Core Competencies

The Pediatric Hospital Medicine Core Competencies were first published in 2010 to help define a specific body of knowledge and measurable skills needed to practice high quality care for hospitalized pediatric patients across all practice settings.¹ Since then, the number of practicing pediatric hospitalists has grown to a conservative estimate of 3,000 physicians and the scope of practice among pediatric hospitalists has matured.² Pediatric hospitalists are increasingly leading or participating in organizational and national efforts that emphasize interprofessional collaboration and the delivery of high value care to hospitalized children and their caregivers—including innovative and family-centered care models, patient safety and quality improvement initiatives, and research and educational enterprises.^3-8 In response to these changes, the American Board of Medical Specialties designated Pediatric Hospital Medicine (PHM) as a pediatric subspecialty in 2016.

The field of PHM in the United States continues to be supported by three core societies—Society of Hospital Medicine (SHM), American Academy of Pediatrics (AAP), and Academic Pediatric Association (APA). Together, these societies serve as tri-sponsors of the annual Pediatric Hospital Medicine national conference, which now welcomes over 1,200 attendees from the United States and abroad.⁹ Each society also individually sponsors a variety of professional development and continuing medical education activities specific to PHM.

In addition, pediatric hospitalists often serve a pivotal role in teaching learners (medical students, residents, and other health profession students), physician colleagues, and other healthcare professionals on the hospital wards and via institutional educational programs. Nearly 50 institutions in the United States offer graduate medical education training in PHM.¹⁰ The PHM Fellowship Directors Council has developed a standardized curricular framework and entrustable professional activities, which reflect the tenets of competency-based medical education, for use in PHM training programs.^11-13

These changes in the practice environment of pediatric hospitalists, as well as the changing landscape of graduate and continuing medical education in PHM, have informed this revision of The PHM Core Competencies. The purpose of this article is to describe the methodology of the review and revision process.

Revision

The PHM Core Competencies: 2020 Revision provide a framework for graduate and continuing medical education that reflects the current roles and expectations for all pediatric hospitalists in the United States. The acuity and complexity of hospitalized children, the availability of pediatric subspecialty care and other resources, and the institutional orientation towards pediatric populations vary across community, tertiary, and children’s hospital settings. In order to unify the practice of PHM across these environments, The PHM Core Competencies: 2020 Revision address the fundamental and most common components of PHM which are encountered by the majority of practicing pediatric hospitalists, as opposed to an extensive review of all aspects of the field.

The compendium includes 66 chapters on both clinical and nonclinical topics, divided into four sections—Common Clinical Diagnoses and Conditions, Core Skills, Specialized Services, and Healthcare Systems: Supporting and Advancing Child Health (Table 1). Within each chapter is an introductory paragraph and learning objectives in three domains of educational outcomes—cognitive (knowledge), psychomotor (skills), and affective (attitudes)—as well as systems organization and improvement, to reflect the emphasis of PHM practice on improving healthcare systems. The objectives encompass a range of observable behaviors and other attributes, from foundational skills such as taking a history and performing a physical exam to more advanced actions such as participating in the development of care models to support the health of complex patient populations. Implicit in these objectives is the expectation that pediatric hospitalists build on experiences in medical school and residency training to attain a level of competency at the advanced levels of a developmental continuum, such as proficient, expert, or master.¹⁴

The objectives also balance specificity to the topic with a timeless quality, allowing for flexibility both as new information emerges and when applied to various educational activities and learner groups. Each chapter can stand alone, and thus themes recur if one reads the compendium in its entirety. However, in order to reflect related content among the chapters, the appendix contains a list of associated chapters (Chapter Links) for further exploration. In addition, a short reference list is provided in each chapter to reflect the literature and best practices at the time of publication.

Finally, The PHM Core Competencies: 2020 Revision reflect the status of children as a vulnerable population. Care for hospitalized children requires attention to many elements unique to the pediatric population. These include age-based differences in development, behavior, physiology, and prevalence of clinical conditions, the impact of acute and chronic disease states on child development, the use of medications and other medical interventions with limited investigative guidance, and the role of caregivers in decision-making and care delivery. Heightened awareness of these factors is required in the hospital setting, where diagnoses and interventions often include the use of high-risk modalities and require coordination of care across multiple providers.

Project Initiation

Revision of The PHM Core Competencies: 2020 Revision began in early 2017 following SHM’s work on The Core Competencies in Hospital Medicine 2017 Revision.¹⁵ The Executive Committee of the SHM Pediatrics Special Interest Group (SIG) supported the initiation of the revision. The 3 editors from the original compendium created an initial plan for the project that included a proposed timeline, processes for engagement of previously involved experts and new talent, and performance of a needs assessment to guide content selection. The Figure highlights these and other important steps in the revision process.

Editor and Associate Editor Selection

The above editors reviewed best practice examples of roles and responsibilities for editor and associate editor positions from relevant, leading societies and journals. From this review, the editors created an editorial structure specifically for The PHM Core Competencies: 2020 Revision. A new position of Contributing Editor was created to address the need for dedicated attention to the community site perspective and ensure review of all content, within and across chapters, by a pediatric hospitalist who is dedicated to this environment. Solicitation for additional editors and associate editors occurred via the SHM Pediatrics SIG to the wider SHM membership. The criteria for selection included active engagement in regional or national activities related to the growth and operations of PHM, strong organizational and leadership skills, including the ability to manage tasks and foster creativity, among others. In addition, a deliberate effort was made to recruit a diverse editorial cohort, considering geographic location, primary work environment, organizational affiliations, content expertise, time in practice, gender, and other factors.

Chapter Topic Selection

The editors conducted a two-pronged needs assessment related to optimal content for inclusion in The PHM Core Competencies: 2020 Revision. First, the editors reviewed content from conferences, textbooks, and handbooks specific to the field of PHM, including the conference programs for the most recent 5 years of both the annual PHM national conference and annual meetings of PHM’s 3 core societies in the United States—SHM, AAP, and APA. Second, the editors conducted a needs assessment survey with several stakeholder groups, including SHM’s Pediatrics and Medicine-Pediatrics SIGs, AAP Section on Hospital Medicine and its subcommittees, APA Hospital Medicine SIG, PHM Fellowship Directors Council, and PHM Division Directors, with encouragement to pass the survey link to others in the PHM community interested in providing input (Appendix Figure). The solicitation asked for comment on existing chapters and suggestions for new chapters. For any new chapter, respondents were asked to note the intended purpose of the chapter and the anticipated value that chapter would bring to our profession and the children and the caregivers served by pediatric hospitalists.

The entire editorial board then reviewed all of the needs assessment data and considered potential changes (additions or deletions) based on emerging trends in pediatric healthcare, the frequency, relevance, and value of the item across all environments in which pediatric hospitalists function, and the value to or impact on hospitalized children and caregivers. Almost all survey ratings and comments were either incorporated into an existing chapter or used to create a new chapter. There was a paucity of comments related to the deletion of chapters, and thus no chapters were entirely excluded. However, there were several comments supporting the exclusion of the suprapubic bladder tap procedure, and thus related content was eliminated from the relevant section in Core Skills. Of the 66 chapters in this revision, the needs assessment data directly informed the creation of 12 new chapters, as well as adjustments and/or additions to the titles of 7 chapters and the content of 29 chapters. In addition, the title of the Specialized Clinical Services section was changed to Specialized Services to represent that both clinical and nonclinical competencies reside in this section devoted to comprehensive management of these unique patient populations commonly encountered by pediatric hospitalists. Many of these changes are highlighted in Table 2.

Author selection

Authors from the initial work were invited to participate again as author of their given chapter. Subsequently, authors were identified for new chapters and chapters for which previous authors were no longer able to be engaged. Authors with content expertise were found by reviewing content from conferences, textbooks, and handbooks specific to the field of PHM. Any content expert who was not identified as a pediatric hospitalist was paired with a pediatric hospitalist as coauthor. In addition, as with the editorial board, a deliberate effort was made to recruit a diverse author cohort, considering geographic location, primary work environment, time in practice, gender, and other factors.

The editorial board held numerous conference calls to review potential authors, and the SHM Pediatrics SIG was directly engaged to ensure authorship opportunities were extended broadly. This vetting process resulted in a robust author list and included members of all three of PHM’s sponsoring societies in the United States. Once participation was confirmed, authors received an “author packet” detailing the process with the proposed timeline, resources related to writing learning objectives, the past chapter (if applicable), assigned associate editor, and other helpful resources.

Internal and External Review Process

After all chapters were drafted, the editorial board conducted a rigorous, internal review process. Each chapter was reviewed by at least one associate editor and two editors, with a focus on content, scope, and a standard approach to phrasing and formatting. In addition, the contributing editor reviewed all the chapters to ensure the community hospitalist perspective was adequately represented.

Thirty-two agencies and societies were solicited for external review, including both those involved in review of the previous edition and new stakeholder groups. External reviewers were first contacted to ascertain their interest in participating in the review process, and if interested, were provided with information on the review process. Robust feedback was received from the APA Hospital Medicine SIG, SHM Pediatrics and Medicine-Pediatrics SIGs, Association of Pediatric Program Directors Curriculum Committee, and 20 AAP committees, councils, and sections.

The feedback from the external reviewers and subsequent edits for each chapter were reviewed by at least one associate editor, two editors, and the contributing editor. Authors were engaged to address any salient changes recommended. As the final steps in the review process, the SHM Board of Directors approved the compendium and the APA provided their endorsement.

This second edition of The PHM Core Competencies: 2020 Revision addresses the knowledge, skills, attitudes, and systems organization and improvement objectives that define the field of pediatric hospital medicine and the leadership roles of pediatric hospitalists. This compendium reflects the recent changes in the practice and educational environments of pediatric hospitalists and can inform education, training, and career development for pediatric hospitalists across all environments in which comprehensive care is rendered for the hospitalized child. Future work at the local and national level can lead to development of associated curricula, conference content, and other training materials.

Acknowledgments

We wish to humbly and respectfully acknowledge the work of the authors, editors, and reviewers involved in the creation of the first edition, as well as this revision, of The PHM Core Competencies. In addition, we are grateful for the input of all pediatric hospitalists and other stakeholders who informed this compendium via contributions to the needs assessment survey, conference proceedings, publications, and other works. Finally, we acknowledge the support and work of SHM project coordinator, Nyla Nicholson, the SHM Pediatrics SIG, and the SHM Board of Directors.

Disclosures

SHM provided administrative support for project coordination (N. Nicholson). No author, editor, or other involved member received any compensation for efforts related to this work. There are no reported conflicts of interest.

The Pediatric Hospital Medicine Core Competencies were first published in 2010 to help define a specific body of knowledge and measurable skills needed to practice high quality care for hospitalized pediatric patients across all practice settings.¹ Since then, the number of practicing pediatric hospitalists has grown to a conservative estimate of 3,000 physicians and the scope of practice among pediatric hospitalists has matured.² Pediatric hospitalists are increasingly leading or participating in organizational and national efforts that emphasize interprofessional collaboration and the delivery of high value care to hospitalized children and their caregivers—including innovative and family-centered care models, patient safety and quality improvement initiatives, and research and educational enterprises.^3-8 In response to these changes, the American Board of Medical Specialties designated Pediatric Hospital Medicine (PHM) as a pediatric subspecialty in 2016.

The field of PHM in the United States continues to be supported by three core societies—Society of Hospital Medicine (SHM), American Academy of Pediatrics (AAP), and Academic Pediatric Association (APA). Together, these societies serve as tri-sponsors of the annual Pediatric Hospital Medicine national conference, which now welcomes over 1,200 attendees from the United States and abroad.⁹ Each society also individually sponsors a variety of professional development and continuing medical education activities specific to PHM.

In addition, pediatric hospitalists often serve a pivotal role in teaching learners (medical students, residents, and other health profession students), physician colleagues, and other healthcare professionals on the hospital wards and via institutional educational programs. Nearly 50 institutions in the United States offer graduate medical education training in PHM.¹⁰ The PHM Fellowship Directors Council has developed a standardized curricular framework and entrustable professional activities, which reflect the tenets of competency-based medical education, for use in PHM training programs.^11-13

These changes in the practice environment of pediatric hospitalists, as well as the changing landscape of graduate and continuing medical education in PHM, have informed this revision of The PHM Core Competencies. The purpose of this article is to describe the methodology of the review and revision process.

Revision

The PHM Core Competencies: 2020 Revision provide a framework for graduate and continuing medical education that reflects the current roles and expectations for all pediatric hospitalists in the United States. The acuity and complexity of hospitalized children, the availability of pediatric subspecialty care and other resources, and the institutional orientation towards pediatric populations vary across community, tertiary, and children’s hospital settings. In order to unify the practice of PHM across these environments, The PHM Core Competencies: 2020 Revision address the fundamental and most common components of PHM which are encountered by the majority of practicing pediatric hospitalists, as opposed to an extensive review of all aspects of the field.

