The role of pediatric hospitalists in coordinating the care provided to children with medical complexity.

Over the past 30 years, the profile of patients requiring admission to children’s hospitals has changed. Such change is the result of multiple factors, the most important of which include the advances accomplished in diagnostic methods, the development of new drugs and vaccines, minimally invasive surgeries, solid organ or hematopoietic stem cell transplantation, the survival rate of children with chronic diseases and technology-dependent, and evidence-based therapeutic decisions. The frequency of acute infections, including bacterial pneumonia, arthritis, osteomyelitis, meningit is , exanthematous disease , has decreased, or if a child with an acute infection is hospitalized, the length of stay is shorter and the child usually completes treatment with oral antibiotics as an outpatient. Viral respiratory tract infections are still prevalent among young children, but their hospitalization is reserved for those with hypoxemia and/or risk factors. A reduced oxygen saturation level accepted for oxygen therapy withdrawal and the generalized use of pulse oximeters have allowed to shorten hospitalization duration and reduce the risk for hospital-acquired infections. With the enhancement of pre-surgical assessments, anesthesia selection, minimally invasive surgery, and an adequate pain management, most children may be hospitalized and discharged the same day of surgery or stay at the hospital for brief periods even after having undergone a major surgical procedure, which used to require several days in the hospital (e.g., closure of an atrial septal defect, splenectomy, cholecystectomy, nephrectomy, anti-reflux surgery, neuroendoscopic surgery for hydrocephalus, etc.). Similarly, interventional hemodynamics allows patients to be discharged within 24 hours after having undergone closure of a patent ductus arteriosus or a ventricular septal defect, radiofrequency ablation for arrhythmias, or the treatment of aneurysms or other arteriovenous malformations. It is not medically acceptable for a stable child with no social risks or life-threatening conditions The role of pediatric hospitalists in coordinating the care provided to children with medical complexity