Lindsay Weiss

Background: Experienced clinical educators often use teaching scripts developed over time to teach frequently encountered clinical topics. Teaching scripts are structured, evidence‐based tools that enhance clinical education by providing concise, high‐yield learning points during patient rounds. Approach: A team of paediatric hospitalists (inpatient attendings) and trainees developed a large repository of online teaching scripts to offer pre‐created, evidence‐based teaching approaches for the inpatient setting. This repository is located on the American Academy of Paediatrics (AAP) Section on Hospital Medicine (SOHM) website. Clinicians around the nation (and globally) were invited to submit teaching scripts incorporating evidence‐based, high‐yield teaching points and strategies. Each script underwent review by multiple members of the AAP SOHM Teaching Script Subcommittee to ensure accuracy, usability, and novelty. Currently, there are over 60 teaching scripts published on the website, each with a link for feedback. Evaluation: Between 2019 and 2021, the repository received 6652 page views. Survey data show that 97% of users found the scripts beneficial for improving their teaching effectiveness, 84% planned to use them and 76% expressed interest in creating their own script. Implications: A national repository of peer‐reviewed teaching scripts is useful to offer readily accessible, high‐quality educational resources. This initiative enhances teaching efficiency, supports faculty development and provides a scalable model for medical education. Future studies should assess the impact on learner comprehension and patient outcomes.

Introduction: Communication between pediatric hospitalists and primary care physicians (PCPs) at discharge is an essential part of a successful transition to home. While many hospitals require communicating with PCPs for all admitted patients, it is unknown if PCPs find such communication valuable or if it improves outcomes. Our global aim was to improve discharge communication for patients that pediatric hospitalists and PCPs deemed appropriate. Methods: We sent surveys to 422 outpatient pediatricians in our care network to understand their communication preferences. Survey results informed local guidelines for when hospitalists should directly contact PCPs. We determined the proportion of inpatient discharges meeting those guidelines and set a target for our primary process metric: the proportion of discharges with attempted direct PCP contact. We engaged in Plan-Do-Study-Act cycles, including a discharge documentation tool in the electronic health record, education of inpatient teams, email reminders including group performance data, asynchronous Health Insurance Portability and Accountability Act-compliant messaging application, and competitions that shared blinded individual data. Results: We increased the percentage of documented direct communication with the PCPs from 2% to 33% and from 4% to 65% for those who met guidelines for direct communication. Conclusions: PCPs only want direct communication on a subset of discharges. Interventions focused on high-yield populations improved discharge communication in our institution.

This study sought to assess clinical characteristics and differences in outcomes between children with Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA) osteomyelitis or septic arthritis and whether initial antibiotic regimen affects patient outcomes. We analyzed records of children ages 15 days to 18 years admitted between 2009 and 2016 to two tertiary children’s hospitals who were diagnosed with an osteoarticular infection and had a microorganism identified. A total of 584 patients met inclusion criteria, of which 365 (62.5%) had a microbiological diagnosis. MSSA was the most common pathogen identified (45.5%), followed by MRSA (31.2%). Compared to MSSA, patients with MRSA had a higher initial C-reactive protein and longer hospitalization. Patients whose initial antibiotic regimens included vancomycin had a longer hospitalization than those initiated on clindamycin without vancomycin, even after removing sicker patients admitted to the pediatric intensive care unit. While MRSA was associated with increased severity of osteoarticular infections compared to MSSA, the incidence of MRSA has been declining at our institution. Patients with longer lengths of stay were more likely to be on vancomycin. Clindamycin should be considered in the initial antibiotic regimen for osteomyelitis and septic arthritis with ongoing surveillance of local microbiology and outcomes.

OBJECTIVES To assess clinical characteristics and differences in outcomes between children with Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA) osteomyelitis or septic arthritis and whether initial antibiotic regimen affects patient outcomes.STUDY DESIGN We analyzed records of children ages 15 days to 18 years admitted between 2009 and 2016 to two tertiary children’s hospitals who were diagnosed with an osteoarticular infection and had a microorganism identified. We compared the relationship of MRSA versus MSSA and initial antibiotic selection on patient outcomes including length of hospitalization and requiring a PICU transfer.RESULTS A total of 584 patients met inclusion criteria of which 365 (62.5%) had a microbiological diagnosis. MSSA was the most common pathogen identified (45.5%) followed by MRSA (31.2%). The percentage of MRSA cases decreased by 25.4% between 2009 and 2016, whereas MSSA infections increased by 18.6%. Compared to MSSA, patients with MRSA had a higher initial C-reactive protein (median 17.3 mg/dL vs 7.8 mg/dL, p<0.05) and a longer hospitalization (median 8.3 days vs 6.1 days, p<0.05). Patients whose initial antibiotic regimens included vancomycin were more likely to require a PICU transfer (15.0% vs 2.2%, p<0.05) and had a longer hospitalization (median 6.7 days vs 5.5 days, p<0.05) compared to those initiated on clindamycin without vancomycin.CONCLUSIONS While MRSA was associated with increased severity of osteoarticular infections compared to MSSA, the incidence of MRSA has been declining at our institution. Patients with longer lengths of stay and those requiring a PICU transfer were more likely to be on vancomycin. Clindamycin should be considered in the initial antibiotic regimen for osteomyelitis and septic arthritis with ongoing surveillance of local microbiology and outcomes.