The compendium includes 66 chapters on both clinical and nonclinical topics, divided into four sections—Common Clinical Diagnoses and Conditions, Core Skills, Specialized Services, and Healthcare Systems: Supporting and Advancing Child Health (Table 1). Within each chapter is an introductory paragraph and learning objectives in three domains of educational outcomes—cognitive (knowledge), psychomotor (skills), and affective (attitudes)—as well as systems organization and improvement, to reflect the emphasis of PHM practice on improving healthcare systems. The objectives encompass a range of observable behaviors and other attributes, from foundational skills such as taking a history and performing a physical exam to more advanced actions such as participating in the development of care models to support the health of complex patient populations. Implicit in these objectives is the expectation that pediatric hospitalists build on experiences in medical school and residency training to attain a level of competency at the advanced levels of a developmental continuum, such as proficient, expert, or master.¹⁴

The objectives also balance specificity to the topic with a timeless quality, allowing for flexibility both as new information emerges and when applied to various educational activities and learner groups. Each chapter can stand alone, and thus themes recur if one reads the compendium in its entirety. However, in order to reflect related content among the chapters, the appendix contains a list of associated chapters (Chapter Links) for further exploration. In addition, a short reference list is provided in each chapter to reflect the literature and best practices at the time of publication.

Finally, The PHM Core Competencies: 2020 Revision reflect the status of children as a vulnerable population. Care for hospitalized children requires attention to many elements unique to the pediatric population. These include age-based differences in development, behavior, physiology, and prevalence of clinical conditions, the impact of acute and chronic disease states on child development, the use of medications and other medical interventions with limited investigative guidance, and the role of caregivers in decision-making and care delivery. Heightened awareness of these factors is required in the hospital setting, where diagnoses and interventions often include the use of high-risk modalities and require coordination of care across multiple providers.

Project Initiation

Revision of The PHM Core Competencies: 2020 Revision began in early 2017 following SHM’s work on The Core Competencies in Hospital Medicine 2017 Revision.¹⁵ The Executive Committee of the SHM Pediatrics Special Interest Group (SIG) supported the initiation of the revision. The 3 editors from the original compendium created an initial plan for the project that included a proposed timeline, processes for engagement of previously involved experts and new talent, and performance of a needs assessment to guide content selection. The Figure highlights these and other important steps in the revision process.

Editor and Associate Editor Selection

The above editors reviewed best practice examples of roles and responsibilities for editor and associate editor positions from relevant, leading societies and journals. From this review, the editors created an editorial structure specifically for The PHM Core Competencies: 2020 Revision. A new position of Contributing Editor was created to address the need for dedicated attention to the community site perspective and ensure review of all content, within and across chapters, by a pediatric hospitalist who is dedicated to this environment. Solicitation for additional editors and associate editors occurred via the SHM Pediatrics SIG to the wider SHM membership. The criteria for selection included active engagement in regional or national activities related to the growth and operations of PHM, strong organizational and leadership skills, including the ability to manage tasks and foster creativity, among others. In addition, a deliberate effort was made to recruit a diverse editorial cohort, considering geographic location, primary work environment, organizational affiliations, content expertise, time in practice, gender, and other factors.

Chapter Topic Selection

The editors conducted a two-pronged needs assessment related to optimal content for inclusion in The PHM Core Competencies: 2020 Revision. First, the editors reviewed content from conferences, textbooks, and handbooks specific to the field of PHM, including the conference programs for the most recent 5 years of both the annual PHM national conference and annual meetings of PHM’s 3 core societies in the United States—SHM, AAP, and APA. Second, the editors conducted a needs assessment survey with several stakeholder groups, including SHM’s Pediatrics and Medicine-Pediatrics SIGs, AAP Section on Hospital Medicine and its subcommittees, APA Hospital Medicine SIG, PHM Fellowship Directors Council, and PHM Division Directors, with encouragement to pass the survey link to others in the PHM community interested in providing input (Appendix Figure). The solicitation asked for comment on existing chapters and suggestions for new chapters. For any new chapter, respondents were asked to note the intended purpose of the chapter and the anticipated value that chapter would bring to our profession and the children and the caregivers served by pediatric hospitalists.

The entire editorial board then reviewed all of the needs assessment data and considered potential changes (additions or deletions) based on emerging trends in pediatric healthcare, the frequency, relevance, and value of the item across all environments in which pediatric hospitalists function, and the value to or impact on hospitalized children and caregivers. Almost all survey ratings and comments were either incorporated into an existing chapter or used to create a new chapter. There was a paucity of comments related to the deletion of chapters, and thus no chapters were entirely excluded. However, there were several comments supporting the exclusion of the suprapubic bladder tap procedure, and thus related content was eliminated from the relevant section in Core Skills. Of the 66 chapters in this revision, the needs assessment data directly informed the creation of 12 new chapters, as well as adjustments and/or additions to the titles of 7 chapters and the content of 29 chapters. In addition, the title of the Specialized Clinical Services section was changed to Specialized Services to represent that both clinical and nonclinical competencies reside in this section devoted to comprehensive management of these unique patient populations commonly encountered by pediatric hospitalists. Many of these changes are highlighted in Table 2.

Author selection

Authors from the initial work were invited to participate again as author of their given chapter. Subsequently, authors were identified for new chapters and chapters for which previous authors were no longer able to be engaged. Authors with content expertise were found by reviewing content from conferences, textbooks, and handbooks specific to the field of PHM. Any content expert who was not identified as a pediatric hospitalist was paired with a pediatric hospitalist as coauthor. In addition, as with the editorial board, a deliberate effort was made to recruit a diverse author cohort, considering geographic location, primary work environment, time in practice, gender, and other factors.

The editorial board held numerous conference calls to review potential authors, and the SHM Pediatrics SIG was directly engaged to ensure authorship opportunities were extended broadly. This vetting process resulted in a robust author list and included members of all three of PHM’s sponsoring societies in the United States. Once participation was confirmed, authors received an “author packet” detailing the process with the proposed timeline, resources related to writing learning objectives, the past chapter (if applicable), assigned associate editor, and other helpful resources.

Internal and External Review Process

After all chapters were drafted, the editorial board conducted a rigorous, internal review process. Each chapter was reviewed by at least one associate editor and two editors, with a focus on content, scope, and a standard approach to phrasing and formatting. In addition, the contributing editor reviewed all the chapters to ensure the community hospitalist perspective was adequately represented.

Thirty-two agencies and societies were solicited for external review, including both those involved in review of the previous edition and new stakeholder groups. External reviewers were first contacted to ascertain their interest in participating in the review process, and if interested, were provided with information on the review process. Robust feedback was received from the APA Hospital Medicine SIG, SHM Pediatrics and Medicine-Pediatrics SIGs, Association of Pediatric Program Directors Curriculum Committee, and 20 AAP committees, councils, and sections.

The feedback from the external reviewers and subsequent edits for each chapter were reviewed by at least one associate editor, two editors, and the contributing editor. Authors were engaged to address any salient changes recommended. As the final steps in the review process, the SHM Board of Directors approved the compendium and the APA provided their endorsement.

This second edition of The PHM Core Competencies: 2020 Revision addresses the knowledge, skills, attitudes, and systems organization and improvement objectives that define the field of pediatric hospital medicine and the leadership roles of pediatric hospitalists. This compendium reflects the recent changes in the practice and educational environments of pediatric hospitalists and can inform education, training, and career development for pediatric hospitalists across all environments in which comprehensive care is rendered for the hospitalized child. Future work at the local and national level can lead to development of associated curricula, conference content, and other training materials.

Acknowledgments

We wish to humbly and respectfully acknowledge the work of the authors, editors, and reviewers involved in the creation of the first edition, as well as this revision, of The PHM Core Competencies. In addition, we are grateful for the input of all pediatric hospitalists and other stakeholders who informed this compendium via contributions to the needs assessment survey, conference proceedings, publications, and other works. Finally, we acknowledge the support and work of SHM project coordinator, Nyla Nicholson, the SHM Pediatrics SIG, and the SHM Board of Directors.

Disclosures

SHM provided administrative support for project coordination (N. Nicholson). No author, editor, or other involved member received any compensation for efforts related to this work. There are no reported conflicts of interest.

The Pediatric Hospital Medicine Core Competencies were first published in 2010 to help define a specific body of knowledge and measurable skills needed to practice high quality care for hospitalized pediatric patients across all practice settings.¹ Since then, the number of practicing pediatric hospitalists has grown to a conservative estimate of 3,000 physicians and the scope of practice among pediatric hospitalists has matured.² Pediatric hospitalists are increasingly leading or participating in organizational and national efforts that emphasize interprofessional collaboration and the delivery of high value care to hospitalized children and their caregivers—including innovative and family-centered care models, patient safety and quality improvement initiatives, and research and educational enterprises.^3-8 In response to these changes, the American Board of Medical Specialties designated Pediatric Hospital Medicine (PHM) as a pediatric subspecialty in 2016.

The field of PHM in the United States continues to be supported by three core societies—Society of Hospital Medicine (SHM), American Academy of Pediatrics (AAP), and Academic Pediatric Association (APA). Together, these societies serve as tri-sponsors of the annual Pediatric Hospital Medicine national conference, which now welcomes over 1,200 attendees from the United States and abroad.⁹ Each society also individually sponsors a variety of professional development and continuing medical education activities specific to PHM.

In addition, pediatric hospitalists often serve a pivotal role in teaching learners (medical students, residents, and other health profession students), physician colleagues, and other healthcare professionals on the hospital wards and via institutional educational programs. Nearly 50 institutions in the United States offer graduate medical education training in PHM.¹⁰ The PHM Fellowship Directors Council has developed a standardized curricular framework and entrustable professional activities, which reflect the tenets of competency-based medical education, for use in PHM training programs.^11-13

These changes in the practice environment of pediatric hospitalists, as well as the changing landscape of graduate and continuing medical education in PHM, have informed this revision of The PHM Core Competencies. The purpose of this article is to describe the methodology of the review and revision process.

Revision

The PHM Core Competencies: 2020 Revision provide a framework for graduate and continuing medical education that reflects the current roles and expectations for all pediatric hospitalists in the United States. The acuity and complexity of hospitalized children, the availability of pediatric subspecialty care and other resources, and the institutional orientation towards pediatric populations vary across community, tertiary, and children’s hospital settings. In order to unify the practice of PHM across these environments, The PHM Core Competencies: 2020 Revision address the fundamental and most common components of PHM which are encountered by the majority of practicing pediatric hospitalists, as opposed to an extensive review of all aspects of the field.

The compendium includes 66 chapters on both clinical and nonclinical topics, divided into four sections—Common Clinical Diagnoses and Conditions, Core Skills, Specialized Services, and Healthcare Systems: Supporting and Advancing Child Health (Table 1). Within each chapter is an introductory paragraph and learning objectives in three domains of educational outcomes—cognitive (knowledge), psychomotor (skills), and affective (attitudes)—as well as systems organization and improvement, to reflect the emphasis of PHM practice on improving healthcare systems. The objectives encompass a range of observable behaviors and other attributes, from foundational skills such as taking a history and performing a physical exam to more advanced actions such as participating in the development of care models to support the health of complex patient populations. Implicit in these objectives is the expectation that pediatric hospitalists build on experiences in medical school and residency training to attain a level of competency at the advanced levels of a developmental continuum, such as proficient, expert, or master.¹⁴

The objectives also balance specificity to the topic with a timeless quality, allowing for flexibility both as new information emerges and when applied to various educational activities and learner groups. Each chapter can stand alone, and thus themes recur if one reads the compendium in its entirety. However, in order to reflect related content among the chapters, the appendix contains a list of associated chapters (Chapter Links) for further exploration. In addition, a short reference list is provided in each chapter to reflect the literature and best practices at the time of publication.

Finally, The PHM Core Competencies: 2020 Revision reflect the status of children as a vulnerable population. Care for hospitalized children requires attention to many elements unique to the pediatric population. These include age-based differences in development, behavior, physiology, and prevalence of clinical conditions, the impact of acute and chronic disease states on child development, the use of medications and other medical interventions with limited investigative guidance, and the role of caregivers in decision-making and care delivery. Heightened awareness of these factors is required in the hospital setting, where diagnoses and interventions often include the use of high-risk modalities and require coordination of care across multiple providers.

Project Initiation

Revision of The PHM Core Competencies: 2020 Revision began in early 2017 following SHM’s work on The Core Competencies in Hospital Medicine 2017 Revision.¹⁵ The Executive Committee of the SHM Pediatrics Special Interest Group (SIG) supported the initiation of the revision. The 3 editors from the original compendium created an initial plan for the project that included a proposed timeline, processes for engagement of previously involved experts and new talent, and performance of a needs assessment to guide content selection. The Figure highlights these and other important steps in the revision process.

Editor and Associate Editor Selection

The above editors reviewed best practice examples of roles and responsibilities for editor and associate editor positions from relevant, leading societies and journals. From this review, the editors created an editorial structure specifically for The PHM Core Competencies: 2020 Revision. A new position of Contributing Editor was created to address the need for dedicated attention to the community site perspective and ensure review of all content, within and across chapters, by a pediatric hospitalist who is dedicated to this environment. Solicitation for additional editors and associate editors occurred via the SHM Pediatrics SIG to the wider SHM membership. The criteria for selection included active engagement in regional or national activities related to the growth and operations of PHM, strong organizational and leadership skills, including the ability to manage tasks and foster creativity, among others. In addition, a deliberate effort was made to recruit a diverse editorial cohort, considering geographic location, primary work environment, organizational affiliations, content expertise, time in practice, gender, and other factors.

