Background: Between 2007 and 2015, inpatient fluoroquinolone use declined in U.S. Veterans Affairs (VA) hospitals. Whether fluoroquinolone use at discharge has also declined, in particular since antibiotic stewardship programs became mandated at VA hospitals in 2014, is unknown. Methods: In this retrospective cohort study of hospitalizations with infection between January 1, 2014 and December 31, [...]

Background: Clinicians often diagnose bacterial infections such as urinary tract infection (UTI) and pneumonia in patients who are asymptomatic or have non-bacterial causes of their symptoms. Misdiagnosis of infection leads to unnecessary antibiotic use and potentially delays correct diagnoses. Interventions to improve diagnosis often focus on infections separately. However, if misdiagnosis is linked at the [...]

Background: Lumbar Punctures (LPs) are generally considered to be safe bedside procedures, but when bleeding complications arise they can be catastrophic with epidural hematomas risking spinal cord compression and paralysis if untreated. Our institution serves a large number of patients with hematologic malignancies requiring intrathecal chemotherapy, sometimes as frequently as twice weekly, who often have [...]

Background: Pediatric venous thromboembolism (VTE), although less common than in adults, is increasingly recognized as a significant and preventable cause of morbidity and mortality. There are no universal pediatric VTE guidelines, although the American College of Chest Physicians (ACCP) limits prophylaxis recommendations to a limited set of risk factors. Multiple centers have published institutional guidelines [...]

Background: Approximately one-fourth of the estimated 676,000 children in the US who were victims of abuse and neglect in 2016 were less than 3 years of age. Fractures are a common manifestation of child abuse. To our knowledge, no research study to date has examined the factors associated with medical staff filing Department of Child [...]

Background: Hypotonic fluids have been historically used for maintenance intravenous fluids (mIVF) in acutely ill children (1). In 2018, the American Academy of Pediatrics released a Clinical Practice Guideline (AAP CPG) recommending that patients 28 days to 18 years receive maintenance isotonic fluids in order to prevent hyponatremia (2). Several published surveys have assessed mIVF [...]

Background: Migraine headache (MHA) is a common pediatric disorder, which frequently leads to hospital admission. Inpatient MHA treatment involves ever-increasingly complex treatment plans, including fluid resuscitation and a variety of medications. Severe Migraine headache may require more aggressive therapy such as dihydroergotamine (DHE) and sphenopalatine ganglion (SPG) block that may prolong hospital stay and increase [...]

Background: Family centered rounds (FCR) is an important approach in patient care that allows for multi-disciplinary collaboration and active involvement of patients and families in shared medical decision making. FCR has been recognized by the American Academy of Pediatrics (AAP) as a standard of care but the definition and implementation of FCR can be highly [...]

Background: Despite the benefits of electronic health records, they have propagated lengthy and redundant notes. At our tertiary care pediatric hospital with a high degree of trainee turnover we identified high variability in documentation in our pediatric hospital medicine (PHM) progress notes with significant note bloat. We aimed to standardize and shorten the length of [...]

Background: Each year, 14 million Americans are diagnosed with HPV and 33,700 Americans are diagnosed with a cancer caused by HPV. The HPV vaccination can prevent 92% of these cancers. In 2018 only 42.74% of adolescents in Wisconsin ages 13-18 had completed the HPV series and only 56.47% had received the first dose. Hospitalization represents [...]