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  • American Academy of Pediatrics (AAP)  (2)
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  • American Academy of Pediatrics (AAP)  (2)
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  • 1
    Online Resource
    Online Resource
    Provider Knowledge, Attitudes, and Practices Regarding Bronchiolitis and Pneumonia Guidelines
    American Academy of Pediatrics (AAP) ; 2019
    In:  Hospital Pediatrics Vol. 9, No. 2 ( 2019-02-01), p. 87-91
    Details
    In: Hospital Pediatrics, American Academy of Pediatrics (AAP), Vol. 9, No. 2 ( 2019-02-01), p. 87-91
    Abstract: Practice guidelines have been published for bronchiolitis and community-acquired pneumonia (CAP), but little is known about pediatricians’ knowledge of and attitudes toward these guidelines since their publication. METHODS: We surveyed pediatric providers at 6 children’s hospitals in the New York City area. Two vignettes, an infant with bronchiolitis and a child with CAP, were provided, and respondents were asked about management. Associations between respondent characteristics and their reported practices were examined using χ2 and Fisher’s exact tests. Associations between questions probing knowledge and attitude barriers relevant to guideline adherence and reported practices were examined using Cochran-Mantel-Haenszel relative risk estimates. RESULTS: Of 283 respondents, 58% were trainees; 57% of attending physician respondents had finished training within 10 years. Overall, 76% and 45% of respondents reported they had read the bronchiolitis and CAP guidelines, respectively. For the bronchiolitis vignette, 40% reported ordering a chest radiograph (CXR), and 38% prescribed bronchodilators (neither recommended). For the CAP vignette, 38% prescribed ceftriaxone (not recommended). Study site, level of training, and practice locations were associated with nonrecommended practices. Site-adjusted knowledge and attitude barriers were used to identify that those who agreed CXRs were useful in managing bronchiolitis were more likely to order CXRs, and those who felt bronchodilators shortened length of stay were more likely to prescribe them. Concerns about ampicillin resistance and lack of confidence using local susceptibility patterns to guide prescribing were associated with ordering ceftriaxone. CONCLUSIONS: Provider-level factors and knowledge gaps were associated with ordering nonrecommended treatments for bronchiolitis and CAP.
    Type of Medium: Online Resource
    ISSN: 2154-1663 , 2154-1671
    URL: Article
    DOI: 10.1542/hpeds.2018-0211
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2019
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Improving Ventilation Rates During Pediatric Cardiopulmonary Resuscitation
    American Academy of Pediatrics (AAP) ; 2022
    In:  Pediatrics Vol. 150, No. 3 ( 2022-09-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 150, No. 3 ( 2022-09-01)
    Abstract: Excessive ventilation at rates of 30 breaths per minute (bpm) or more during cardiopulmonary resuscitation (CPR) decreases venous return and coronary perfusion pressure, leading to lower survival rates in animal models. A review of our institution’s pediatric CPR data revealed that patients frequently received excessive ventilation. METHODS We designed a multifaceted quality improvement program to decrease the incidence of clinically significant hyperventilation (≥30 bpm) during pediatric CPR. The program consisted of provider education, CPR ventilation tools (ventilation reminder cards, ventilation metronome), and individual CPR team member feedback. CPR events were reviewed pre- and postintervention. The first 10 minutes of each CPR event were divided into 20 second epochs, and the ventilation rate in each epoch was measured via end-tidal carbon dioxide waveform. Individual epochs were classified as within the target ventilation range ( & lt;30 bpm) or clinically significant hyperventilation (≥30 bpm). The proportion of epochs with clinically significant hyperventilation, as well as median ventilation rates, were analyzed in the pre- and postintervention periods. RESULTS In the preintervention period (37 events, 699 epochs), 51% of CPR epochs had ventilation rates ≥30 bpm. In the postintervention period (24 events, 426 epochs), the proportion of CPR epochs with clinically significant hyperventilation decreased to 29% (P & lt; .001). Median respiratory rates decreased from 30 bpm (interquartile range 21–36) preintervention to 21 bpm (interquartile range 12–30) postintervention (P & lt; .001). CONCLUSIONS A quality improvement initiative grounded in improved provider education, CPR team member feedback, and tools focused on CPR ventilation rates was effective at reducing rates of clinically significant hyperventilation during pediatric CPR.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2021-053030
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2022
    detail.hit.zdb_id: 1477004-0
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