BACKGROUND: National health care policy recommends that patients and families be actively involved in discharge planning. Although children with medical complexity (CMC) account for more than half of pediatric readmissions, scalable, family-centered methods to effectively engage families of CMC in discharge planning are lacking. We aimed to systematically examine the scope of preferences, priorities, and goals of parents of CMC regarding planning for hospital-to-home transitions and to ascertain health care providers' perceptions of families' transitional care goals and needs.

Background Direct admissions account for 25% of pediatric unscheduled hospitalizations. Despite this, our knowledge of direct admission practices and safety is limited. This study aimed to characterize direct admission practices, benefits and challenges at a diverse sample of hospitals, and to identify diagnoses most appropriate for this admission approach. Methods We conducted a national survey at a stratified random sample of 177 US hospitals, employing both closed- and open-ended questions. Descriptive statistics were calculated to summarize numeric responses while qualitative content analysis was performed to identify emergent themes. Results Reponses were received from 108 hospitals (61%). Hospitals represented all geographic regions and employed varied emergency medicine and inpatient care models. 103 (95%) respondents reported that their hospitals accepted direct admissions and 45 (50%) expressed the view that more children should be admitted directly. Perceived benefits included: (i) improved efficiency; (ii) patient and physician satisfaction; (iii) earlier access to pediatric-specific care; (iv) continuity of care; and (v) reduced risk of nosocomial infection. Risks and challenges included: (i) difficulties determining admission appropriateness; (ii) inconsistent processes; (iii) provision of timely care; and (iv) patient safety. Populations and diagnoses reported as most appropriate and inappropriate for direct admission varied considerably across respondents. Conclusions While respondents described benefits of direct admission for both patients and healthcare systems, many also reported challenges and safety concerns. Our results may inform subsequent epidemiologic and patient-centered outcomes research to evaluate the safety and effectiveness of direct admissions.

Families received preadmission care in several settings and described varying degrees of care coordination during their admission processes. This research can guide improvements in hospitals' admission systems, necessary to achieve health system integration and continuity of care.

Objectives To characterize determinants of career satisfaction among pediatric hospitalists working in diverse practice settings, and to develop a framework to conceptualize factors influencing career satisfaction. Methods Semi-structured interviews were conducted with community and tertiary care hospitalists, using purposeful sampling to attain maximum response diversity. We employed close- and open-ended questions to assess levels of career satisfaction and its determinants. Interviews were conducted by telephone, recorded, and transcribed verbatim. Emergent themes were identified and analyzed using an inductive approach to qualitative analysis. Results A total of 30 interviews were conducted with community and tertiary care hospitalists, representing 20 hospital medicine programs and 7 Northeastern states. Qualitative analysis yielded 657 excerpts which were coded and categorized into four domains and associated determinants of career satisfaction: (i) professional responsibilities; (ii) hospital medicine program administration; (iii) hospital and healthcare systems; and (iv) career development. While community and tertiary care hospitalists reported similar levels of career satisfaction, they expressed variation in perspectives across these four domains. While the role of hospital medicine program administration was consistently emphasized by all hospitalists, community hospitalists prioritized resource availability, work schedule and clinical responsibilities while tertiary care hospitalists prioritized diversity in non-clinical responsibilities and career development. Conclusions We illustrate how hospitalists in different organizational settings prioritize both consistent and unique determinants of career satisfaction. Given associations between physician satisfaction and healthcare quality, efforts to optimize modifiable factors within this framework, at both community and tertiary care hospitals, may have broad impacts.