Caring for a hospitalized child is no easy task—the patient, often ill and in an unfamiliar environment encounters numerous new faces both day and night. The child’s caregivers, concerned and stressed with an acute change in their loved one’s health, bears the burden of maintaining a family structure in the health care environment. Providers hold in balance the demands of treating both acute and chronic illness with the individual needs of the patient and family. While each inpatient encounter offers unique challenges and opportunities, children and families deserve an exemplary standard of care during their hospitalization across the industry. But how do we accomplish this as pediatric providers when the setting for care is as unique as the very patients we treat?
In this month’s Pediatrics, Dr. Daniel Rauch, along with the American Academy of Pediatrics Committee on Hospital Care and Section on Hospital Medicine, share an updated clinical report highlighting how physicians can provide coordinated care for hospitalized children (10.1542/peds.2018-1503). The first central theme of the report is that of communication between the inpatient provider and the child’s primary care provider (PCP). Authors encourage direct, verbal communication starting ideally as soon as possible after admission. This approach can provide context to a child’s course of illness for the inpatient provider who more often than not is meeting a patient for the first time upon admission. Additionally, discussion with the PCP can assist with medication reconciliation and the identification of laboratory testing already completed. A second central theme is that of care coordination and discharge planning. A child’s departure from the hospital is “the achievement of the goal of admission”, a goal mutually agreed upon by both the medical team and family. On the journey to discharge, it is the primary inpatient provider’s responsibility to communicate with subspecialists, ensure appropriate follow-up, and prescribe and reconcile medications in an accurate and safe manner. Furthermore, the care both provided inpatient and planned as an outpatient, should be communicated via patient- and family-centered rounds whenever possible. Whether you practice near a non-freestanding hospital that admits pediatric patients or a large quaternary children’s medical center, this clinical report proposes standards for the rapidly growing field of pediatric hospital medicine. Check out this updated clinical report and see for yourself what other roles you can fulfill during a child’s hospitalization!