Chapter Topic Selection

The editors conducted a two-pronged needs assessment related to optimal content for inclusion in The PHM Core Competencies: 2020 Revision. First, the editors reviewed content from conferences, textbooks, and handbooks specific to the field of PHM, including the conference programs for the most recent 5 years of both the annual PHM national conference and annual meetings of PHM’s 3 core societies in the United States—SHM, AAP, and APA. Second, the editors conducted a needs assessment survey with several stakeholder groups, including SHM’s Pediatrics and Medicine-Pediatrics SIGs, AAP Section on Hospital Medicine and its subcommittees, APA Hospital Medicine SIG, PHM Fellowship Directors Council, and PHM Division Directors, with encouragement to pass the survey link to others in the PHM community interested in providing input (Appendix Figure). The solicitation asked for comment on existing chapters and suggestions for new chapters. For any new chapter, respondents were asked to note the intended purpose of the chapter and the anticipated value that chapter would bring to our profession and the children and the caregivers served by pediatric hospitalists.

The entire editorial board then reviewed all of the needs assessment data and considered potential changes (additions or deletions) based on emerging trends in pediatric healthcare, the frequency, relevance, and value of the item across all environments in which pediatric hospitalists function, and the value to or impact on hospitalized children and caregivers. Almost all survey ratings and comments were either incorporated into an existing chapter or used to create a new chapter. There was a paucity of comments related to the deletion of chapters, and thus no chapters were entirely excluded. However, there were several comments supporting the exclusion of the suprapubic bladder tap procedure, and thus related content was eliminated from the relevant section in Core Skills. Of the 66 chapters in this revision, the needs assessment data directly informed the creation of 12 new chapters, as well as adjustments and/or additions to the titles of 7 chapters and the content of 29 chapters. In addition, the title of the Specialized Clinical Services section was changed to Specialized Services to represent that both clinical and nonclinical competencies reside in this section devoted to comprehensive management of these unique patient populations commonly encountered by pediatric hospitalists. Many of these changes are highlighted in Table 2.

Author selection

Authors from the initial work were invited to participate again as author of their given chapter. Subsequently, authors were identified for new chapters and chapters for which previous authors were no longer able to be engaged. Authors with content expertise were found by reviewing content from conferences, textbooks, and handbooks specific to the field of PHM. Any content expert who was not identified as a pediatric hospitalist was paired with a pediatric hospitalist as coauthor. In addition, as with the editorial board, a deliberate effort was made to recruit a diverse author cohort, considering geographic location, primary work environment, time in practice, gender, and other factors.

The editorial board held numerous conference calls to review potential authors, and the SHM Pediatrics SIG was directly engaged to ensure authorship opportunities were extended broadly. This vetting process resulted in a robust author list and included members of all three of PHM’s sponsoring societies in the United States. Once participation was confirmed, authors received an “author packet” detailing the process with the proposed timeline, resources related to writing learning objectives, the past chapter (if applicable), assigned associate editor, and other helpful resources.

Internal and External Review Process

After all chapters were drafted, the editorial board conducted a rigorous, internal review process. Each chapter was reviewed by at least one associate editor and two editors, with a focus on content, scope, and a standard approach to phrasing and formatting. In addition, the contributing editor reviewed all the chapters to ensure the community hospitalist perspective was adequately represented.

Thirty-two agencies and societies were solicited for external review, including both those involved in review of the previous edition and new stakeholder groups. External reviewers were first contacted to ascertain their interest in participating in the review process, and if interested, were provided with information on the review process. Robust feedback was received from the APA Hospital Medicine SIG, SHM Pediatrics and Medicine-Pediatrics SIGs, Association of Pediatric Program Directors Curriculum Committee, and 20 AAP committees, councils, and sections.

The feedback from the external reviewers and subsequent edits for each chapter were reviewed by at least one associate editor, two editors, and the contributing editor. Authors were engaged to address any salient changes recommended. As the final steps in the review process, the SHM Board of Directors approved the compendium and the APA provided their endorsement.

This second edition of The PHM Core Competencies: 2020 Revision addresses the knowledge, skills, attitudes, and systems organization and improvement objectives that define the field of pediatric hospital medicine and the leadership roles of pediatric hospitalists. This compendium reflects the recent changes in the practice and educational environments of pediatric hospitalists and can inform education, training, and career development for pediatric hospitalists across all environments in which comprehensive care is rendered for the hospitalized child. Future work at the local and national level can lead to development of associated curricula, conference content, and other training materials.

Acknowledgments

We wish to humbly and respectfully acknowledge the work of the authors, editors, and reviewers involved in the creation of the first edition, as well as this revision, of The PHM Core Competencies. In addition, we are grateful for the input of all pediatric hospitalists and other stakeholders who informed this compendium via contributions to the needs assessment survey, conference proceedings, publications, and other works. Finally, we acknowledge the support and work of SHM project coordinator, Nyla Nicholson, the SHM Pediatrics SIG, and the SHM Board of Directors.

Disclosures

SHM provided administrative support for project coordination (N. Nicholson). No author, editor, or other involved member received any compensation for efforts related to this work. There are no reported conflicts of interest.

Alvarez F, Alverson B, Balighian E, Beauchamp-Walters J, Biondi E, Blankenberg R, Bridgeman C, Brown J, Buchanan AO, Carlson D, Chang P, Coon E, Daud YN, Denniston S, DeWolfe CC, Deutsch SA, Doshi A, Fisher E, Gage S, Gallagher MP, Gill A, Goel Jones V, Grill J, Gupta A, Herbst BF Jr, Hershey D, Hoang K, Holmes AV, Hopkins A, Jones Y, Khan A, Lee V, Li ST, Lye, PS, Maginot T, Maloney C, Maniscalco J, Mannino Avila E, Markowsky A, Marks M, Matheny Antommaria AH, Maul E, McCulloh R, Melwani A, Miller C, Mittal V, Natt B, O'Toole J, Ottolini M, Percelay J, Phillips S, Pressel D, Quinonez R, Ralston S, Rappaport DI, Rauch D, Rhee K, Riese J, Roberts K, Rogers A, Rosenberg RE, Ruhlen M, Russell CJ, Russo C, Schwenk KM, Sekaran A, Shadman KA, Shah SS, Shen M, Simon T, Singh A, Smith K, Srinivas N Srivastava R, Sterni L, Thompson ED Jr, Thomson J, Tieder J, Tremoulet A, Wang ME, Williams R, Wu S. Name of Chapter. In: Pediatric Hospital Medicine Core Competencies: 2020 Revision. Section 4: Healthcare Systems: Supporting and Advancing Child Health. J Hosp Med. 2020;15(S1):xxx-xxx (insert page numbers). https://doi.org/jhm.3400

Alvarez F, Alverson B, Balighian E, Beauchamp-Walters J, Biondi E, Blankenberg R, Bridgeman C, Brown J, Buchanan AO, Carlson D, Chang P, Coon E, Daud YN, Denniston S, DeWolfe CC, Deutsch SA, Doshi A, Fisher E, Gage S, Gallagher MP, Gill A, Goel Jones V, Grill J, Gupta A, Herbst BF Jr, Hershey D, Hoang K, Holmes AV, Hopkins A, Jones Y, Khan A, Lee V, Li ST, Lye, PS, Maginot T, Maloney C, Maniscalco J, Mannino Avila E, Markowsky A, Marks M, Matheny Antommaria AH, Maul E, McCulloh R, Melwani A, Miller C, Mittal V, Natt B, O'Toole J, Ottolini M, Percelay J, Phillips S, Pressel D, Quinonez R, Ralston S, Rappaport DI, Rauch D, Rhee K, Riese J, Roberts K, Rogers A, Rosenberg RE, Ruhlen M, Russell CJ, Russo C, Schwenk KM, Sekaran A, Shadman KA, Shah SS, Shen M, Simon T, Singh A, Smith K, Srinivas N Srivastava R, Sterni L, Thompson ED Jr, Thomson J, Tieder J, Tremoulet A, Wang ME, Williams R, Wu S. Name of Chapter. In: Pediatric Hospital Medicine Core Competencies: 2020 Revision. Section 4: Healthcare Systems: Supporting and Advancing Child Health. J Hosp Med. 2020;15(S1):xxx-xxx (insert page numbers). https://doi.org/jhm.3400

Alvarez F, Alverson B, Balighian E, Beauchamp-Walters J, Biondi E, Blankenberg R, Bridgeman C, Brown J, Buchanan AO, Carlson D, Chang P, Coon E, Daud YN, Denniston S, DeWolfe CC, Deutsch SA, Doshi A, Fisher E, Gage S, Gallagher MP, Gill A, Goel Jones V, Grill J, Gupta A, Herbst BF Jr, Hershey D, Hoang K, Holmes AV, Hopkins A, Jones Y, Khan A, Lee V, Li ST, Lye, PS, Maginot T, Maloney C, Maniscalco J, Mannino Avila E, Markowsky A, Marks M, Matheny Antommaria AH, Maul E, McCulloh R, Melwani A, Miller C, Mittal V, Natt B, O'Toole J, Ottolini M, Percelay J, Phillips S, Pressel D, Quinonez R, Ralston S, Rappaport DI, Rauch D, Rhee K, Riese J, Roberts K, Rogers A, Rosenberg RE, Ruhlen M, Russell CJ, Russo C, Schwenk KM, Sekaran A, Shadman KA, Shah SS, Shen M, Simon T, Singh A, Smith K, Srinivas N Srivastava R, Sterni L, Thompson ED Jr, Thomson J, Tieder J, Tremoulet A, Wang ME, Williams R, Wu S. Name of Chapter. In: Pediatric Hospital Medicine Core Competencies: 2020 Revision. Section 4: Healthcare Systems: Supporting and Advancing Child Health. J Hosp Med. 2020;15(S1):xxx-xxx (insert page numbers). https://doi.org/jhm.3400

How to cite articles within Section 2

Alvarez F, Alverson B, Balighian E, Beauchamp-Walters J, Biondi E, Blankenberg R, Bridgeman C, Brown J, Buchanan AO, Carlson D, Chang P, Coon E, Daud YN, Denniston S, DeWolfe CC, Deutsch SA, Doshi A, Fisher E, Gage S, Gallagher MP, Gill A, Goel Jones V, Grill J, Gupta A, Herbst BF Jr, Hershey D, Hoang K, Holmes AV, Hopkins A, Jones Y, Khan A, Lee V, Li ST, Lye, PS, Maginot T, Maloney C, Maniscalco J, Mannino Avila E, Markowsky A, Marks M, Matheny Antommaria AH, Maul E, McCulloh R, Melwani A, Miller C, Mittal V, Natt B, O'Toole J, Ottolini M, Percelay J, Phillips S, Pressel D, Quinonez R, Ralston S, Rappaport DI, Rauch D, Rhee K, Riese J, Roberts K, Rogers A, Rosenberg RE, Ruhlen M, Russell CJ, Russo C, Schwenk KM, Sekaran A, Shadman KA, Shah SS, Shen M, Simon T, Singh A, Smith K, Srinivas N Srivastava R, Sterni L, Thompson ED Jr, Thomson J, Tieder J, Tremoulet A, Wang ME, Williams R, Wu S. Name of Chapter. In: Pediatric Hospital Medicine Core Competencies: 2020 Revision. Section 3: Specialized Services. J Hosp Med. 2020;15(S1):xx-xxx (insert page numbers). https://doi.org/10.12788/jhm.3399

How to cite articles within Section 2

Alvarez F, Alverson B, Balighian E, Beauchamp-Walters J, Biondi E, Blankenberg R, Bridgeman C, Brown J, Buchanan AO, Carlson D, Chang P, Coon E, Daud YN, Denniston S, DeWolfe CC, Deutsch SA, Doshi A, Fisher E, Gage S, Gallagher MP, Gill A, Goel Jones V, Grill J, Gupta A, Herbst BF Jr, Hershey D, Hoang K, Holmes AV, Hopkins A, Jones Y, Khan A, Lee V, Li ST, Lye, PS, Maginot T, Maloney C, Maniscalco J, Mannino Avila E, Markowsky A, Marks M, Matheny Antommaria AH, Maul E, McCulloh R, Melwani A, Miller C, Mittal V, Natt B, O'Toole J, Ottolini M, Percelay J, Phillips S, Pressel D, Quinonez R, Ralston S, Rappaport DI, Rauch D, Rhee K, Riese J, Roberts K, Rogers A, Rosenberg RE, Ruhlen M, Russell CJ, Russo C, Schwenk KM, Sekaran A, Shadman KA, Shah SS, Shen M, Simon T, Singh A, Smith K, Srinivas N Srivastava R, Sterni L, Thompson ED Jr, Thomson J, Tieder J, Tremoulet A, Wang ME, Williams R, Wu S. Name of Chapter. In: Pediatric Hospital Medicine Core Competencies: 2020 Revision. Section 3: Specialized Services. J Hosp Med. 2020;15(S1):xx-xxx (insert page numbers). https://doi.org/10.12788/jhm.3399

