Introduction: Children with sickle cell disease (SCD) are at increased risk for sepsis secondary to functional asplenia. Timely administration of antibiotics, within 60 minutes of triage, is a national indicator of quality SCD care in the United States. However, there are no reports demonstrating the feasibility of doing so in the outpatient hematology–oncology clinic setting. Local Problem: At baseline, in our pediatric hematology–oncology outpatient center, just 10% of children with SCD and fever received timely antibiotics. Methods: We implemented a process improvement initiative for children with SCD and fever with the aim of ≥90% receiving timely antibiotics. We enacted interventions focused on general clinic processes from check-in to antibiotics and population-specific interventions, including an intravenous access protocol, notification/communication among staff members, and design of an electronic order set. Results: The percentage of children receiving timely antibiotics improved from 10% to 77% with successful maintenance following the interventions. Residual delays are due to nonexpeditious order placement and difficult intravenous access. Conclusion: Improving the timely administration of antibiotics in the outpatient hematology–oncology clinic setting for children with SCD and fever is possible. Achieving at least 90% timely antibiotics for children with SCD and fever in the outpatient clinic setting will require ongoing efforts at expeditious order placement and intravenous access.

Restrictive visitation policies produce inequities in healthcare that have meaningful consequences for patients’ health and well-being. There is a surplus of existing literature exploring the consequences of reduced visitation in the setting of pediatric patients lacking decision-making capacity, but relatively little scholarship addressing visitation restriction for less vulnerable adults possessing capacity. Here, we present the case of a patient who suffered serious complications of childbirth, during the delivery of her healthy newborn, leading to prolonged hospitalization. During her treatment course, she was subsequently denied visitation with her newborn, who had been discharged from the hospital, and this had detrimental effects on her recovery. Hospital policies restricting visitation during the COVID-19 pandemic were intended to reduce the risk of disease exposure for both patients and staff, despite conflicting evidence demonstrating this benefit. In contrast, they often have negative effects on patient stress, mood, and physical recovery. The sequelae of this US-based case study argue the need for more holistic hospital visitation policies, placing a specific lens on adult patients receiving a visitation from their newborn children.

Introduction: Many children and adolescents who were vaccinated prior to cancer treatment lose humoral immunity after completion of therapy. Pediatricians and pediatric oncologists often recommend re-immunization, although there is little consensus on timing and approach to serologic testing. However, vaccine hesitancy in the U.S. is a growing problem. It is not known whether parents who initially permitted vaccination might demonstrate secondary hesitancy regarding re-immunization. Methods: We conducted a qualitative study to explore parental attitudes toward re-immunization after completion of cancer therapy. Twenty primary caregivers of current pediatric cancer patients participated in structured interviews exploring knowledge and understanding of immunity and vaccination; previous experiences with vaccines; and attitudes toward vaccines and revaccination. Results: Of those interviewed, 80% were female and 90% were White Non-Hispanic. Of interviewees’ children with cancer, 60% were male, 75% had been diagnosed within the past 6 months, and 45% had leukemia or lymphoma. All caregivers demonstrated a basic understanding of vaccination, but only 65% understood that it was possible to lose immunity even with previous vaccination. All caregivers were willing to have their children immunized if tests showed lack of humoral immunity, with 85% expressing a preference for testing prior to revaccination. Conclusions: Primary caregivers of children with cancer are willing to consider re-immunization interest but do express some secondary hesitancy and strongly prefer that the need for re-immunization be established via serologic testing, rather than performed empirically. Caregivers’ beliefs and preferences regarding re-immunization in pediatric oncology should be considered in the development of post-treatment guidelines.