programs to increase physical activity by all facets of society should be supported. Further research into the long-term implications of childhood musculoskeletal disorders related to childhood obesity is necessary.

Background Children’s oral health maintenance are influenced by their parent's knowledge and behaviors. Parents knowledge and attitude play an important role in preventing oral diseases and improving dental health in their children. Aim: to assess the knowledge and behavior of pediatric parent's attending pediatric dental clinics in King Abdul-Aziz University Dental Hospital toward caries prevention. Materials and method Questionnaires consisting of 36 demographic and knowledge and patients’ practices questions were interviewed with All pediatric parent's (549 parents) attending the pediatric specialty clinics with their children during the year 2018 (from 1st of August 2017 to 31st of July 2018). Results There was a total of 283 respondents (51.5% response rate). Out of them, 79.5% were Saudi, 48.4% of children were males with a mean age 8.6 ± 2.54. Their mean knowledge score was 2.29 and 13.8% scored zero. In addition, 66.4% did not take their children to dentist except if there was a dental problem. The most significant factors affecting parental knowledge was maternal occupation and family income. Conclusion Parental dental knowledge and their behavior after their children dental experience were not satisfactory. Anticipatory guidance should be reinforced by oral health providers.

Most pediatric trauma patients are cared for in non-children's hospitals by providers without pediatric specialty training and in facilities that may not be used to caring for children. Children have different physiologic and psychologic responses to injury than adults. Children have different service and evaluative needs. Several studies have shown that pediatric trauma patients have improved outcomes with lower mortality, fewer operations, and improved function when cared for in pediatric facilities or adult trauma centers with pediatric expertise. Differences between injured adults and injured children need to be understood, recognized, and acted upon by care providers to optimize treatment for injured children. Limitations in the availability of pediatric specialists require that all hospitals be prepared to effectively and successfully treat pediatric trauma patients.

Robin L. Wootten, MBA, RN*, Gregory Sorensen, MD, Tasha Burwinkle, PhD Russell D. and Mary B. Shelden Clinical Simulation Center, Clinical Support and Education Building, Five Hospital Drive, Columbia, MO 65212, USA The Standardized Patient Program, The University of Missouri School of Medicine, Clinical Support and Education Building, Five Hospital Drive, Columbia, MO 65212, USA Pediatric Specialty Care, Swedish Medical Center, 747 Broadway, Nordstrom Tower, Suite 650, Seattle, WA 98122, USA Gossman Center for Pediatric and Perinatal Simulation, Swedish Medical Center, 747 Broadway, Nordstrom Tower, Suite 650, Seattle, WA 98122, USA

To assess the performance of the Pediatric Trust in Physician Scale (Pedi-TiPS) that refers to a child's physician and is a modified version of the Trust in Physician Scale (TiPS), and to explore the association of trust to demographic variables.We performed a cross-sectional survey of parents in pediatric specialty and primary care sites. Parents completed an anonymous questionnaire that included the Pedi-TiPS. Our main outcome variable was total Pedi-TiPS score (higher scores = higher trust). Reliability was determined by Cronbach's alpha. Bivariate comparisons and linear regression modeling explored potential associations between demographic variables and total score.Five hundred twenty-six parents completed surveys (73% response rate). The mean total score was 45.4 (SD 6), with good internal consistency (alpha = .84). In bivariate analysis, lower scores were associated with being a father (P = 0.03), older parent age (P = 0.02), private insurance status (P0.01), parent education greater than high school (P = 0.04), and not having a child age3 years (P = 0.03). In a regression model adjusted for other factors, parents who were either African American (P = 0.05), or "other" race (P0.01), parents with private insurance (P = 0.02), and parents who had no children3 years of age (P = 0.04) had lower trust.The Pedi-TiPS has properties similar to the original instrument. We found associations between trust and demographic factors that should be confirmed with further studies.

As part of the ongoing effort to minimize health care expenses, mothers and newborns are being discharged after shorter hospital stays. Problems that previously would have been noticed in the hospital nursery are now being seen in the emergency department. We report the case of a 1-day-old infant who was brought to our ED with grossly bloody stool. An Apt test was performed to determine whether the blood was of infant or maternal origin. After determining that the blood was the infant's, we transferred the child to a pediatric specialty center, where a diagnosis of necrotizing enterocolitis was made.

C a THE DECISION TO PUBLISH the December 2004 issue of the Journal of Perianesthesia Nursing (JoPAN), which focuses on the specialty of geriatric perianesthesia nursing, was stimulated by our desire to provide a gerontological nursing resource to improve the clinical care of older adults. This geriatric focus issue provides the reader with diverse geriatric content/topics spanning the perianesthesia continuum of care from preadmission assessment to preanesthesia, day of surgery phase through the PACU Phases I, II, and III levels of care. Perianesthesia nursing presents unique challenges when combined with agerelated physical changes, altered illness presentations, and diminished coping abilities that reveal some of the highest acuity and complex cases in our Phase I PACUs today. Consequently, effective nursing care of the older adult requires a specialized knowledge base. Just as the pediatric specialty has evolved, a new body of knowledge related to geriatric perianesthesia nursing is emerging. We are hopeful that our geriatric specialty issue will cultivate a foundational understanding of the essential concepts of care for the geriatric patient and provide our perianesthesia nurses with practical nursing strategies.