How to cite articles within Section 2

Alvarez F, Alverson B, Balighian E, Beauchamp-Walters J, Biondi E, Blankenberg R, Bridgeman C, Brown J, Buchanan AO, Carlson D, Chang P, Coon E, Daud YN, Denniston S, DeWolfe CC, Deutsch SA, Doshi A, Fisher E, Gage S, Gallagher MP, Gill A, Goel Jones V, Grill J, Gupta A, Herbst BF Jr, Hershey D, Hoang K, Holmes AV, Hopkins A, Jones Y, Khan A, Lee V, Li ST, Lye, PS, Maginot T, Maloney C, Maniscalco J, Mannino Avila E, Markowsky A, Marks M, Matheny Antommaria AH, Maul E, McCulloh R, Melwani A, Miller C, Mittal V, Natt B, O'Toole J, Ottolini M, Percelay J, Phillips S, Pressel D, Quinonez R, Ralston S, Rappaport DI, Rauch D, Rhee K, Riese J, Roberts K, Rogers A, Rosenberg RE, Ruhlen M, Russell CJ, Russo C, Schwenk KM, Sekaran A, Shadman KA, Shah SS, Shen M, Simon T, Singh A, Smith K, Srinivas N Srivastava R, Sterni L, Thompson ED Jr, Thomson J, Tieder J, Tremoulet A, Wang ME, Williams R, Wu S. Name of Chapter. In: Pediatric Hospital Medicine Core Competencies: 2020 Revision. Section 3: Specialized Services. J Hosp Med. 2020;15(S1):xx-xxx (insert page numbers). https://doi.org/10.12788/jhm.3399

How to cite articles within Section 2

Alvarez F, Alverson B, Balighian E, Beauchamp-Walters J, Biondi E, Blankenberg R, Bridgeman C, Brown J, Buchanan AO, Carlson D, Chang P, Coon E, Daud YN, Denniston S, DeWolfe CC, Deutsch SA, Doshi A, Fisher E, Gage S, Gallagher MP, Gill A, Goel Jones V, Grill J, Gupta A, Herbst BF Jr, Hershey D, Hoang K, Holmes AV, Hopkins A, Jones Y, Khan A, Lee V, Li ST, Lye, PS, Maginot T, Maloney C, Maniscalco J, Mannino Avila E, Markowsky A, Marks M, Matheny Antommaria AH, Maul E, McCulloh R, Melwani A, Miller C, Mittal V, Natt B, O'Toole J, Ottolini M, Percelay J, Phillips S, Pressel D, Quinonez R, Ralston S, Rappaport DI, Rauch D, Rhee K, Riese J, Roberts K, Rogers A, Rosenberg RE, Ruhlen M, Russell CJ, Russo C, Schwenk KM, Sekaran A, Shadman KA, Shah SS, Shen M, Simon T, Singh A, Smith K, Srinivas N Srivastava R, Sterni L, Thompson ED Jr, Thomson J, Tieder J, Tremoulet A, Wang ME, Williams R, Wu S. Name of Chapter. In: Pediatric Hospital Medicine Core Competencies: 2020 Revision. Section 2: Core Skills. J Hosp Med. 2020;15(S1):XX-XX (insert page numbers). https://doi.org/10.12788/jhm.3398

How to cite articles within Section 2

Alvarez F, Alverson B, Balighian E, Beauchamp-Walters J, Biondi E, Blankenberg R, Bridgeman C, Brown J, Buchanan AO, Carlson D, Chang P, Coon E, Daud YN, Denniston S, DeWolfe CC, Deutsch SA, Doshi A, Fisher E, Gage S, Gallagher MP, Gill A, Goel Jones V, Grill J, Gupta A, Herbst BF Jr, Hershey D, Hoang K, Holmes AV, Hopkins A, Jones Y, Khan A, Lee V, Li ST, Lye, PS, Maginot T, Maloney C, Maniscalco J, Mannino Avila E, Markowsky A, Marks M, Matheny Antommaria AH, Maul E, McCulloh R, Melwani A, Miller C, Mittal V, Natt B, O'Toole J, Ottolini M, Percelay J, Phillips S, Pressel D, Quinonez R, Ralston S, Rappaport DI, Rauch D, Rhee K, Riese J, Roberts K, Rogers A, Rosenberg RE, Ruhlen M, Russell CJ, Russo C, Schwenk KM, Sekaran A, Shadman KA, Shah SS, Shen M, Simon T, Singh A, Smith K, Srinivas N Srivastava R, Sterni L, Thompson ED Jr, Thomson J, Tieder J, Tremoulet A, Wang ME, Williams R, Wu S. Name of Chapter. In: Pediatric Hospital Medicine Core Competencies: 2020 Revision. Section 2: Core Skills. J Hosp Med. 2020;15(S1):XX-XX (insert page numbers). https://doi.org/10.12788/jhm.3398

How to cite articles within Section 2

Alvarez F, Alverson B, Balighian E, Beauchamp-Walters J, Biondi E, Blankenberg R, Bridgeman C, Brown J, Buchanan AO, Carlson D, Chang P, Coon E, Daud YN, Denniston S, DeWolfe CC, Deutsch SA, Doshi A, Fisher E, Gage S, Gallagher MP, Gill A, Goel Jones V, Grill J, Gupta A, Herbst BF Jr, Hershey D, Hoang K, Holmes AV, Hopkins A, Jones Y, Khan A, Lee V, Li ST, Lye, PS, Maginot T, Maloney C, Maniscalco J, Mannino Avila E, Markowsky A, Marks M, Matheny Antommaria AH, Maul E, McCulloh R, Melwani A, Miller C, Mittal V, Natt B, O'Toole J, Ottolini M, Percelay J, Phillips S, Pressel D, Quinonez R, Ralston S, Rappaport DI, Rauch D, Rhee K, Riese J, Roberts K, Rogers A, Rosenberg RE, Ruhlen M, Russell CJ, Russo C, Schwenk KM, Sekaran A, Shadman KA, Shah SS, Shen M, Simon T, Singh A, Smith K, Srinivas N Srivastava R, Sterni L, Thompson ED Jr, Thomson J, Tieder J, Tremoulet A, Wang ME, Williams R, Wu S. Name of Chapter. In: Pediatric Hospital Medicine Core Competencies: 2020 Revision. Section 2: Core Skills. J Hosp Med. 2020;15(S1):XX-XX (insert page numbers). https://doi.org/10.12788/jhm.3398

How to cite articles within Section 1

Alvarez F, Alverson B, Balighian E, Beauchamp-Walters J, Biondi E, Blankenberg R, Bridgeman C, Brown J, Buchanan AO, Carlson D, Chang P, Coon E, Daud YN, Denniston S, DeWolfe CC, Deutsch SA, Doshi A, Fisher E, Gage S, Gallagher MP, Gill A, Goel Jones V, Grill J, Gupta A, Herbst BF Jr, Hershey D, Hoang K, Holmes AV, Hopkins A, Jones Y, Khan A, Lee V, Li ST, Lye, PS, Maginot T, Maloney C, Maniscalco J, Mannino Avila E, Markowsky A, Marks M, Matheny Antommaria AH, Maul E, McCulloh R, Melwani A, Miller C, Mittal V, Natt B, O'Toole J, Ottolini M, Percelay J, Phillips S, Pressel D, Quinonez R, Ralston S, Rappaport DI, Rauch D, Rhee K, Riese J, Roberts K, Rogers A, Rosenberg RE, Ruhlen M, Russell CJ, Russo C, Schwenk KM, Sekaran A, Shadman KA, Shah SS, Shen M, Simon T, Singh A, Smith K, Srinivas N Srivastava R, Sterni L, Thompson ED Jr, Thomson J, Tieder J, Tremoulet A, Wang ME, Williams R, Wu S. Name of Chapter. In: Pediatric Hospital Medicine Core Competencies: 2020 Revision. Section 1: Common Clinical Diagnoses and Conditions. J Hosp Med. 2020;15(S1):xx-xx (insert page numbers). https://doi.org/10.12788/jhm.3397

How to cite articles within Section 1

Alvarez F, Alverson B, Balighian E, Beauchamp-Walters J, Biondi E, Blankenberg R, Bridgeman C, Brown J, Buchanan AO, Carlson D, Chang P, Coon E, Daud YN, Denniston S, DeWolfe CC, Deutsch SA, Doshi A, Fisher E, Gage S, Gallagher MP, Gill A, Goel Jones V, Grill J, Gupta A, Herbst BF Jr, Hershey D, Hoang K, Holmes AV, Hopkins A, Jones Y, Khan A, Lee V, Li ST, Lye, PS, Maginot T, Maloney C, Maniscalco J, Mannino Avila E, Markowsky A, Marks M, Matheny Antommaria AH, Maul E, McCulloh R, Melwani A, Miller C, Mittal V, Natt B, O'Toole J, Ottolini M, Percelay J, Phillips S, Pressel D, Quinonez R, Ralston S, Rappaport DI, Rauch D, Rhee K, Riese J, Roberts K, Rogers A, Rosenberg RE, Ruhlen M, Russell CJ, Russo C, Schwenk KM, Sekaran A, Shadman KA, Shah SS, Shen M, Simon T, Singh A, Smith K, Srinivas N Srivastava R, Sterni L, Thompson ED Jr, Thomson J, Tieder J, Tremoulet A, Wang ME, Williams R, Wu S. Name of Chapter. In: Pediatric Hospital Medicine Core Competencies: 2020 Revision. Section 1: Common Clinical Diagnoses and Conditions. J Hosp Med. 2020;15(S1):xx-xx (insert page numbers). https://doi.org/10.12788/jhm.3397

How to cite articles within Section 1

Alvarez F, Alverson B, Balighian E, Beauchamp-Walters J, Biondi E, Blankenberg R, Bridgeman C, Brown J, Buchanan AO, Carlson D, Chang P, Coon E, Daud YN, Denniston S, DeWolfe CC, Deutsch SA, Doshi A, Fisher E, Gage S, Gallagher MP, Gill A, Goel Jones V, Grill J, Gupta A, Herbst BF Jr, Hershey D, Hoang K, Holmes AV, Hopkins A, Jones Y, Khan A, Lee V, Li ST, Lye, PS, Maginot T, Maloney C, Maniscalco J, Mannino Avila E, Markowsky A, Marks M, Matheny Antommaria AH, Maul E, McCulloh R, Melwani A, Miller C, Mittal V, Natt B, O'Toole J, Ottolini M, Percelay J, Phillips S, Pressel D, Quinonez R, Ralston S, Rappaport DI, Rauch D, Rhee K, Riese J, Roberts K, Rogers A, Rosenberg RE, Ruhlen M, Russell CJ, Russo C, Schwenk KM, Sekaran A, Shadman KA, Shah SS, Shen M, Simon T, Singh A, Smith K, Srinivas N Srivastava R, Sterni L, Thompson ED Jr, Thomson J, Tieder J, Tremoulet A, Wang ME, Williams R, Wu S. Name of Chapter. In: Pediatric Hospital Medicine Core Competencies: 2020 Revision. Section 1: Common Clinical Diagnoses and Conditions. J Hosp Med. 2020;15(S1):xx-xx (insert page numbers). https://doi.org/10.12788/jhm.3397

Introduction

Research is a rapidly growing aspect of inpatient medicine. The practice of evidence-based medicine and the acute need for more evidence on inpatient conditions require that pediatric hospitalists understand and participate in research related activities. Pediatric hospitalists’ role in research will vary depending on their setting and job description. This role may include many facets, from reviewing relevant patient-based articles, to participating in multi-institutional studies requiring enrollment of patients, to leading local or national studies. Pediatric hospitalists should have a basic understanding of research methods and processes in order to participate in and benefit from research. Pediatric hospitalists are well positioned to promote research to patients, the family/caregivers, colleagues, and other healthcare providers and through this, to contribute to the effective care of hospitalized patients.

Pediatric hospitalists should be able to:

• Compare and contrast the advantages and disadvantages of experimental (such as randomized control trials) and observational (such as descriptive, cohort, or case control) study designs, including meta-analyses and systematic reviews.
• Define common sources of bias, including information bias, selection bias, and uncontrolled confounding, and describe how each may impact a study.
• Define basic statistical terms such as sample, discrete and continuous data variables, measures of central tendency (mean, median, and mode), and variability (variance, standard deviation, range).
• List resources available to access current or proposed studies including The Pediatric Health Information System (PHIS), the Healthcare Cost and Utilization Project (HCUP), the Kids’ Inpatient Database (KID), clinicaltrials.gov, and others.
• Name potential research funding sources, such as the Agency for Healthcare Research and Quality (AHRQ), the National Institutes of Health (NIH), the Patient-Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation, local and state funding sources, and others.
• Summarize the goals of pediatric hospital medicine-specific research networks, including the Pediatric Research in the Inpatient Setting (PRIS) network and the Value in Pediatrics (VIP) network.
• Discuss the basic resources commonly required to support research components, including data collection, data analysis, abstract and manuscript preparation, grant funding, and others.
• Review the aspects of the research process that relate to protection of participants, including informed consent and/or assent, the institutional review boards (IRB) review, and HIPAA (Health Insurance Portability and Accountability Act) forms.
• Discuss special protections needed when conducting research with vulnerable populations.
• Define “minimal risk” for a healthy child and for a child with an illness.
• Discuss why common training that addresses ethics, vulnerable populations, consenting, data safety, and other items is required prior to participating as a research team member for a research study.
• Compare and contrast the goals, intent, study focus, and IRB requirements for quality improvement studies from those of traditional clinical research.
• Cite the steps needed to obtain approval for a QI study within the local context.
• Compare and contrast the goals, intent, study focus, and IRB requirements for education studies to those of traditional clinical research.
• Cite the steps needed to obtain approval for a study focused on educational outcomes.
• List common barriers to implementation of clinical studies and describe the pediatric hospitalist’s role in overcoming these barriers.

