Background: Increased asthma and obesity prevalence are independently associated with health disparities.  This study sought to examine the relationship between these two conditions, particularly within the pediatric population at a major inner city teaching hospital. Methods: Patients aged 3 to 18 with a diagnosis of bronchial asthma and at least one hospital encounter for an [...]

Background: Bronchiolitis is a clinical diagnosis, with growing research supporting limited use of diagnostic tests and interventions. Hospitals have reduced use of bronchodilators and imaging, but the national average of respiratory viral testing (RVT) in these children continues to be high at 33%. Over the past three years, RCHSD’s rate has persisted at 31-35%, despite [...]

Background: Nationally, there has been a loss of pediatric inpatient beds (-4.3%), and large swings in ward (-7.2%) and pediatric (non-neonatal) intensive care (PICU; +15.8%) beds.  These shifts have important implications for access, safety and costs; however, studies on this topic are limited.  We aimed to identify variation in pediatric inpatient beds (change in absolute [...]

Background: Maternal chorioamnionitis usually means an otherwise healthy appearing newborn gets cultured and treated for presumptive bacterial infection pending culture results. This is often done in a NICU setting. These babies are overwhelmingly well and are discharged after they ‘rule out’. However, the need for additional treatment and care in a NICU setting as well [...]

Background: Many pediatric hospitalist programs in community hospitals around the country function with a 24-hour shift model for 24/7 coverage. This creates significant discontinuity and daily inefficiencies in patient care. Furthermore, there is a robust amount of adult literature that points to the benefits of both inpatient and outpatient continuity of care. When our community [...]

Background: Surgical site infections (SSI) can complicate any operative procedure although this risk is mitigated through the use of preoperative antibiotic prophylaxis.  While antibiotic prophylaxis can provide great benefit, inappropriate use can lead to the development of multi-drug resistant organisms causing increased morbidity, mortality, and cost. Although national clinical guidelines for preoperative antibiotics prophylaxis were [...]

Background: Severe aortic stenosis (SAS) had been identified as being at elevated risk for non-cardiac surgery. However, two reports demonstrated that SAS did not increase mortality of intermediate to high risk non-cardiac surgery. The European Society of Cardiology guideline states non-cardiac surgery of low to intermediate risk can be safely performed among patients with SAS. [...]

Background: The Affordable Care Act intended to “extend affordable coverage” and “ensure access” for vulnerable patient populations. Therefore, this investigation examined whether the type of insurance (Medicaid, Medicare, BlueCross, cash pay) carried by trauma patients influences access to pain management specialty care. The study was designed to identify barriers that patients experience as well as [...]

Background: Patient experience scores are now widely accepted as a measure of healthcare quality and contribute to Medicare’s value-based purchasing quality reimbursement program. In order to enhance the patient’s experience, we must first seek to understand their perspective of the care received. A previous study suggested that patients’ perception of the amount of time that [...]

Background: Hospital-acquired delirium is a common cause of increased morbidity and mortality. In an earlier pilot study, we identified through surveys that adult medicine inpatients slept an average of 4 hours. Also, multiple factors including environmental noise, vital sign checks, and lab draws were recognized as barriers to sleep. Based on this information and prior [...]