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PurposeTo examine how intermediate care units (IMCUs) are used in relation to pediatric intensive care units (PICUs), characterize PICU patients that utilize IMCUs, and estimate the impact of IMCUs on PICU metrics.Materials & methodsRetrospective study of PICU patients discharged from 108 hospitals from 2009 to 2011. Patients admitted from or discharged to IMCUs were characterized. We explored the relationships between having an IMCU and several PICU metrics: physical length-of-stay (LOS), medical LOS, discharge wait time, admission severity of illness, unplanned PICU admissions from wards, and early PICU readmissions.ResultsThirty-three percent of sites had an IMCU. After adjusting for known confounders, there was no association between having an IMCU and PICU LOS, mean severity of illness of PICU patients admitted from general wards, or proportion of PICU readmissions or unplanned ward admissions. At sites with an IMCU, patients waited 3.1h longer for transfer from the PICU once medically cleared (p

ObjectivesTo characterize patients who received tracheostomies for airway compromise or were initiated on long-term ventilation for chronic respiratory failure in PICUs and to examine variation in the incidence of initiation, patient characteristics, and modalities across sites.DesignRetrospective cross-sectional analysis.SettingsSeventy-three North American PICUs that participated in the Virtual Pediatric Systems, LLC.PatientsPICU patients admitted between 2009 and 2011.InterventionsNone.Measurements and main resultsAmong 115,437 PICU patients, 1.8% received a tracheostomy or were initiated on long-term ventilation; 1,034 received a tracheostomy only, 717 were initiated on invasive ventilation, and 381 were initiated on noninvasive ventilation. Ninety percent had substantial chronic conditions and comorbidities, including more than 50% with moderate or worse cerebral disability upon discharge. Seven percent were initiated after a catastrophic injury/event. Across sites, there was variation in incidence of tracheotomy and initiation of long-term ventilation, ranging from 0% to 4.6%. There also was variation in patient characteristics, time to tracheotomy, number of extubations prior to tracheostomy, and the use of invasive ventilation versus noninvasive ventilation.ConclusionsAlthough the PICU incidence of initiation of tracheostomies and long-term ventilation was relatively uncommon, it suggests that thousands of children and young adults receive these interventions each year in North American PICUs. The majority of them have conditions and comorbidities that impose on-going care needs, beyond those required by artificial airways and long-term ventilation themselves.

ObjectivesTo determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions.DesignRetrospective cohort analysis.SettingNinety North American PICUs that participated in the Virtual Pediatric Intensive Care Unit Systems.PatientsOne hundred five thousand four hundred thirty-seven admissions between July 2009 and March 2011.InterventionsNone.Measurements and main resultsUnplanned PICU readmission within 48 hours of index discharge was the primary outcome. Summary statistics, bivariate analyses, and mixed-effects logistic regression model with random effects for each hospital were performed.There were 1,161 readmissions (1.2%). The readmission rate varied among PICUs (0-3.3%), and acute respiratory (56%), infectious (35%), neurological (28%), and cardiovascular (20%) diagnoses were often present on readmission. Readmission risk increased in patients with two or more complex chronic conditions (adjusted odds ratio, 1.72; p < 0.001), unscheduled index admission (adjusted odds ratio, 1.37; p < 0.001), and transfer to an intermediate unit (adjusted odds ratio, 1.29; p = 0.004, compared with ward). Trauma patients had a decreased risk of readmission (adjusted odds ratio, 0.67; p = 0.003). Gender, race, insurance, age more than 6 months, perioperative status, and nighttime transfer were not associated with readmission. Compared with index admissions, readmissions had longer median PICU length of stay (3.1 vs 1.7 d, p < 0.001) and higher mortality (4% vs 2.5%, p = 0.002).ConclusionsUnplanned PICU readmissions were relatively uncommon, but were associated with worse outcomes. Several patient and admission characteristics were associated with readmission. These data help identify high-risk patient groups and inform risk-adjustment for standardized readmission rates.

"WeBWorK," an online homework system, can be be used to deliver daily reading questions to students. The author studied its use for this purpose with a lower division Introduction to Programming course and an upper division Probability and Statistics course. In the lower division course, "WeBWorK" significantly improved peer instruction performance, and resulted in students spending on average 45% more time on reading their textbook. In the upper division course, "WeBWorK" had no effect. We discuss and conjecture explanations. (Contains 4 figures.)

Rationale: Primary continuity intensivists and nurses for long-stay patients (LSP) in pediatric intensive care unit (PICU) are understudied strategies used to mitigate the fragmented care of typical rotating care models.Objectives: To investigate the advantages and disadvantages of primary continuity intensivists and nurses for LSP as perceived by their parents and PICU providers.Methods: Prospective cross-sectional mixed-methods study of 1) the perspectives of parents whose children were admitted to a PICU for >10 days and had >1 complex chronic condition regarding the care provided their PICU intensivists and nurses. As part of a trial, patients had been randomized to care from a rotating on-service intensivist who changed weekly and by PICU nurses who changed every 12 hours (usual care group) or to care from the same on-service intensivist plus a primary continuity intensivist and primary nurses (primary group). Additionally, 2) their PICU providers (intensivists, fellows, nurses) were queried for their perspectives on primary intensivists and nurses. Novel questionnaires, assessed for content and face validity and readability, were used. The parental questionnaire involved indicating their degree of agreement to 16 statements about their care. The provider questionnaire involved rating potential advantages of primary continuity intensivists and nurses and estimating the frequency of disadvantages. Descriptive statistics and divergent stack bar charts were used; parents' and providers' responses were compared, stratified by their child's group (usual care or primary) and provider role, respectively.Results: There was 71% parental response rate (120 completed questionnaires). For 10 of 16 statements, parents whose children received primary continuity intensivists and nurses indicated significantly more positive perceptions of care (eg, communication, listening, decision-making, problems due changing providers). There was a 61% provider response rate (117 completed questionnaires); >80% felt that primary intensivists and nurses were highly or very highly beneficial for LSP. Providers perceived more benefits for patients/families (eg, informational continuity and facilitating/expediting decision-making) than for staff/institutions (eg, staff satisfaction). Providers reported associated stress, expenditure of time/effort, and decreased staffing flexibility with primary practices.Conclusions: Perceived benefits of primary continuity intensivists and nurses by both parents and providers support more widespread adoption and study of these continuity strategies. [ABSTRACT FROM AUTHOR]

WeBWorK, an online homework system, can be be used to deliver daily reading questions to students. The author studied its use for this purpose with a lower division Introduction to Programming course and an upper division Probability and Statistics course. In the lower division course, WeBWorK significantly improved peer instruction performance, and resulted in students spending on average 45% more time on reading their textbook. In the upper division course, WeBWorK had no effect. We discuss and conjecture explanations. [ABSTRACT FROM PUBLISHER]