Pediatric hospitalists should be able to:

• Utilize a format such as PICO (Population, Intervention, Comparison, Outcome) to generate an answerable patient-centered clinical question that is relevant to improving patient care.
• Demonstrate proficiency in systematic searching of the primary medical literature using online search engines.
• Perform critical appraisal of the literature, including identifying threats to study validity, determining if study subjects were similar to local patients, and determining if all clinically important outcomes were considered.
• Apply and integrate the results of studies to clinical practice.
• Determine if the likely benefits noted in a treatment study are worth the potential harm and cost.
• Determine whether a test noted in a diagnostic study is available, affordable, accurate, and precise in the present clinical setting and determine whether the results of the test will change the management of patients being treated.
• Determine if the magnitude of risk warrants an attempt to stop the exposure for a given study on harm.
• Identify if the results of a given study on disease prognosis will lead directly to selecting therapy and/or are useful for counseling patients.
• Participate in educating learners and junior faculty about research and research methodologies, within the local context.
• Determine the relevance of potential research studies with regards to impact on patient care.
• Perform effective informed consent or assent for patients participating in research studies, as appropriate.
• Identify and resolve conflict of interest or potential conflict of interest when participating in research studies.
• Demonstrate basic skills in acquiring, managing, and sharing data collected for research purposes in a responsible and professional manner.
• Adhere to standards for protecting confidentiality, avoiding unjustified exclusions, sharing data, and adhering to copyright law.
• Perform peer-review of a manuscript, abstract, or other research-based work, in collaboration with colleagues as appropriate.
• Demonstrate basic skills in communicating about research opportunities with patients and the family/caregivers within the local context.

Pediatric hospitalists should be able to:

• Recognize the value of seeking the research that supports clinical care decisions and how research fills knowledge gaps and challenges the field to advance.
• Realize the importance of informed consent for patient participation in clinical research.
• Reflect on the importance of patient assent, even in the presence of legal guardian informed consent, when involving children in clinical research.
• Exemplify highly ethical behaviors when promoting or participating in research studies.
• Realize the value of and exemplify a willingness to perform journal-requested peer review of manuscripts, conference abstracts, or other research-based work.
• Reflect on and provide support and education for patients and the family/caregivers on the benefits of research for hospitalized children.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in interdisciplinary initiatives to develop and sustain participation of interdisciplinary teams in performance of research.
• Collaborate with colleagues, hospital administration, and community leaders for thoughtful application of research findings to improve systems of healthcare delivery.
• Lead, coordinate, or participate in national multi-center research efforts that improve the evidence base in inpatient pediatrics, within local context.
• Collaborate with leaders in the university department of pediatrics and school of medicine, hospital administration, and medical staff to encourage local hospital participation in national multi-center research efforts.
• Collaborate with research team members to educate colleagues, hospital staff, and others on the importance of research in improving child health outcomes.

Introduction

Research is a rapidly growing aspect of inpatient medicine. The practice of evidence-based medicine and the acute need for more evidence on inpatient conditions require that pediatric hospitalists understand and participate in research related activities. Pediatric hospitalists’ role in research will vary depending on their setting and job description. This role may include many facets, from reviewing relevant patient-based articles, to participating in multi-institutional studies requiring enrollment of patients, to leading local or national studies. Pediatric hospitalists should have a basic understanding of research methods and processes in order to participate in and benefit from research. Pediatric hospitalists are well positioned to promote research to patients, the family/caregivers, colleagues, and other healthcare providers and through this, to contribute to the effective care of hospitalized patients.

Pediatric hospitalists should be able to:

• Compare and contrast the advantages and disadvantages of experimental (such as randomized control trials) and observational (such as descriptive, cohort, or case control) study designs, including meta-analyses and systematic reviews.
• Define common sources of bias, including information bias, selection bias, and uncontrolled confounding, and describe how each may impact a study.
• Define basic statistical terms such as sample, discrete and continuous data variables, measures of central tendency (mean, median, and mode), and variability (variance, standard deviation, range).
• List resources available to access current or proposed studies including The Pediatric Health Information System (PHIS), the Healthcare Cost and Utilization Project (HCUP), the Kids’ Inpatient Database (KID), clinicaltrials.gov, and others.
• Name potential research funding sources, such as the Agency for Healthcare Research and Quality (AHRQ), the National Institutes of Health (NIH), the Patient-Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation, local and state funding sources, and others.
• Summarize the goals of pediatric hospital medicine-specific research networks, including the Pediatric Research in the Inpatient Setting (PRIS) network and the Value in Pediatrics (VIP) network.
• Discuss the basic resources commonly required to support research components, including data collection, data analysis, abstract and manuscript preparation, grant funding, and others.
• Review the aspects of the research process that relate to protection of participants, including informed consent and/or assent, the institutional review boards (IRB) review, and HIPAA (Health Insurance Portability and Accountability Act) forms.
• Discuss special protections needed when conducting research with vulnerable populations.
• Define “minimal risk” for a healthy child and for a child with an illness.
• Discuss why common training that addresses ethics, vulnerable populations, consenting, data safety, and other items is required prior to participating as a research team member for a research study.
• Compare and contrast the goals, intent, study focus, and IRB requirements for quality improvement studies from those of traditional clinical research.
• Cite the steps needed to obtain approval for a QI study within the local context.
• Compare and contrast the goals, intent, study focus, and IRB requirements for education studies to those of traditional clinical research.
• Cite the steps needed to obtain approval for a study focused on educational outcomes.
• List common barriers to implementation of clinical studies and describe the pediatric hospitalist’s role in overcoming these barriers.

Pediatric hospitalists should be able to:

• Utilize a format such as PICO (Population, Intervention, Comparison, Outcome) to generate an answerable patient-centered clinical question that is relevant to improving patient care.
• Demonstrate proficiency in systematic searching of the primary medical literature using online search engines.
• Perform critical appraisal of the literature, including identifying threats to study validity, determining if study subjects were similar to local patients, and determining if all clinically important outcomes were considered.
• Apply and integrate the results of studies to clinical practice.
• Determine if the likely benefits noted in a treatment study are worth the potential harm and cost.
• Determine whether a test noted in a diagnostic study is available, affordable, accurate, and precise in the present clinical setting and determine whether the results of the test will change the management of patients being treated.
• Determine if the magnitude of risk warrants an attempt to stop the exposure for a given study on harm.
• Identify if the results of a given study on disease prognosis will lead directly to selecting therapy and/or are useful for counseling patients.
• Participate in educating learners and junior faculty about research and research methodologies, within the local context.
• Determine the relevance of potential research studies with regards to impact on patient care.
• Perform effective informed consent or assent for patients participating in research studies, as appropriate.
• Identify and resolve conflict of interest or potential conflict of interest when participating in research studies.
• Demonstrate basic skills in acquiring, managing, and sharing data collected for research purposes in a responsible and professional manner.
• Adhere to standards for protecting confidentiality, avoiding unjustified exclusions, sharing data, and adhering to copyright law.
• Perform peer-review of a manuscript, abstract, or other research-based work, in collaboration with colleagues as appropriate.
• Demonstrate basic skills in communicating about research opportunities with patients and the family/caregivers within the local context.

Pediatric hospitalists should be able to:

• Recognize the value of seeking the research that supports clinical care decisions and how research fills knowledge gaps and challenges the field to advance.
• Realize the importance of informed consent for patient participation in clinical research.
• Reflect on the importance of patient assent, even in the presence of legal guardian informed consent, when involving children in clinical research.
• Exemplify highly ethical behaviors when promoting or participating in research studies.
• Realize the value of and exemplify a willingness to perform journal-requested peer review of manuscripts, conference abstracts, or other research-based work.
• Reflect on and provide support and education for patients and the family/caregivers on the benefits of research for hospitalized children.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in interdisciplinary initiatives to develop and sustain participation of interdisciplinary teams in performance of research.
• Collaborate with colleagues, hospital administration, and community leaders for thoughtful application of research findings to improve systems of healthcare delivery.
• Lead, coordinate, or participate in national multi-center research efforts that improve the evidence base in inpatient pediatrics, within local context.
• Collaborate with leaders in the university department of pediatrics and school of medicine, hospital administration, and medical staff to encourage local hospital participation in national multi-center research efforts.
• Collaborate with research team members to educate colleagues, hospital staff, and others on the importance of research in improving child health outcomes.

Introduction

Research is a rapidly growing aspect of inpatient medicine. The practice of evidence-based medicine and the acute need for more evidence on inpatient conditions require that pediatric hospitalists understand and participate in research related activities. Pediatric hospitalists’ role in research will vary depending on their setting and job description. This role may include many facets, from reviewing relevant patient-based articles, to participating in multi-institutional studies requiring enrollment of patients, to leading local or national studies. Pediatric hospitalists should have a basic understanding of research methods and processes in order to participate in and benefit from research. Pediatric hospitalists are well positioned to promote research to patients, the family/caregivers, colleagues, and other healthcare providers and through this, to contribute to the effective care of hospitalized patients.

Pediatric hospitalists should be able to:

• Compare and contrast the advantages and disadvantages of experimental (such as randomized control trials) and observational (such as descriptive, cohort, or case control) study designs, including meta-analyses and systematic reviews.
• Define common sources of bias, including information bias, selection bias, and uncontrolled confounding, and describe how each may impact a study.
• Define basic statistical terms such as sample, discrete and continuous data variables, measures of central tendency (mean, median, and mode), and variability (variance, standard deviation, range).
• List resources available to access current or proposed studies including The Pediatric Health Information System (PHIS), the Healthcare Cost and Utilization Project (HCUP), the Kids’ Inpatient Database (KID), clinicaltrials.gov, and others.
• Name potential research funding sources, such as the Agency for Healthcare Research and Quality (AHRQ), the National Institutes of Health (NIH), the Patient-Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation, local and state funding sources, and others.
• Summarize the goals of pediatric hospital medicine-specific research networks, including the Pediatric Research in the Inpatient Setting (PRIS) network and the Value in Pediatrics (VIP) network.
• Discuss the basic resources commonly required to support research components, including data collection, data analysis, abstract and manuscript preparation, grant funding, and others.
• Review the aspects of the research process that relate to protection of participants, including informed consent and/or assent, the institutional review boards (IRB) review, and HIPAA (Health Insurance Portability and Accountability Act) forms.
• Discuss special protections needed when conducting research with vulnerable populations.
• Define “minimal risk” for a healthy child and for a child with an illness.
• Discuss why common training that addresses ethics, vulnerable populations, consenting, data safety, and other items is required prior to participating as a research team member for a research study.
• Compare and contrast the goals, intent, study focus, and IRB requirements for quality improvement studies from those of traditional clinical research.
• Cite the steps needed to obtain approval for a QI study within the local context.
• Compare and contrast the goals, intent, study focus, and IRB requirements for education studies to those of traditional clinical research.
• Cite the steps needed to obtain approval for a study focused on educational outcomes.
• List common barriers to implementation of clinical studies and describe the pediatric hospitalist’s role in overcoming these barriers.

Pediatric hospitalists should be able to:

• Utilize a format such as PICO (Population, Intervention, Comparison, Outcome) to generate an answerable patient-centered clinical question that is relevant to improving patient care.
• Demonstrate proficiency in systematic searching of the primary medical literature using online search engines.
• Perform critical appraisal of the literature, including identifying threats to study validity, determining if study subjects were similar to local patients, and determining if all clinically important outcomes were considered.
• Apply and integrate the results of studies to clinical practice.
• Determine if the likely benefits noted in a treatment study are worth the potential harm and cost.
• Determine whether a test noted in a diagnostic study is available, affordable, accurate, and precise in the present clinical setting and determine whether the results of the test will change the management of patients being treated.
• Determine if the magnitude of risk warrants an attempt to stop the exposure for a given study on harm.
• Identify if the results of a given study on disease prognosis will lead directly to selecting therapy and/or are useful for counseling patients.
• Participate in educating learners and junior faculty about research and research methodologies, within the local context.
• Determine the relevance of potential research studies with regards to impact on patient care.
• Perform effective informed consent or assent for patients participating in research studies, as appropriate.
• Identify and resolve conflict of interest or potential conflict of interest when participating in research studies.
• Demonstrate basic skills in acquiring, managing, and sharing data collected for research purposes in a responsible and professional manner.
• Adhere to standards for protecting confidentiality, avoiding unjustified exclusions, sharing data, and adhering to copyright law.
• Perform peer-review of a manuscript, abstract, or other research-based work, in collaboration with colleagues as appropriate.
• Demonstrate basic skills in communicating about research opportunities with patients and the family/caregivers within the local context.

Pediatric hospitalists should be able to:

• Recognize the value of seeking the research that supports clinical care decisions and how research fills knowledge gaps and challenges the field to advance.
• Realize the importance of informed consent for patient participation in clinical research.
• Reflect on the importance of patient assent, even in the presence of legal guardian informed consent, when involving children in clinical research.
• Exemplify highly ethical behaviors when promoting or participating in research studies.
• Realize the value of and exemplify a willingness to perform journal-requested peer review of manuscripts, conference abstracts, or other research-based work.
• Reflect on and provide support and education for patients and the family/caregivers on the benefits of research for hospitalized children.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in interdisciplinary initiatives to develop and sustain participation of interdisciplinary teams in performance of research.
• Collaborate with colleagues, hospital administration, and community leaders for thoughtful application of research findings to improve systems of healthcare delivery.
• Lead, coordinate, or participate in national multi-center research efforts that improve the evidence base in inpatient pediatrics, within local context.
• Collaborate with leaders in the university department of pediatrics and school of medicine, hospital administration, and medical staff to encourage local hospital participation in national multi-center research efforts.
• Collaborate with research team members to educate colleagues, hospital staff, and others on the importance of research in improving child health outcomes.

