Publications by authors named "Justin M Lockwood"

8 Publications

  • Page 1 of 1

IVIG Compared to IVIG Plus Infliximab in Multisystem Inflammatory Syndrome in Children.

Pediatrics 2021 Sep 22. Epub 2021 Sep 22.

Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.

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http://dx.doi.org/10.1542/peds.2021-052702DOI Listing
September 2021

IVIG Compared to IVIG Plus Infliximab in Multisystem Inflammatory Syndrome in Children.

Pediatrics 2021 Sep 21. Epub 2021 Sep 21.

Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO;

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http://dx.doi.org/10.1542/peds.2021-052702DOI Listing
September 2021

Confidence-weighted Testing as an Impactful Education Intervention within a Pediatric Sepsis Quality Improvement Initiative.

Pediatr Qual Saf 2021 Sep-Oct;6(5):e460. Epub 2021 Aug 26.

Section of Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.

Introduction: Confidence-weighted testing assesses learners' beliefs about their knowledge and skills. As part of a hospital-wide quality improvement initiative to enhance care for pediatric patients with suspected sepsis, we developed a novel intervention using confidence-weighted testing to identify institutional areas of misinformation and knowledge gaps while also providing real-time feedback to individual learners.

Methods: We developed pediatric sepsis eLearning modules incorporating confidence-weighted testing. We distributed them to nurses, advanced practitioners, and physicians in emergency departments and acute care/non-intensive care unit inpatient settings in our hospital system. We analyzed completion and response data over 2 years following module distribution. Our outcomes included completion, (CHM; when a learner answers a question confidently but incorrectly), (when a learner repeatedly answers a question incorrectly or with low confidence), and (when a learner initially answers a question correctly and confidently).

Results: Eighty-three percent of assigned learners completed the modules (1,463/1,754). Although nurses had significantly more misinformation and struggled more than physicians and advanced practitioners, learners of all roles achieved 100% mastery as part of module completion. The greatest CHM and struggle were found in serum lactate interpretation's nuances and the hemodynamic shock states commonly seen in sepsis.

Conclusions: Our novel application of confidence-weighted testing enhanced learning by correcting learners' misinformation. It also identified systems issues and institutional knowledge gaps as targets for future improvement.
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http://dx.doi.org/10.1097/pq9.0000000000000460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8389944PMC
August 2021

An Acute Care Sepsis Response System Targeting Improved Antibiotic Administration.

Hosp Pediatr 2021 09;11(9):944-955

Emergency Medicine, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado.

Background And Objectives: Pediatric sepsis quality improvement in emergency departments has been well described and associated with improved survival. Acute care (non-ICU inpatient) units differ in important ways, and optimal approaches to improving sepsis processes and outcomes in this setting are not yet known. Our objective was to increase the proportion of acute care sepsis cases in our health system with initial antibiotic order-to-administration time ≤60 minutes by 20% from a baseline of 43% to 52% by December 2020.

Methods: Employing the Model for Improvement with broad stakeholder engagement, we developed and implemented interventions aimed at effective intervention for sepsis cases on acute care units. We analyzed process and outcome metrics over time using statistical process control charts. We used descriptive statistics to explore differences in antibiotic order-to-administration time and inform ongoing improvement.

Results: We cared for 187 patients with sepsis over the course of our initiative. The proportion within our goal antibiotic order-to-administration time rose from 43% to 64% with evidence of special cause variation after our interventions. Of all patients, 66% experienced ICU transfer and 4% died.

Conclusions: We successfully decreased antibiotic order-to-administration time. We also introduced a novel model for sepsis response systems that integrates interventions designed for the complexities of acute care settings. We demonstrated impactful local improvements in the acute care setting where quality improvement reports and success have previously been limited.
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http://dx.doi.org/10.1542/hpeds.2021-006011DOI Listing
September 2021

Characteristics of Pediatric Rapid Response Systems: Results From a Survey of PRIS Hospitals.

Hosp Pediatr 2021 02;11(2):144-152

School of Medicine, University of Colorado and Children's Hospital Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, Colorado.

