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No longer are healthcare-acquired conditions considered expected costs of care. Given the lack of randomized controlled trials in children, often we are left with extrapolating from adult literature, recommended prevention bundles, and expert opinion. Additionally, strategies that are considered adjunct to the standard prevention bundles have been examined. Here, we review standard central line-associated bloodstream infection (CLABSI) prevention bundles as well as adjunct prevention strategies. Due to the mortality and morbidity risk, indirect and direct costs, and the inevitable penalties associated with these largely preventable harms, we must reliably implement bundles to avoid these healthcare-acquired infections.

6505 Background: A small number of patients (super-utilizers) are responsible for much of the cost in healthcare. In several studies, 5% of patients are responsible for 50% of the cost. Healthcare hot-spotting is the strategic use of data to deliver enhanced resources to selected super-utilizers in an effort to improve the quality of care and to reduce costs. Methods: Patients enrolled in the Oncology Care Model (OCM) who were scheduled to receive cytotoxic, targeted therapy or immunotherapy beginning in the fall of 2017 were screened by nurse practitioners prior to initiating treatment in an effort to identify super-utilizers. Risk factors included high risk disease (stem cell transplant, myelodysplastic syndrome, acute leukemia, stage IV disease), significant co-morbidities (CHF, COPD, renal failure, Insulin Dependent Diabetes , presence of a gastrostomy tube), or an admission to the hospital in the past 6 months. Such patients were provided with enhanced services which included twice weekly outreach by a nurse practitioner between 8am and 10am for a telephonic evaluation of their health status. If the patient was found to have either a new problem that required intervention or a worsening chronic problem, then a same-day appointment was made with the nurse practitioner, oncologist, primary care provider or appropriate specialist. Results: Inpatient admissions decreased from 21.3 per 100 OCM beneficiaries to 18.7 per 100 OCM beneficiaries representing a 12.2% decrease. Inpatient costs were reduced from $979 per beneficiary per month (PBPM) to $885 PBPM representing a decrease of $94 PBPM (9.6% decrease). Conclusions: Targeting oncology super-utilizers based on the nature of their diagnosis, co-morbidities, or history of a recent hospital admission and offering telephonic evaluation reduced hospitalizations and decreased cost resulting in a savings of nearly $600,000 per year for our OCM cohort of 600 beneficiaries. [Table: see text]

Very high doses of narcotics and benzodiazepines are often needed for sedation and analgesia after extensive abdominal surgery in children, with the potential for excessive sedation, prolonged ventilation and withdrawal. We hypothesized that neuromuscular blockade used as an adjunct to sedation and analgesia during the first postoperative day would decrease need for treating withdrawal without increasing ventilator days and PICU length of stay (LOS). Starting in July 2011, we gave a weakening dose of atracurium during the first 24 hours after surgery in addition to usual fentanyl, benzodiazepines, morphine and dexmedetomidine to pediatric single or multiple abdominal organ transplant recipients (Group P, n=12). Cumulative narcotic doses given during the first 48 hrs and need for methadone-lorazepam on transfer out of the PICU were compared with a non-paralyzed cohort (Group NP, n=12) from the previous year. Patients with early surgical complications were excluded from analysis. There were no differences in demographics including age, diagnosis and type of transplant. For Group P vs. Group NP, median fentanyl used (µg/Kg/day) was 46.0 (29.7-69.7) vs 24.6 (24.1-29.6) (P= 0.036, Mann-Whitney). Methadone-lorazepam treatment on transfer out of the PICU was less common in Group P (P= 0.046, Fisher’s exact test) with no increase in ventilator days or PICU-LOS as compared to Group NP. We conclude that the use of brief, early post-operative paralysis reduces narcotic dependence without prolonging mechanical ventilation in pediatric abdominal solid organ transplant recipients.

Previous research indicates the presence of certain odors is associated with enhanced task performance. The present study investigated use of peppermint odor during typing performance, memorization, and alphabetization. Participants completed the protocol twice—once with peppermint odor present and once without. Analysis indicated significant differences in the gross speed, net speed, and accuracy on the typing task, with odor associated with improved performance. Alphabetization also improved significantly under the odor condition but not typing duration or memorization. These results suggest peppermint odor may promote a general arousal of attention, so participants stay focused on their task and increase performance.