Introduction

Quality Improvement (QI) in healthcare involves planning, implementation, and ongoing assessment of care to proactively improve healthcare outcomes. Hospitals use QI programs to optimize care, streamline systems operations, meet regulatory requirements, and enhance customer service quality. Since the publication of Crossing the Quality Chasm decades ago by the Institutes of Medicine (now the National Academies of Medicine), even greater attention has been focused on improving use and assessing outcomes of evidence-based practices. Proving that “quality of care” and healthcare “value” (quality achieved relative to cost) has been achieved is critical for individual hospitals as well as the national healthcare system. The challenge is to maintain fiscal viability while delivering appropriate healthcare. Healthcare leaders therefore consider QI programs integral to system operations as a means to assure that resources are used wisely and delivery of consistent outcomes that improve the health of the populations served occurs. Pediatric hospitalists work on the front lines of clinical care and are aware of opportunities to improve acute care management, address gaps in chronic care needs, and identify opportunities for system-wide enhancements. Pediatric hospitalists are well positioned to act as influential change agents to promote, champion, and lead QI projects to ensure the highest value of healthcare for hospitalized children.

Pediatric hospitalists should be able to:

• Compare and contrast between Quality Assurance (focus on individual compliance with standards) and Quality Improvement (proactive systems improvement via integration of best practices).
• Define the “Model for Improvement.”
• Summarize the steps of the Shewart-Deming Plan Do Study Act (PDSA) cycle of improvement.
• Explain the value of demonstrating small gains and identifying failures for correction through rapid cycle improvement.
• Describe how lean methodology attempts to eliminate waste and Six Sigma attempts to reduce variation and defects within a process.
• Define commonly used QI tools and terms such as common cause and special cause variation, run charts, cumulative proportion charts, process map, and others.
• Cite examples of structure, process, outcome, and balancing metrics, attending to areas such as clinical, financial, resource use, and perceptions of care improvement.
• Summarize how QI supports effective development of care standardization, best practices, and practice guidelines in order to improve clinical outcomes.
• Discuss the importance of integrating evidence-based medicine into the planning stage of QI projects affecting patient care.
• Explain how QI can be effectively used for both clinical and system operations improvements using examples such as clinical care guidelines and hospital procedures.
• Describe the business case for quality and review why quality should drive cost and resource allocation.
• Define the role of the patient and family in QI and illustrate how their involvement or perspectives are central to QI project success.
• Discuss how interprofessional teams and a culture of commitment to QI impact the success of QI Programs.
• Explain the role of human factors in implementing healthcare improvements.
• List the attributes necessary to moderate, facilitate, and lead QI initiatives and discuss the importance of team building methods.
• Summarize how regulatory, accrediting, advocacy, research funders, and insurers impact QI initiatives and outcomes reporting for hospitalized children, attending to the Centers for Medicare and Medicaid, The Joint Commission, Agency for Healthcare Research and Quality, Leapfrog, and the National Quality Forum.
• Discuss the value of national, state, and local comparative quality data reporting and the clinical, educational, and research utility of national sources such as the Pediatric Health Information Dataset (PHIS).
• Review how reporting quality outcomes to external sources and posting on local hospital websites can affect the patient experience and community trust.
• Summarize the value of continuous participation in QI activities, noting the expectations from medical school through American Board of Pediatrics initial and ongoing certification.

Pediatric hospitalists should be able to:

• Identify processes in need of improvement and engage the appropriate personnel to gain approval for a QI project.
• Demonstrate proficiency in performing each step in a basic QI project.
• Demonstrate proficiency in utilizing basic QI tools such as a process map, key driver diagram, and fishbone diagram.
• Perform review of quality data, including basic data analysis, interpretation, and development of recommendations from the data.
• Serve as a liaison between physician staff and hospital administrative staff when interpreting physician-specific information and clinical care outliers.
• Utilize communication and leadership skills to participate effectively on an interdisciplinary team.
• Educate trainees, nursing staff, ancillary staff, and peers on the basic principles of QI.
• Assist with development of practice guidelines to assure delivery of standardized high value care in the hospital setting.
• Use best practice guidelines effectively and consistently.
• Demonstrate facility with the use of common computer applications, including spreadsheet and database management for information retrieval and analysis.

Pediatric hospitalists should be able to:

• Realize the value of leading as an “early adopter” and “change agent” by building an awareness of and consensus for changes needed to make patient care quality a high priority.
• Recognize the importance of team building, leadership, and family centeredness in performing effective QI.
• Acknowledge the importance of collaboration with healthcare providers critical to QI efforts, such as clinical team members, information technology staff, data analysts, and others.
• Seek opportunities to initiate or actively participate in QI projects.
• Work collaboratively to help create and maintain a QI culture within the institution.
• Exemplify professional behavior when reviewing and interpreting data.
• Recognize how value is defined by the patient and family/caregivers and support QI efforts to increase this value.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Engage hospital, medical group, and medical staff leadership in creating, implementing, and sustaining short- and long-term QI goals that add value for all customers.
• Participate on QI committees and seek opportunities to serve as QI officers or consultants.
• Advocate for the necessary information systems and other infrastructure to secure accurate data and assure success in the QI process.

Introduction

Quality Improvement (QI) in healthcare involves planning, implementation, and ongoing assessment of care to proactively improve healthcare outcomes. Hospitals use QI programs to optimize care, streamline systems operations, meet regulatory requirements, and enhance customer service quality. Since the publication of Crossing the Quality Chasm decades ago by the Institutes of Medicine (now the National Academies of Medicine), even greater attention has been focused on improving use and assessing outcomes of evidence-based practices. Proving that “quality of care” and healthcare “value” (quality achieved relative to cost) has been achieved is critical for individual hospitals as well as the national healthcare system. The challenge is to maintain fiscal viability while delivering appropriate healthcare. Healthcare leaders therefore consider QI programs integral to system operations as a means to assure that resources are used wisely and delivery of consistent outcomes that improve the health of the populations served occurs. Pediatric hospitalists work on the front lines of clinical care and are aware of opportunities to improve acute care management, address gaps in chronic care needs, and identify opportunities for system-wide enhancements. Pediatric hospitalists are well positioned to act as influential change agents to promote, champion, and lead QI projects to ensure the highest value of healthcare for hospitalized children.

Pediatric hospitalists should be able to:

• Compare and contrast between Quality Assurance (focus on individual compliance with standards) and Quality Improvement (proactive systems improvement via integration of best practices).
• Define the “Model for Improvement.”
• Summarize the steps of the Shewart-Deming Plan Do Study Act (PDSA) cycle of improvement.
• Explain the value of demonstrating small gains and identifying failures for correction through rapid cycle improvement.
• Describe how lean methodology attempts to eliminate waste and Six Sigma attempts to reduce variation and defects within a process.
• Define commonly used QI tools and terms such as common cause and special cause variation, run charts, cumulative proportion charts, process map, and others.
• Cite examples of structure, process, outcome, and balancing metrics, attending to areas such as clinical, financial, resource use, and perceptions of care improvement.
• Summarize how QI supports effective development of care standardization, best practices, and practice guidelines in order to improve clinical outcomes.
• Discuss the importance of integrating evidence-based medicine into the planning stage of QI projects affecting patient care.
• Explain how QI can be effectively used for both clinical and system operations improvements using examples such as clinical care guidelines and hospital procedures.
• Describe the business case for quality and review why quality should drive cost and resource allocation.
• Define the role of the patient and family in QI and illustrate how their involvement or perspectives are central to QI project success.
• Discuss how interprofessional teams and a culture of commitment to QI impact the success of QI Programs.
• Explain the role of human factors in implementing healthcare improvements.
• List the attributes necessary to moderate, facilitate, and lead QI initiatives and discuss the importance of team building methods.
• Summarize how regulatory, accrediting, advocacy, research funders, and insurers impact QI initiatives and outcomes reporting for hospitalized children, attending to the Centers for Medicare and Medicaid, The Joint Commission, Agency for Healthcare Research and Quality, Leapfrog, and the National Quality Forum.
• Discuss the value of national, state, and local comparative quality data reporting and the clinical, educational, and research utility of national sources such as the Pediatric Health Information Dataset (PHIS).
• Review how reporting quality outcomes to external sources and posting on local hospital websites can affect the patient experience and community trust.
• Summarize the value of continuous participation in QI activities, noting the expectations from medical school through American Board of Pediatrics initial and ongoing certification.

Pediatric hospitalists should be able to:

• Identify processes in need of improvement and engage the appropriate personnel to gain approval for a QI project.
• Demonstrate proficiency in performing each step in a basic QI project.
• Demonstrate proficiency in utilizing basic QI tools such as a process map, key driver diagram, and fishbone diagram.
• Perform review of quality data, including basic data analysis, interpretation, and development of recommendations from the data.
• Serve as a liaison between physician staff and hospital administrative staff when interpreting physician-specific information and clinical care outliers.
• Utilize communication and leadership skills to participate effectively on an interdisciplinary team.
• Educate trainees, nursing staff, ancillary staff, and peers on the basic principles of QI.
• Assist with development of practice guidelines to assure delivery of standardized high value care in the hospital setting.
• Use best practice guidelines effectively and consistently.
• Demonstrate facility with the use of common computer applications, including spreadsheet and database management for information retrieval and analysis.

Pediatric hospitalists should be able to:

• Realize the value of leading as an “early adopter” and “change agent” by building an awareness of and consensus for changes needed to make patient care quality a high priority.
• Recognize the importance of team building, leadership, and family centeredness in performing effective QI.
• Acknowledge the importance of collaboration with healthcare providers critical to QI efforts, such as clinical team members, information technology staff, data analysts, and others.
• Seek opportunities to initiate or actively participate in QI projects.
• Work collaboratively to help create and maintain a QI culture within the institution.
• Exemplify professional behavior when reviewing and interpreting data.
• Recognize how value is defined by the patient and family/caregivers and support QI efforts to increase this value.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Engage hospital, medical group, and medical staff leadership in creating, implementing, and sustaining short- and long-term QI goals that add value for all customers.
• Participate on QI committees and seek opportunities to serve as QI officers or consultants.
• Advocate for the necessary information systems and other infrastructure to secure accurate data and assure success in the QI process.

Introduction

Quality Improvement (QI) in healthcare involves planning, implementation, and ongoing assessment of care to proactively improve healthcare outcomes. Hospitals use QI programs to optimize care, streamline systems operations, meet regulatory requirements, and enhance customer service quality. Since the publication of Crossing the Quality Chasm decades ago by the Institutes of Medicine (now the National Academies of Medicine), even greater attention has been focused on improving use and assessing outcomes of evidence-based practices. Proving that “quality of care” and healthcare “value” (quality achieved relative to cost) has been achieved is critical for individual hospitals as well as the national healthcare system. The challenge is to maintain fiscal viability while delivering appropriate healthcare. Healthcare leaders therefore consider QI programs integral to system operations as a means to assure that resources are used wisely and delivery of consistent outcomes that improve the health of the populations served occurs. Pediatric hospitalists work on the front lines of clinical care and are aware of opportunities to improve acute care management, address gaps in chronic care needs, and identify opportunities for system-wide enhancements. Pediatric hospitalists are well positioned to act as influential change agents to promote, champion, and lead QI projects to ensure the highest value of healthcare for hospitalized children.

Pediatric hospitalists should be able to:

• Compare and contrast between Quality Assurance (focus on individual compliance with standards) and Quality Improvement (proactive systems improvement via integration of best practices).
• Define the “Model for Improvement.”
• Summarize the steps of the Shewart-Deming Plan Do Study Act (PDSA) cycle of improvement.
• Explain the value of demonstrating small gains and identifying failures for correction through rapid cycle improvement.
• Describe how lean methodology attempts to eliminate waste and Six Sigma attempts to reduce variation and defects within a process.
• Define commonly used QI tools and terms such as common cause and special cause variation, run charts, cumulative proportion charts, process map, and others.
• Cite examples of structure, process, outcome, and balancing metrics, attending to areas such as clinical, financial, resource use, and perceptions of care improvement.
• Summarize how QI supports effective development of care standardization, best practices, and practice guidelines in order to improve clinical outcomes.
• Discuss the importance of integrating evidence-based medicine into the planning stage of QI projects affecting patient care.
• Explain how QI can be effectively used for both clinical and system operations improvements using examples such as clinical care guidelines and hospital procedures.
• Describe the business case for quality and review why quality should drive cost and resource allocation.
• Define the role of the patient and family in QI and illustrate how their involvement or perspectives are central to QI project success.
• Discuss how interprofessional teams and a culture of commitment to QI impact the success of QI Programs.
• Explain the role of human factors in implementing healthcare improvements.
• List the attributes necessary to moderate, facilitate, and lead QI initiatives and discuss the importance of team building methods.
• Summarize how regulatory, accrediting, advocacy, research funders, and insurers impact QI initiatives and outcomes reporting for hospitalized children, attending to the Centers for Medicare and Medicaid, The Joint Commission, Agency for Healthcare Research and Quality, Leapfrog, and the National Quality Forum.
• Discuss the value of national, state, and local comparative quality data reporting and the clinical, educational, and research utility of national sources such as the Pediatric Health Information Dataset (PHIS).
• Review how reporting quality outcomes to external sources and posting on local hospital websites can affect the patient experience and community trust.
• Summarize the value of continuous participation in QI activities, noting the expectations from medical school through American Board of Pediatrics initial and ongoing certification.