Background: Many hospitals use rapid response systems (RRSs) to identify and intervene on hospitalized children at risk for deterioration.

Objectives: To describe RRS characteristics across hospitals in the Pediatric Research in Inpatient Settings (PRIS) network.

Methods: We developed the survey through a series of prospective respondent, expert, and cognitive interviews. One institutional expert per PRIS hospital ( = 109) was asked to complete the web survey. We summarized responses using descriptive statistics with a secondary analysis of univariate associations between RRS characteristics and perceived effectiveness.

Results: The response rate was 72% (79 of 109). Respondents represented diverse hospital types and were primarily physicians (97%) with leadership roles in care escalation. Many hospitals used an early warning score (77%) for identification with variable characteristics (46% automated versus 54% full or partially manual calculation; inputs included vital signs [98%], physical examination findings [88%], diagnoses [23%], medications [19%], and diagnostic tests [14%]). Few incorporated a validated prediction model (9%). Similarly, many RRSs used a rapid response team for intervention (93%) with variable team composition (respiratory therapists [94%], ICU nurses [93%], ICU providers [67%], and pharmacists [27%]). Some used the early warning score to trigger the rapid response team (50%). Only a few staffed a clinician to proactively surveil hospitalized children for risk of deterioration (18%), and these tended to be larger hospitals (annual admissions 12 000 vs 6000, = .007). Most responding experts stated their RRSs improved patient outcomes (92%).

Conclusions: RRS characteristics varied across PRIS hospitals.
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http://dx.doi.org/10.1542/hpeds.2020-002659DOI Listing
February 2021

Surviving Sepsis Screening: The Unintended Consequences of Continuous Surveillance.

Hosp Pediatr 2020 12 12;10(12):e14-e17. Epub 2020 Nov 12.

Division of Hospital Medicine, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado.

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http://dx.doi.org/10.1542/hpeds.2020-002121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7684552PMC
December 2020

AutoPEWS: Automating Pediatric Early Warning Score Calculation Improves Accuracy Without Sacrificing Predictive Ability.

Pediatr Qual Saf 2020 Mar-Apr;5(2):e274. Epub 2020 Mar 25.

University of Colorado School of Medicine, Department of Pediatrics, Section of Hospital Medicine, Aurora, Colo.

Introduction: Pediatric early warning scores (PEWS) identify hospitalized children at risk for deterioration. Manual calculation is prone to human error. Electronic health records (EHRs) enable automated calculation, removing human error. This study's objective was to compare the accuracy of automated EHR-based PEWS calculation (AutoPEWS) to manual calculation and evaluate the non-inferiority of AutoPEWS in predicting deterioration.

Methods: We performed a retrospective cohort study inclusive of non-intensive care unit inpatients at a freestanding children's hospital over 4.5 months in Fall 2018. AutoPEWS mapped the historical manual PEWS scoring rubric to frequently used EHR documentation. We determined accuracy by comparing the expected respiratory subset score based on the current respiratory rate to the actual respiratory score of AutoPEWS and the manual PEWS. The agreement was determined using kappa statistics. We used predicted probabilities from a generalized linear mixed model to calculate areas under the curve for each combination of scores (AutoPEWS, manual) and deterioration outcome (rapid response team activation, unplanned intensive care unit transfer, critical deterioration event). We compared the adjusted difference in areas under the curves between the scores. Non-inferiority was defined as a difference of <0.05.

Results: There were 23,514 total PEWS representative of 5,384 patients. AutoPEWS respiratory scores were 99.97% accurate, while the manual PEWS respiratory scores were 86% accurate. AutoPEWS were higher overall than the manual PEWS (mean 0.65 versus 0.34). They showed a fair-to-good agreement (weighted kappa 0.42). Non-inferiority of AutoPEWS compared with the manual PEWS was demonstrated for all deterioration outcomes.

Conclusions: Automation of PEWS calculation improved accuracy without sacrificing predictive ability.
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http://dx.doi.org/10.1097/pq9.0000000000000274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190249PMC
March 2020
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