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Objectives To characterize the recommended posthospitalization follow-up by provider type and location after a pediatric critical illness due to respiratory failure. Working hypothesis After pediatric critical illness due to respiratory failure, patients will not have a standard follow-up pattern with regard to provider type or follow-up location. Study design A retrospective cohort study. Subject selection Children, 18 years or younger, admitted to a quaternary care pediatric intensive care unit with respiratory failure between January 1, 2013 and December 31, 2014. Methodology For eligible patients, recommendations for posthospitalization follow-up including provider type (primary care and specialty care) and location (community care center vs. tertiary care center) were characterized from medical chart review. Recommendations were examined for all patients and two patient subgroups (patients who received extracorporeal membrane oxygenation and patients with tracheostomy). Results Of 155 patients alive at hospital discharge, the median age was 2.1 (interquartile range, 0.7-10.6) years. Eighty percent of patients were instructed to follow-up with a primary care provider but only 52.9% with a pulmonologist. We found 10 unique follow-up patterns between provider location (community care center, tertiary care center, or both) and global provider type (primary care versus specialty care). Primary care follow-up was recommended more often at community locations (74.2%), whereas specialty care was more often recommended at tertiary care centers (68.6%). Conclusions Our study findings demonstrate significant variability in the recommendations for follow-up by provider type and location after hospitalization for acute respiratory failure and highlight areas for improvement in follow-up care after pediatric critical illness.

Objective: To describe pre-hospital healthcare provider contact and the impact of a child’s medical complexity on patterns of contact in the 7 days prior to admission for pediatric critical illness due to respiratory failure.Study Design: Retrospective analysis of data on patients ≤18 years with respiratory failure admitted to a quaternary pediatric intensive care unit between January 1, 2013 and December 31, 2014. Pre-hospitalization provider contact was compared to the child’s medical complexity using Chi square and Kruskal-Wallis tests for categorical and continuous data, respectively.Results: Of 163 patients, the median age was 2.1 years, 59.5% were male, and 33.1% had medical complexity. In the 7 days prior to hospitalization, 68 families (41.7%) had 71 encounters with providers including primary care provider telephone call/office visit (66.2%), telephone contact/office visit with a specialist provider (31%), or urgent care visit (2.8%). Children without medical complexity were more likely than children with medical complexity to have a primary care provider telephone call/ office visit (36.7% vs 13.0%, p=0.004). In contrast, children with medical complexity were more likely to have a telephone call or office visit with a specialist (29.6% vs 5.5%, pConclusions: In the 7 days before hospitalization for pediatric respiratory failure, nearly 1 in 2 families contacted a healthcare provider with illness-related concerns. During acute medical crisis, children without medical complexity were more likely to contact their primary care provider, while children with medical complexity were more likely to contact a specialist. These findings have important implications for pediatric care delivery.

OBJECTIVES To quantify home care needs, healthcare utilization, and 2-year mortality after pediatric critical illness due to respiratory failure, and evaluate the impact of new morbidity and abnormal function at hospital discharge on resource use and outcomes. DESIGN Retrospective cohort study. SETTING Quaternary care PICU. PATIENTS Patients less than or equal to 18 years with respiratory failure from January 1, 2013, to December 31, 2014. MEASUREMENTS AND MAIN RESULTS Patient demographics, hospitalization characteristics, and healthcare utilization were quantified and compared according to morbidity development and discharge functional status. Multivariable regression methods evaluated 2-year readmission rates and mortality by morbidity development and discharge functional status. Of 163 patients, the median age was 2.1 years (interquartile range, 0.6-10.9 yr), 61 (37.4%) had a comorbidity, and 73 (44.8%) had abnormal function at admission. Median ventilation duration was 6.0 days (interquartile range, 3.0-11.7 d), and median PICU and hospital length of stay were 8 (interquartile range, 4-15) and 14 days (interquartile range, 8-23 d), respectively. At hospital discharge, eight of 163 (4.9%) had died, and 14 of 163 (8.6%) had a new morbidity. Of the surviving 155 patients at hospital discharge, 87 (56.1%) had abnormal function, 120 (77.4%) had new medications, 24 (15.5%) had new medical devices, and 43 (27.7%) had new home care equipment. Cumulative 2-year mortality was 14 of 163 (8.6%) with six of 163 (3.7%) occurring after discharge. Within 2 years, 81 of 155 of patients (52.2%) were readmitted, often (58/81, 71.6%) to the PICU. Abnormal function at discharge was associated with elevated odds of readmission to the hospital (odds ratio, 1.49; 1.28-1.74; p < 0.0001) and PICU (odds ratio, 1.47; 1.27-1.71; p < 0.0001) within 2 years. CONCLUSIONS After critical illness, children have significant new healthcare burdens heretofore unrecognized. Abnormal functional status at hospital discharge was associated with increased healthcare utilization up to 2 years thereafter.

A 16-year-old boy with Chiari 1 malformation presented for an elective suboccipital craniectomy and C1 laminectomy. His intraoperative course was uneventful. At the conclusion of the procedure, he met extubation criteria and followed commands. After extubation, he developed progressive upper airway obstruction and became obtunded. He was reintubated via videolaryngoscopy, which showed edema not only to the tongue, but also to the posterior pharynx and blisters over the vocal folds and epiglottis. The patient was transferred to the pediatric intensive care unit intubated and sedated. This report describes the clinical course of his massive macroglossia and discusses short- and long-term management.

Background Large amounts of information are provided to applicants during the residency interview process. It is important to share this information in an efficient, environmentally sound, and engaging manner. Preparing information packets requires significant administrative time and results in discarded paper or unused flash-drives. OBJECTIVE We sought to eliminate paper documents, minimize administrative effort, and streamline communication during interview season. Methods With the assistance of LegitApps Company we designed an app for Android and Apple devices that allows us to communicate in real time with applicants. The app delivers all required documentation prior to the applicant's arrival. It provides interview day schedule details and logistics, maps to their specific pre-interview dinner, and helps with navigating our city (finding hotels, identifying places to eat, highlighting fun things to do, etc). An easy to complete interview day survey is automatically pushed to all applicants at the end of the day. After initial programming, only minimal maintenance was needed by our administrative staff throughout the season. Results The app was downloaded 522 times this season. Based on results from the end-of-the-day survey, almost all 353 applicants downloaded the app. They appreciated the streamlined communication and hub for information. They used it to find Uber rides, book hotels, explore the city, and to prepare for their interview day. By eliminating paper, we saved money and manpower, allowing our staff to dedicate their time to the applicant experience. Survey comments include: “I appreciated the UM Pediatrics App, as it made the resources easy to access and reference throughout the day” and “I liked the App and that you tried to save some trees and not print out all of the information.” Conclusion The app successfully conveyed information efficiently to applicants and decreasing the administrative workload. We plan to expand the app to include our fellowship programs and are working with other programs at our institution to develop similar apps for their programs.