Pediatric hospitalists should be able to:

• Identify processes in need of improvement and engage the appropriate personnel to gain approval for a QI project.
• Demonstrate proficiency in performing each step in a basic QI project.
• Demonstrate proficiency in utilizing basic QI tools such as a process map, key driver diagram, and fishbone diagram.
• Perform review of quality data, including basic data analysis, interpretation, and development of recommendations from the data.
• Serve as a liaison between physician staff and hospital administrative staff when interpreting physician-specific information and clinical care outliers.
• Utilize communication and leadership skills to participate effectively on an interdisciplinary team.
• Educate trainees, nursing staff, ancillary staff, and peers on the basic principles of QI.
• Assist with development of practice guidelines to assure delivery of standardized high value care in the hospital setting.
• Use best practice guidelines effectively and consistently.
• Demonstrate facility with the use of common computer applications, including spreadsheet and database management for information retrieval and analysis.

Pediatric hospitalists should be able to:

• Realize the value of leading as an “early adopter” and “change agent” by building an awareness of and consensus for changes needed to make patient care quality a high priority.
• Recognize the importance of team building, leadership, and family centeredness in performing effective QI.
• Acknowledge the importance of collaboration with healthcare providers critical to QI efforts, such as clinical team members, information technology staff, data analysts, and others.
• Seek opportunities to initiate or actively participate in QI projects.
• Work collaboratively to help create and maintain a QI culture within the institution.
• Exemplify professional behavior when reviewing and interpreting data.
• Recognize how value is defined by the patient and family/caregivers and support QI efforts to increase this value.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Engage hospital, medical group, and medical staff leadership in creating, implementing, and sustaining short- and long-term QI goals that add value for all customers.
• Participate on QI committees and seek opportunities to serve as QI officers or consultants.
• Advocate for the necessary information systems and other infrastructure to secure accurate data and assure success in the QI process.

Introduction

Patient safety is defined as freedom from accidental injury caused by medical care, such as harm or death attributable to adverse drug events, patient misidentifications, or health care-acquired infections. In 1999 the Institute of Medicine (IOM; now the National Academy of Medicine) published the “To Err is Human” report, which challenged United States healthcare systems and providers to recognize, report, and mitigate error and harm to patients. Children, as a vulnerable population, are at particular risk for medical errors and specifically medication errors. Pediatric hospitalists work in the acute care hospital setting where high-risk diagnostic decision-making, transitions of care, medication safety, and handoffs are commonly performed. Pediatric hospitalists therefore have a duty to promote patient safety and help develop and implement systems to reduce both error and harm to hospitalized children.

Pediatric hospitalists should be able to:

• Review the basic principles of patient safety, including systems redesign and the prevention, identification, and mitigation of preventable adverse events.
• Review the difference between error and harm including different types of errors.
• Cite the key components of a culture of safety.
• Review the fundamental components of a “Just Culture” and describe how organizations can achieve them.
• Discuss why errors are multifactorial and more often the result of systems failures rather than individual failures.
• Define the concept of “second victim” and review steps to support colleagues, trainees, and other providers when they become a second victim.
• Define common features of a “High Reliability Organization” and explain how high reliability principles apply to clinical care and work on patient safety initiatives.
• Review common patient safety interventions to reduce errors, including electronic order sets, practice guidelines, checklists, clinical decision support, double checks, bar coding, lock-out drawers, and others.
• Discuss factors unique to children that lead to increased risk for medication errors.
• Describe how using structured communication techniques, such as standardized handoffs, closed loop communication, active listening, and critical language are critical to safety.
• Describe the role of patient/family engagement in patient safety.
• Describe the safety components of hospital accreditation and how pediatric hospitalists can help ensure these standards are met.
• Describe common types of cognitive biases, such as premature closure, anchoring, and others, and review how they contribute to diagnostic error.
• Discuss the goals of national safety collaboratives, such as Solutions for Patient Safety (SPS) and describe safety bundles for common hospital-acquired conditions (HACs).
• Review the role of pediatric hospitalists in maintaining national safety goals required by common key accrediting organizations, such as The Joint Commission (TJC) and others.

Pediatric hospitalists should be able to:

• Demonstrate skill in creating an environment that reflects a high reliability organization.
• Facilitate safe and efficient hospital admissions and discharges.
• Identify and order the level of nursing care needed for safe patient care.
• Engage and educate patients and the family/caregivers on their role in ensuring patient safety.
• Utilize and participate in optimizing patient safety features of health information technology.
• Educate trainees, colleagues, and other healthcare providers on basic safety principles.
• Demonstrate proficiency in reporting errors using safety reporting systems.
• Work effectively and collaboratively with patient safety teams.
• Engage in patient safety event reviews, including (root) causal analyses, Morbidity and Mortality committees, and sentinel event reviews.
• Disclose medical errors clearly, concisely, and completely to patients and the family/caregivers.
• Participate in continuous readiness for accreditation agencies by consistently adhering to patient safety practices.

Pediatric hospitalists should be able to:

• Reflect on the importance of creating and sustaining a culture of patient safety.
• Role model behaviors that exemplify a “Just Culture,” accountability, and learning from failure.
• Recognize that patient safety improvements come from consistently reporting near misses as well as medical errors.
• Promote an awareness of the need for and will for change to make patient safety a high and consistent priority.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in multidisciplinary broad strategies to positively impact patient safety in the organization.
• Collaborate with hospital administration and community leaders for the necessary information systems and other infrastructure to ensure success with pediatric patient safety initiatives.
• Lead, coordinate, or participate in multidisciplinary initiatives to develop and implement patient safety interventions where possible.

• Actively participate in hospital-wide safety committees and seek to become leaders in pediatric patient safety in their institutions.

Introduction

Patient safety is defined as freedom from accidental injury caused by medical care, such as harm or death attributable to adverse drug events, patient misidentifications, or health care-acquired infections. In 1999 the Institute of Medicine (IOM; now the National Academy of Medicine) published the “To Err is Human” report, which challenged United States healthcare systems and providers to recognize, report, and mitigate error and harm to patients. Children, as a vulnerable population, are at particular risk for medical errors and specifically medication errors. Pediatric hospitalists work in the acute care hospital setting where high-risk diagnostic decision-making, transitions of care, medication safety, and handoffs are commonly performed. Pediatric hospitalists therefore have a duty to promote patient safety and help develop and implement systems to reduce both error and harm to hospitalized children.

Pediatric hospitalists should be able to:

• Review the basic principles of patient safety, including systems redesign and the prevention, identification, and mitigation of preventable adverse events.
• Review the difference between error and harm including different types of errors.
• Cite the key components of a culture of safety.
• Review the fundamental components of a “Just Culture” and describe how organizations can achieve them.
• Discuss why errors are multifactorial and more often the result of systems failures rather than individual failures.
• Define the concept of “second victim” and review steps to support colleagues, trainees, and other providers when they become a second victim.
• Define common features of a “High Reliability Organization” and explain how high reliability principles apply to clinical care and work on patient safety initiatives.
• Review common patient safety interventions to reduce errors, including electronic order sets, practice guidelines, checklists, clinical decision support, double checks, bar coding, lock-out drawers, and others.
• Discuss factors unique to children that lead to increased risk for medication errors.
• Describe how using structured communication techniques, such as standardized handoffs, closed loop communication, active listening, and critical language are critical to safety.
• Describe the role of patient/family engagement in patient safety.
• Describe the safety components of hospital accreditation and how pediatric hospitalists can help ensure these standards are met.
• Describe common types of cognitive biases, such as premature closure, anchoring, and others, and review how they contribute to diagnostic error.
• Discuss the goals of national safety collaboratives, such as Solutions for Patient Safety (SPS) and describe safety bundles for common hospital-acquired conditions (HACs).
• Review the role of pediatric hospitalists in maintaining national safety goals required by common key accrediting organizations, such as The Joint Commission (TJC) and others.

Pediatric hospitalists should be able to:

• Demonstrate skill in creating an environment that reflects a high reliability organization.
• Facilitate safe and efficient hospital admissions and discharges.
• Identify and order the level of nursing care needed for safe patient care.
• Engage and educate patients and the family/caregivers on their role in ensuring patient safety.
• Utilize and participate in optimizing patient safety features of health information technology.
• Educate trainees, colleagues, and other healthcare providers on basic safety principles.
• Demonstrate proficiency in reporting errors using safety reporting systems.
• Work effectively and collaboratively with patient safety teams.
• Engage in patient safety event reviews, including (root) causal analyses, Morbidity and Mortality committees, and sentinel event reviews.
• Disclose medical errors clearly, concisely, and completely to patients and the family/caregivers.
• Participate in continuous readiness for accreditation agencies by consistently adhering to patient safety practices.

Pediatric hospitalists should be able to:

• Reflect on the importance of creating and sustaining a culture of patient safety.
• Role model behaviors that exemplify a “Just Culture,” accountability, and learning from failure.
• Recognize that patient safety improvements come from consistently reporting near misses as well as medical errors.
• Promote an awareness of the need for and will for change to make patient safety a high and consistent priority.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in multidisciplinary broad strategies to positively impact patient safety in the organization.
• Collaborate with hospital administration and community leaders for the necessary information systems and other infrastructure to ensure success with pediatric patient safety initiatives.
• Lead, coordinate, or participate in multidisciplinary initiatives to develop and implement patient safety interventions where possible.

• Actively participate in hospital-wide safety committees and seek to become leaders in pediatric patient safety in their institutions.

Introduction

Patient safety is defined as freedom from accidental injury caused by medical care, such as harm or death attributable to adverse drug events, patient misidentifications, or health care-acquired infections. In 1999 the Institute of Medicine (IOM; now the National Academy of Medicine) published the “To Err is Human” report, which challenged United States healthcare systems and providers to recognize, report, and mitigate error and harm to patients. Children, as a vulnerable population, are at particular risk for medical errors and specifically medication errors. Pediatric hospitalists work in the acute care hospital setting where high-risk diagnostic decision-making, transitions of care, medication safety, and handoffs are commonly performed. Pediatric hospitalists therefore have a duty to promote patient safety and help develop and implement systems to reduce both error and harm to hospitalized children.

Pediatric hospitalists should be able to:

• Review the basic principles of patient safety, including systems redesign and the prevention, identification, and mitigation of preventable adverse events.
• Review the difference between error and harm including different types of errors.
• Cite the key components of a culture of safety.
• Review the fundamental components of a “Just Culture” and describe how organizations can achieve them.
• Discuss why errors are multifactorial and more often the result of systems failures rather than individual failures.
• Define the concept of “second victim” and review steps to support colleagues, trainees, and other providers when they become a second victim.
• Define common features of a “High Reliability Organization” and explain how high reliability principles apply to clinical care and work on patient safety initiatives.
• Review common patient safety interventions to reduce errors, including electronic order sets, practice guidelines, checklists, clinical decision support, double checks, bar coding, lock-out drawers, and others.
• Discuss factors unique to children that lead to increased risk for medication errors.
• Describe how using structured communication techniques, such as standardized handoffs, closed loop communication, active listening, and critical language are critical to safety.
• Describe the role of patient/family engagement in patient safety.
• Describe the safety components of hospital accreditation and how pediatric hospitalists can help ensure these standards are met.
• Describe common types of cognitive biases, such as premature closure, anchoring, and others, and review how they contribute to diagnostic error.
• Discuss the goals of national safety collaboratives, such as Solutions for Patient Safety (SPS) and describe safety bundles for common hospital-acquired conditions (HACs).
• Review the role of pediatric hospitalists in maintaining national safety goals required by common key accrediting organizations, such as The Joint Commission (TJC) and others.

Pediatric hospitalists should be able to:

• Demonstrate skill in creating an environment that reflects a high reliability organization.
• Facilitate safe and efficient hospital admissions and discharges.
• Identify and order the level of nursing care needed for safe patient care.
• Engage and educate patients and the family/caregivers on their role in ensuring patient safety.
• Utilize and participate in optimizing patient safety features of health information technology.
• Educate trainees, colleagues, and other healthcare providers on basic safety principles.
• Demonstrate proficiency in reporting errors using safety reporting systems.
• Work effectively and collaboratively with patient safety teams.
• Engage in patient safety event reviews, including (root) causal analyses, Morbidity and Mortality committees, and sentinel event reviews.
• Disclose medical errors clearly, concisely, and completely to patients and the family/caregivers.
• Participate in continuous readiness for accreditation agencies by consistently adhering to patient safety practices.

Pediatric hospitalists should be able to:

• Reflect on the importance of creating and sustaining a culture of patient safety.
• Role model behaviors that exemplify a “Just Culture,” accountability, and learning from failure.
• Recognize that patient safety improvements come from consistently reporting near misses as well as medical errors.
• Promote an awareness of the need for and will for change to make patient safety a high and consistent priority.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in multidisciplinary broad strategies to positively impact patient safety in the organization.
• Collaborate with hospital administration and community leaders for the necessary information systems and other infrastructure to ensure success with pediatric patient safety initiatives.
• Lead, coordinate, or participate in multidisciplinary initiatives to develop and implement patient safety interventions where possible.

