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OBJECTIVES: To increase the number of essential consult elements (ECEs) included in initial inpatient consultation requests between pediatric residents and fellows through implementation of a novel consult communication tool. METHODS: Literature review and previous needs assessment of pediatric residents and fellows were used to identify 4 specific ECEs. From February to June 2018, fellows audited verbal consult requests at a medium-sized, quaternary care children’s hospital to determine the baseline percentage of ECE components within consults. A novel consult communication tool containing all ECEs was then developed by using a modified situation-background-assessment-recommendation (SBAR) format. The SBAR tool was implemented over 3 plan-do-study-act cycles. Adherence to SBAR, inclusion of ECEs, and consult question clarity were tracked via audits of consult requests. A pre- and postintervention survey of residents and fellows was used to examine perceived miscommunication and patient care errors and overall satisfaction. RESULTS: The median percentage of consults containing ≥3 ECEs increased from 50% preintervention to 100% postintervention with consult question clarity increasing from 52% to 92% (P < .001). Overall perception of consult miscommunication frequency decreased (52% vs 18%; P < .01), although there was no significant change in resident- or fellow-reported patient errors. SBAR maintained residents’ already high consult satisfaction (96% vs 92%; P = .39) and increased fellows’ consult satisfaction (51% vs 91%; P < .001). CONCLUSIONS: Implementation of a standardized consult communication tool resulted in increased inclusion of ECEs. Use of the tool led to greater consult question clarity, decreased perceived miscommunication, and improved overall consult satisfaction.

The majority of US youth perceive e-cigarettes as less harmful and addictive than cigarettes. Perceived safety parallels the rise in the use of e-cigarettes. REVIEWER COMMENTS. There are a number of original research articles in Pediatrics this year dealing with the meteoric rise in the use of e-cigarettes by children. The authors of this study are limited in their conclusions by the study's cross-sectional nature, reliance on self-reported data, and the lack of individual-level investigation of alterations in the perception and use of e-cigarettes over time. Nonetheless, the conclusion still stands that children in grades 6 to 12 perceive e-cigarettes as safer than their counterpart tobacco products, which is likely contributing to the rapid rise in e-cigarette use. Additional contributors include the low cost of these products and the ability to use them anywhere, as is demonstrated in another study (Bold KW et al. Pediatrics. 2016;138[3]:e20160895); these factors may also influence use in adolescents who would not have used tobacco products otherwise (Barrington-Trimis JL et al. Pediatrics. 2016;138[2]:e20153983).

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