Background: Children with medical complexity (CMC) are a growing pediatric population with disproportionately high health needs and costs often insured by Medicaid. Identification of CMC using complexity classification systems applied to population-level data and establishment of baseline patterns of population-level health care utilization are essential to target patients who may benefit most from complex care [...]

Background: Length of stay (LOS) is an important outcome measure in the evaluation of the quality of care for hospitalized patients. LOS in adults with diabetic ketoacidosis (DKA) is reported to be about 3 days, but detailed information about LOS in pediatric patients with DKA is lacking. Knowledge of factors that impact LOS is essential [...]

Background: Adolescents have poor access to preventive care and outpatient providers face many barriers to addressing sexual health with adolescents. Recent literature advises providers to address sexual health in nontraditional settings including emergency department (ED) visits and hospitalizations. In our previous work we identified missed opportunities to address sexual health on the hospital medicine service, [...]

Background: Sleep is critical to children’s health and recovery, but pediatric inpatient sleep is often disrupted by nonessential overnight interruptions. The COVID-19 pandemic necessitated social distancing policies which minimized contact with low-risk patients. These policies have the potential to decrease overnight disruptions and improve sleep for hospitalized patients. Methods: This cohort study compared sleep disruptions [...]

Background: Bronchiolitis is one of the most common reasons for hospitalizations in children with > 100,000 admissions each year. High-flow nasal cannula (HFNC) therapy has been widely adopted to treat bronchiolitis with increasing use outside of the pediatric intensive care unit (PICU). The use of oral feeding while on HFNC has been questioned due to [...]

Background: The management of cellulitis in young infants has not been well-studied and appears to be largely variable. Infants with cellulitis often present without fever and only skin findings, with only a small minority having invasive infection. There is no consensus on the need for admission and further workup, such as a lumbar puncture. The [...]

Background: Infants ≤ 60 days of age with a urinary tract infection (UTI) are a challenging population. Without clear guidelines for management, there is variability in renal imaging and antibiotic use. Our study examined patterns of renal imaging and antibiotic use in infants ≤ 60 days of age with UTI at a tertiary care children’s [...]

Background: Pediatric orbital cellulitis/abscess (OC) is a known complication of sinusitis that can have detrimental outcomes such as vision loss and intracranial extension if not diagnosed and treated promptly. In many patients with OC, the microbiologic data is not available to guide provider selection of targeted antibiotics, so variation in prescribing patterns exists. Many institutions [...]

Background: The indications for lumbar puncture (LP) among febrile infants 29-60 days old continue to evolve. We studied febrile infants age 29-60 days with an ED visit and compared the characteristics and outcomes of those with and without an LP. We also describe the clinical course of infants receiving antibiotics before or after the LP. [...]

Background: For hospitalists rounding on inpatient units, admitting new patients at varying times through the day greatly disrupts workflow efficiency. Deferring these admissions to the next shift can result in delays in patient care. Admitting teams dedicated to the needs of new patients offer a potential solution. Methods: A quality improvement project was conducted on [...]