• Actively participate in hospital-wide safety committees and seek to become leaders in pediatric patient safety in their institutions.

Introduction

Risk Management is a discipline commonly perceived to be the domain of institutional personnel and committees who are called upon to address adverse events that have already occurred. However, consequence management is far from the most effective utilization of such resources, as they are most efficiently and ethically deployed in preventive programs. Risk management therefore prospectively draws upon the disciplines of patient safety, performance improvement, systems management (including engineering and technology), ethics, and human factors in addition to medicine, in an effort to eliminate or ameliorate the undesirable consequences of delivering healthcare services. Hospitalized children are a highly vulnerable population due to social dependencies and developmental needs and have unique legal regulations that may impact care delivery. Pediatric hospitalists deliver care in this acute, high-risk healthcare environment and should be knowledgeable about legal and regulatory requirements, prevention strategies, and ways in which to collaborate with other professionals in management of hospitalized children.

Pediatric hospitalists should be able to:

• Summarize the role of common entities that accredit and license organizations, including The Joint Commission (TJC), the Centers for Medicare and Medicaid Services (CMS), and state health departments.
• Cite examples of how interfacility transfer of patients may be affected by the Emergency Medical Treatment and Active Labor Act (EMTALA).
• Summarize the basic regulatory and legal stipulations that may impact pediatric hospitalist contracting and practice, as noted in the anti-kickback regulations (Stark Rules) and anti-trust regulations (Sherman Act).
• Discuss the importance of fraud and abuse regulations for billing, coding, documentation, collections, utilization review, and managed care operations.
• Describe the common features of privacy regulations, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Review the role of physician licensing and oversight agencies such as the state Medical Board, National Practitioner Data Bank, and Drug Enforcement Agency.
• Define “medical liability,” “standard of practice,” and “negligence” and discuss the role of state malpractice statutes of limitation for children.
• Discuss the role of behavior and attitudes in generating patient and family/caregiver complaints.
• Describe the behavioral and physical characteristics of the impaired practitioner, including fatigue, substance abuse, and disruptive behavior.
• Summarize the role of the hospital medical staff in granting clinical privileges and initiating disciplinary actions through peer review process.
• List responsibilities associated with maintaining malpractice insurance, including documentation and disclosure requirements.
• Define the terms “assent” and “consent” and describe the circumstances in which informed assent or consent is needed.
• Give an example of legal issues that can arise in various clinical scenarios, such as end of life care, “no code” discussions (do-not-resuscitate or allow-natural-death), organ donation, guardianship, and newborn resuscitation.
• Describe the role of pediatric hospitalists in appropriate and timely notification to risk management or hospital counsel when medical errors or preventable events occur.
• Describe the role of pediatric hospitalists in recognizing and reporting family violence for the child, spouse, or elder.
• Provide examples of potential errors related to devices and technology, including Electronic Health Record (EHR) data entry, use, and documentation, privacy, device alert fatigue, and others.
• Review the relationship between human factors, design factors, risk management, patient safety, and quality improvement.

Pediatric hospitalists should be able to:

• Obtain informed assent and/or consent from patients and/or the family/caregivers.
• Disclose medical errors clearly, concisely, and completely to patients and the family/caregivers.
• Communicate in difficult situations and when delivering sensitive information, with compassion and a professional attitude.
• Support and communicate end-of-life decisions and planning.
• Transfer patient information concisely and precisely to other healthcare providers during all transitions of care.
• Prescribe treatments using safe medication prescribing practices.
• Document in the medical record with accuracy and appropriate detail.
• Identify when legal and risk management notification and/or expert consultation is indicated and initiate the escalation process.
• Demonstrate basic skills in utilizing risk reduction strategies, in partnership with local legal and risk management experts.

Pediatric hospitalists should be able to:

• Role model professional behavior.
• Recognize the importance of responding to complaints in a compassionate and sensitive manner.
• Reflect on the importance of collaborating with legal and risk management experts to learn and practice risk reduction strategies, such as failure modes and effects analysis (FMEA) and others.
• Reflect on and provide support and education for trainees in discussions on the importance of communication and documentation from the legal and risk management perspective.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in organizational risk management efforts and promote risk prevention by active participation in appropriate hospital committees.
• Collaborate with hospital administration and other colleagues to advocate for and modify systems and processes that help risk reduction.
• Lead, coordinate, or participate in healthcare information systems related initiatives that enhance the ease and accuracy of documentation and prescribing.
• Lead, coordinate, or participate in efforts to create a comprehensive risk reduction program encompassing education for hospital staff, medical staff, and trainees.

Introduction

Risk Management is a discipline commonly perceived to be the domain of institutional personnel and committees who are called upon to address adverse events that have already occurred. However, consequence management is far from the most effective utilization of such resources, as they are most efficiently and ethically deployed in preventive programs. Risk management therefore prospectively draws upon the disciplines of patient safety, performance improvement, systems management (including engineering and technology), ethics, and human factors in addition to medicine, in an effort to eliminate or ameliorate the undesirable consequences of delivering healthcare services. Hospitalized children are a highly vulnerable population due to social dependencies and developmental needs and have unique legal regulations that may impact care delivery. Pediatric hospitalists deliver care in this acute, high-risk healthcare environment and should be knowledgeable about legal and regulatory requirements, prevention strategies, and ways in which to collaborate with other professionals in management of hospitalized children.

Pediatric hospitalists should be able to:

• Summarize the role of common entities that accredit and license organizations, including The Joint Commission (TJC), the Centers for Medicare and Medicaid Services (CMS), and state health departments.
• Cite examples of how interfacility transfer of patients may be affected by the Emergency Medical Treatment and Active Labor Act (EMTALA).
• Summarize the basic regulatory and legal stipulations that may impact pediatric hospitalist contracting and practice, as noted in the anti-kickback regulations (Stark Rules) and anti-trust regulations (Sherman Act).
• Discuss the importance of fraud and abuse regulations for billing, coding, documentation, collections, utilization review, and managed care operations.
• Describe the common features of privacy regulations, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Review the role of physician licensing and oversight agencies such as the state Medical Board, National Practitioner Data Bank, and Drug Enforcement Agency.
• Define “medical liability,” “standard of practice,” and “negligence” and discuss the role of state malpractice statutes of limitation for children.
• Discuss the role of behavior and attitudes in generating patient and family/caregiver complaints.
• Describe the behavioral and physical characteristics of the impaired practitioner, including fatigue, substance abuse, and disruptive behavior.
• Summarize the role of the hospital medical staff in granting clinical privileges and initiating disciplinary actions through peer review process.
• List responsibilities associated with maintaining malpractice insurance, including documentation and disclosure requirements.
• Define the terms “assent” and “consent” and describe the circumstances in which informed assent or consent is needed.
• Give an example of legal issues that can arise in various clinical scenarios, such as end of life care, “no code” discussions (do-not-resuscitate or allow-natural-death), organ donation, guardianship, and newborn resuscitation.
• Describe the role of pediatric hospitalists in appropriate and timely notification to risk management or hospital counsel when medical errors or preventable events occur.
• Describe the role of pediatric hospitalists in recognizing and reporting family violence for the child, spouse, or elder.
• Provide examples of potential errors related to devices and technology, including Electronic Health Record (EHR) data entry, use, and documentation, privacy, device alert fatigue, and others.
• Review the relationship between human factors, design factors, risk management, patient safety, and quality improvement.

Pediatric hospitalists should be able to:

• Obtain informed assent and/or consent from patients and/or the family/caregivers.
• Disclose medical errors clearly, concisely, and completely to patients and the family/caregivers.
• Communicate in difficult situations and when delivering sensitive information, with compassion and a professional attitude.
• Support and communicate end-of-life decisions and planning.
• Transfer patient information concisely and precisely to other healthcare providers during all transitions of care.
• Prescribe treatments using safe medication prescribing practices.
• Document in the medical record with accuracy and appropriate detail.
• Identify when legal and risk management notification and/or expert consultation is indicated and initiate the escalation process.
• Demonstrate basic skills in utilizing risk reduction strategies, in partnership with local legal and risk management experts.

Pediatric hospitalists should be able to:

• Role model professional behavior.
• Recognize the importance of responding to complaints in a compassionate and sensitive manner.
• Reflect on the importance of collaborating with legal and risk management experts to learn and practice risk reduction strategies, such as failure modes and effects analysis (FMEA) and others.
• Reflect on and provide support and education for trainees in discussions on the importance of communication and documentation from the legal and risk management perspective.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in organizational risk management efforts and promote risk prevention by active participation in appropriate hospital committees.
• Collaborate with hospital administration and other colleagues to advocate for and modify systems and processes that help risk reduction.
• Lead, coordinate, or participate in healthcare information systems related initiatives that enhance the ease and accuracy of documentation and prescribing.
• Lead, coordinate, or participate in efforts to create a comprehensive risk reduction program encompassing education for hospital staff, medical staff, and trainees.

Introduction

Risk Management is a discipline commonly perceived to be the domain of institutional personnel and committees who are called upon to address adverse events that have already occurred. However, consequence management is far from the most effective utilization of such resources, as they are most efficiently and ethically deployed in preventive programs. Risk management therefore prospectively draws upon the disciplines of patient safety, performance improvement, systems management (including engineering and technology), ethics, and human factors in addition to medicine, in an effort to eliminate or ameliorate the undesirable consequences of delivering healthcare services. Hospitalized children are a highly vulnerable population due to social dependencies and developmental needs and have unique legal regulations that may impact care delivery. Pediatric hospitalists deliver care in this acute, high-risk healthcare environment and should be knowledgeable about legal and regulatory requirements, prevention strategies, and ways in which to collaborate with other professionals in management of hospitalized children.

Pediatric hospitalists should be able to:

• Summarize the role of common entities that accredit and license organizations, including The Joint Commission (TJC), the Centers for Medicare and Medicaid Services (CMS), and state health departments.
• Cite examples of how interfacility transfer of patients may be affected by the Emergency Medical Treatment and Active Labor Act (EMTALA).
• Summarize the basic regulatory and legal stipulations that may impact pediatric hospitalist contracting and practice, as noted in the anti-kickback regulations (Stark Rules) and anti-trust regulations (Sherman Act).
• Discuss the importance of fraud and abuse regulations for billing, coding, documentation, collections, utilization review, and managed care operations.
• Describe the common features of privacy regulations, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Review the role of physician licensing and oversight agencies such as the state Medical Board, National Practitioner Data Bank, and Drug Enforcement Agency.
• Define “medical liability,” “standard of practice,” and “negligence” and discuss the role of state malpractice statutes of limitation for children.
• Discuss the role of behavior and attitudes in generating patient and family/caregiver complaints.
• Describe the behavioral and physical characteristics of the impaired practitioner, including fatigue, substance abuse, and disruptive behavior.
• Summarize the role of the hospital medical staff in granting clinical privileges and initiating disciplinary actions through peer review process.
• List responsibilities associated with maintaining malpractice insurance, including documentation and disclosure requirements.
• Define the terms “assent” and “consent” and describe the circumstances in which informed assent or consent is needed.
• Give an example of legal issues that can arise in various clinical scenarios, such as end of life care, “no code” discussions (do-not-resuscitate or allow-natural-death), organ donation, guardianship, and newborn resuscitation.
• Describe the role of pediatric hospitalists in appropriate and timely notification to risk management or hospital counsel when medical errors or preventable events occur.
• Describe the role of pediatric hospitalists in recognizing and reporting family violence for the child, spouse, or elder.
• Provide examples of potential errors related to devices and technology, including Electronic Health Record (EHR) data entry, use, and documentation, privacy, device alert fatigue, and others.
• Review the relationship between human factors, design factors, risk management, patient safety, and quality improvement.

Pediatric hospitalists should be able to:

• Obtain informed assent and/or consent from patients and/or the family/caregivers.
• Disclose medical errors clearly, concisely, and completely to patients and the family/caregivers.
• Communicate in difficult situations and when delivering sensitive information, with compassion and a professional attitude.
• Support and communicate end-of-life decisions and planning.
• Transfer patient information concisely and precisely to other healthcare providers during all transitions of care.
• Prescribe treatments using safe medication prescribing practices.
• Document in the medical record with accuracy and appropriate detail.
• Identify when legal and risk management notification and/or expert consultation is indicated and initiate the escalation process.
• Demonstrate basic skills in utilizing risk reduction strategies, in partnership with local legal and risk management experts.

Pediatric hospitalists should be able to:

• Role model professional behavior.
• Recognize the importance of responding to complaints in a compassionate and sensitive manner.
• Reflect on the importance of collaborating with legal and risk management experts to learn and practice risk reduction strategies, such as failure modes and effects analysis (FMEA) and others.
• Reflect on and provide support and education for trainees in discussions on the importance of communication and documentation from the legal and risk management perspective.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in organizational risk management efforts and promote risk prevention by active participation in appropriate hospital committees.
• Collaborate with hospital administration and other colleagues to advocate for and modify systems and processes that help risk reduction.
• Lead, coordinate, or participate in healthcare information systems related initiatives that enhance the ease and accuracy of documentation and prescribing.
• Lead, coordinate, or participate in efforts to create a comprehensive risk reduction program encompassing education for hospital staff, medical staff, and trainees.