Teaching High-Value Care: Case Vignettes for Pediatric Practice

Complex Care Module

This case-based activity introduces learners to the principles of high-value care in children with medical complexity, focusing on diagnostic stewardship and avoidance of unnecessary interventions. Participants evaluate common inpatient and outpatient clinical scenarios to determine when laboratory testing, imaging, or subspecialty consultation is warranted. Emphasis is placed on care coordination, patient safety, and minimizing harm associated with overtesting in medically fragile pediatric populations.

BRUE (Brief Resolved Unexplained Event) Module

This module guides learners through the risk stratification and evidence-based management of infants presenting with a brief resolved unexplained event. Using progressive clinical cases, participants apply American Academy of Pediatrics (AAP) guidelines to determine appropriate observation, testing, and disposition. The activity highlights the importance of avoiding low-yield diagnostic evaluations in low-risk infants while ensuring safe clinical decision-making.

Hyperbilirubinemia Module

Learners review the evaluation and treatment of neonatal hyperbilirubinemia through application of updated clinical practice guidelines. The activity focuses on appropriate use of bilirubin screening, phototherapy thresholds, and follow-up recommendations to reduce the risk of kernicterus while minimizing unnecessary hospitalizations. Participants also examine how evidence-based treatment thresholds support safe and cost-conscious care.

Skin and Soft Tissue Infections (SSTIs) Module

This module presents clinical scenarios involving pediatric skin and soft tissue infections to promote appropriate antibiotic selection and diagnostic testing. Learners differentiate between purulent and nonpurulent infections and apply current treatment guidelines to determine when incision and drainage alone is sufficient. Discussion centers on reducing unnecessary antimicrobial use and limiting diagnostic testing that does not change management.

Blood Culture Utilization Module

Participants examine the appropriate role of blood cultures in the evaluation of febrile children through case-based discussion. The activity emphasizes recognition of patients at low risk for bacteremia in whom blood cultures are unlikely to yield clinically meaningful results. Learners consider how false-positive results may contribute to unnecessary antibiotic exposure, prolonged hospitalization, and increased healthcare costs.

Community-Acquired Pneumonia (CAP) Module

This activity introduces learners to the evidence-based diagnosis and management of pediatric community-acquired pneumonia. Participants apply national guidelines to determine when imaging, viral testing, or antibiotic therapy is indicated. The module underscores the importance of distinguishing viral from bacterial etiologies to reduce unnecessary testing and antibiotic use.

Target Learners

• Pediatric residents

• Medical students (clinical years)

• Pediatric emergency medicine fellows

• Family medicine residents

• Advanced practice providers (NPs/PAs) working in pediatric or urgent care settings

Equipment Needed

• Facilitator guides

• Learner worksheets

• Writing utensils

• Whiteboard or flip chart (optional for group discussion)

• Projector or screen (optional for case review)

• Calculator (optional for evidence-based medicine exercises such as NNT/NNH)