An HSV infection was uncommon in young infants evaluated for CNS infection, particularly in the second month of life. Evidence-based approaches to the evaluation for HSV in young infants are needed.

Objectives: Utilization of emergency departments (EDs) for pediatric mental health (MH) complaints is increasing. These patients require more resources and have higher admission rates than those with nonpsychiatric complaints.Methods: A multistage, multidisciplinary process to reduce length of stay (LOS) and improve the quality of care for patients with psychiatric complaints was performed at a tertiary care children's hospital's ED using Lean methodology. This process resulted in the implementation of a dedicated MH team, led by either a social worker or a psychiatric nurse, to evaluate patients, facilitate admissions, and arrange discharge planning. We conducted a retrospective, before-and-after study analyzing data 1 year before through 1 year after new process implementation (March 28, 2011). Our primary outcome was mean ED LOS.Results: After process implementation there was a statistically significant decrease in mean ED LOS (332 minutes vs. 244 minutes, p < 0.001). An x-bar chart of mean LOS shows special cause variation. Significant decreases were seen in median ED LOS (225 minutes vs. 204 minutes, p = 0.001), security physical interventions (2.0% vs. 0.4%, p = 0.004), and restraint use (1.7% vs. 0.1%, p < 0.001). No significant change was observed in admission rate, 72-hour return rate, or patient elopement/agitation events. Staff surveys showed improved perception of patient satisfaction, process efficacy, and patient safety.Conclusions: Use of quality improvement methodology led to a redesign that was associated with a significant reduction in mean LOS of patients with psychiatric complaints and improved ED staff perception of care.ACADEMIC EMERGENCY MEDICINE 2016;23:440-447 © 2016 by the Society for Academic Emergency Medicine M ental health (MH) disorders are common in children, with an estimated 13%-20% of children in the United States experiencing a mental disorder in a given year.1-5 They also are increasing, with a reported 24% increase in inpatient MH and substance abuse admissions among children from 2007 to 2010 6 and an 80% increase in hospital stays for children with mood disorders from 1997 to 2010. 7 Despite this increasing prevalence, psychiatric services for children in many parts of the country are limited, 8 leaving many with unmet psychiatric care needs. 9Nationally, pediatric emergency department (ED) visits for MH issues increased by over 20% between 2001 and 2010. 10 Pediatric EDs (PEDs) have also seen high volumes of patients presenting with psychiatric crises, with 3.3% of PED visits related to MH issues in one

We demonstrate that a Maintenance of Certification QI project sponsored by a children's hospital can facilitate evidence-based pediatric care and decrease the rate of unnecessary CT use in a community setting.

A B S T R A C TOBJECTIVES: Among patients with food-related anaphylaxis, to describe trends in emergency and hospital care and determine the revisit rate.METHODS: This retrospective cohort study included children 6 months to 18 years of age with food-related anaphylaxis from 37 children's hospitals between 2007 and 2012. Summary statistics and trends for patient characteristics were evaluated. Multivariable regression was used to identify predictors for hospital admission. Revisit rates to either the emergency department (ED) and/or inpatient unit were calculated.RESULTS: 7303 patients were evaluated in the ED; 3652 (50%) were admitted to the hospital.Hospital admission rates varied widely (range, 20%-98% .0-9.0]) were more likely to be admitted to the hospital. The 3-day revisit rate was 3% for patients discharged from the ED and 0.6% for those admitted on the index visit. CONCLUSIONS:The incidence of food-related anaphylaxis in pediatric EDs is increasing, but rates of hospital admission are stable. Hospital admission is common but widely variable. Further research is needed to identify optimal management practices for this potentially life-threatening problem.