RT Book, Section
A1 Hall, David E.
A1 Glader, Laurie
A1 Mauskar, Sangeeta
A2 Zaoutis, Lisa B.
A2 Chiang, Vincent W.
SR Print(0)
ID 1146124566
T1 Acute Care of the Child with Medical Complexity
T2 Comprehensive Pediatric Hospital Medicine, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071829281
LK accesspediatrics.mhmedical.com/content.aspx?aid=1146124566
RD 2024/04/16
AB Children  with  medical  complexity  are  growing  in  number  in  children’s  hospitals.  They  are  at  the  highest  risk  for  medical  errors1,2  and  for  readmission  after  discharge.3  A  definition  of  the  patient  with  medical  complexity  remains  elusive,  but  these  children  are  characterized  by  chronic,  severe  health  conditions,  substantial  health  service  needs,  functional  limitations  that  are  often  severe,  and  high  health  resource  utilization.4  Often  these  patients  have  abnormalities  involving  multiple  organ  systems  and  are  dependent  on  medical  technology  such  as  gastrostomy  tubes,  tracheostomies,  ventilators,  and  ventriculoperitoneal  (VP)  shunts.  Many  inpatients  with  well-defined  chronic  disease  are  cared  for  primarily  by  subspecialists  without  input  from  a  general  pediatric  hospital  provider.  Typical  patients  in  this  group  include  those  with  cystic  fibrosis,  sickle  cell  disease,  inflammatory  bowel  disease,  or  malignancy.  Their  care  is  better  discussed  elsewhere.  However,  many  patients  with  complex  chronic  disease  do  not  fit  neatly  into  a  subspecialty,  and  hospital-based  pediatricians  are  often  asked  to  care  for  them.  Of  this  latter  group,  severe  neurologic  impairment  is  a  frequent  common  denominator.5  This  chapter  focuses  on  the  acute  care  of  this  type  of  child.  The  comorbidities  of  this  population  are  the  focus  of  Chapter  181.