Background: Overdose-related deaths in adolescents have increased, making recognition and treatment of substance use (SU) an issue of critical importance. However, pediatricians are failing to screen and manage SU withdrawal among hospitalized adolescents. Driving factors include no standard process, addiction specialists’ discomfort in treating pediatrics, and discomfort in inpatient providers in managing addiction. Through this [...]

Background: Prior studies of routine blood culture (BC) testing in uncomplicated community acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) have demonstrated low utility given similar rates of pathogen versus contaminant detection and little effect on clinical management. Understanding patterns and outcomes of BC testing can identify opportunities to [...]

Background: Point-of-care ultrasound (POCUS) is a growing interest in pediatric hospital medicine, however few Pediatric Hospital Medicine (PHM) fellowships incorporate POCUS training formally into their curriculum. POCUS can expedite treatment and improve care for patients in resource-limited settings or when specialists are not immediately available. POCUS can also help PHM fellows bring residents back to [...]

Background: In a technology-driven era, it is no surprise that the majority of learners prefer multimodal resources when learning new material. Patient discharge education is no exception to this, and several studies have demonstrated that providing digital discharge education (DDE) can help with patient comprehension, information retention, and patient self-efficacy with medication (1, 2, 3). [...]

Background: Enhanced Recovery After Surgery (ERAS) is a framework or pathway of standardized preoperative, intraoperative, and postoperative elements shown to improve recovery after a surgical operation (Table 1). ERAS has shown benefits in pediatrics by reducing hospital length of stay, opioid use, readmission rates, health care costs and improving patient satisfaction scores(1,2). At our institution, [...]

Background: Hip fracture surgery is associated with a significant incidence of postoperative myocardial infarction (postop-MI) up to 14% in the first 7 days after repair. Patients who sustain postop-MI have 1-year mortality rates up to 36%. However, the impact of risk factor modification and routine troponin monitoring on the incidence and prognosis of postop-MI remains [...]

Background: Perioperative medicine focuses on providing patient-centered care throughout the pre-operative and post-operative periods. This area of medicine is critical given its potential to limit complications, improve post-operative outcomes, and decrease the duration of hospitalization after surgery. In recent years, perioperative medicine teaching during residency has become a requirement by The Accreditation Council for Graduate [...]

Background: Gastric Point-of-Care Ultrasound (POCUS), has been validated for perioperative pulmonary aspiration risk reduction, but data on medical inpatients is lacking (1). Inpatients often have multiple risk factors for delayed gastric emptying, but may need urgent surgery or procedures. According to the American Society of Anesthesiologists (ASA), a fasting period of 2, 6, and 8 [...]

Background: Chronic kidney disease (CKD) is associated with adverse perioperative outcomes, including mortality, with risk increasing with severity of CKD. (1) Long term dialysis is also associated with pneumonia, unplanned intubation, reoperation, and vascular complications. (2) Common preoperative practices for end stage renal disease (ESRD) patients include measuring day of surgery (DOS) potassium levels. Little [...]

Background: Current guidelines recommend continuing aspirin during elective non-cardiac surgery in 1) patients with prior percutaneous coronary intervention (PCI) if the bleeding risk allows and 2) patients without prior PCI if thrombotic risk outweighs bleeding risk. Comparing the risk of thrombosis and bleeding is frequently inexplicit, particularly in low and intermediate bleeding risk surgery. The [...]