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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Policy Statement. Ann Emerg Med 2024; 84:e13-e23. [PMID: 39032991 DOI: 10.1016/j.annemergmed.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 07/23/2024]
Abstract
Advanced imaging, including ultrasonography, computed tomography, and magnetic resonance imaging (MRI), is an integral component to the evaluation and management of ill and injured children in the emergency department. As with any test or intervention, the benefits and potential impacts on management must be weighed against the risks to ensure that high-value care is being delivered. There are important considerations specific to the pediatric patient related to the ordering and interpretation of advanced imaging. This policy statement provides guidelines for institutions and those who care for children to optimize the use of advanced imaging in the emergency department setting and was coauthored by experts in pediatric and general emergency medicine, pediatric radiology, and pediatric surgery. The intent is to guide decision-making where children may access care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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Goparaju N, Pines JM. How can we improve low-volume paediatric emergency departments to enhance readiness? Evid Based Nurs 2024:ebnurs-2024-104046. [PMID: 39009422 DOI: 10.1136/ebnurs-2024-104046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Affiliation(s)
- Niharika Goparaju
- The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Jesse M Pines
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Policy Statement. J Am Coll Radiol 2024; 21:1108-1118. [PMID: 38944444 DOI: 10.1016/j.jacr.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Advanced imaging, including ultrasonography, computed tomography, and magnetic resonance imaging (MRI), is an integral component to the evaluation and management of ill and injured children in the emergency department. As with any test or intervention, the benefits and potential impacts on management must be weighed against the risks to ensure that high-value care is being delivered. There are important considerations specific to the pediatric patient related to the ordering and interpretation of advanced imaging. This policy statement provides guidelines for institutions and those who care for children to optimize the use of advanced imaging in the emergency department setting and was coauthored by experts in pediatric and general emergency medicine, pediatric radiology, and pediatric surgery. The intent is to guide decision-making where children may access care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Policy Statement. Pediatrics 2024; 154:e2024066854. [PMID: 38932710 DOI: 10.1542/peds.2024-066854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 06/28/2024] Open
Abstract
Advanced imaging, including ultrasonography, computed tomography, and magnetic resonance imaging, is an integral component to the evaluation and management of ill and injured children in the emergency department. As with any test or intervention, the benefits and potential impacts on management must be weighed against the risks to ensure that high-value care is being delivered. There are important considerations specific to the pediatric patient related to the ordering and interpretation of advanced imaging. This policy statement provides guidelines for institutions and those who care for children to optimize the use of advanced imaging in the emergency department setting and was coauthored by experts in pediatric and general emergency medicine, pediatric radiology, and pediatric surgery. The intent is to guide decision-making where children may access care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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Simpson JN, Wright JL. Pandemic Planning, Response, and Recovery for Pediatricians: A Focus on Health Equity and Social Determinants of Health. Pediatr Clin North Am 2024; 71:515-528. [PMID: 38754939 DOI: 10.1016/j.pcl.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
This article summarizes how pediatricians may be uniquely positioned to mitigate the long-term trajectory of COVID-19 on the health and wellness of pediatric patients especially with regard to screening for social determinants of health that are recognized drivers of disparate health outcomes. Health inequities, that is, disproportionately deleterious health outcomes that affect marginalized populations, have been a major source of vulnerability in past public health emergencies and natural disasters. Recommendations are provided for pediatricians to collaborate with disaster planning networks and lead strategies for public health communication and community engagement in pediatric pandemic and disaster planning, response, and recovery efforts.
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Affiliation(s)
- Joelle N Simpson
- Department of Pediatrics and Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA; Emergency Medicine & Trauma Center, Children's National Hospital, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA.
| | - Joseph L Wright
- Department of Pediatrics and Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA; Department of Health Policy and Management, George Washington University School of Public Health, Washington DC 20052
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Baker AH, Lee LK, Sard BE, Chung S. The 4 S's of Disaster Management Framework: A Case Study of the 2022 Pediatric Tripledemic Response in a Community Hospital. Ann Emerg Med 2024; 83:568-575. [PMID: 38363279 DOI: 10.1016/j.annemergmed.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/28/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
Most children in the United States present to community hospitals for emergency department (ED) care. Those who are acutely ill and require critical care are stabilized and transferred to a tertiary pediatric hospital with intensive care capabilities. During the fall of 2022 "tripledemic," with a marked increase in viral burden, there was a nationwide surge in pediatric ED patient volume. This caused ED crowding and decreased availability of pediatric hospital intensive care beds across the United States. As a result, there was an inability to transfer patients who were critically ill out, and the need for prolonged management increased at the community hospital level. We describe the experience of a Massachusetts community ED during this surge, including the large influx in pediatric patients, the increase in those requiring critical care, and the total number of critical care hours as compared with the same time period (September to December) in 2021. To combat these challenges, the pediatric ED leadership applied a disaster management framework based on the 4 S's of space, staff, stuff, and structure. We worked collaboratively with general emergency medicine leadership, nursing, respiratory therapy, pharmacy, local clinicians, our regional health care coalition, and emergency medical services (EMS) to create and implement the pediatric surge strategy. Here, we present the disaster framework strategy, the interventions employed, and the barriers and facilitators for implementation in our community hospital setting, which could be applied to other community hospital facing similar challenges.
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Affiliation(s)
- Alexandra H Baker
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA; Department of Pediatrics, St. Luke's Hospital, New Bedford, MA.
| | - Lois K Lee
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA
| | - Brian E Sard
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA; Department of Pediatrics, St. Luke's Hospital, New Bedford, MA
| | - Sarita Chung
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA
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Sacchetti A, Hicken E, Bukata WR, Durso D. Emergency Department Arrival Modes: Time for Mandatory Pediatric Readiness. Pediatr Emerg Care 2024; 40:289-291. [PMID: 37548956 DOI: 10.1097/pec.0000000000003027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Because small children can be transported by private vehicles, many children seek emergency care outside of Emergency Medical Services (EMS). Such transports may access the closest emergency departments (EDs) without knowledge of their pediatric competence. This study quantifies this practice and the concept of mandatory pediatric readiness. METHODS The electronic health records of 3 general EDs and 2 pediatric EDs were queried for all pediatric and young adult visits for the year 2022. Data collected included patient age, ED type, arrival mode (EMS/police or private mode), and disposition (admission/transfer or discharge). Study patients were categorized as "small children" if aged younger than 10 years, "large children" if 10 to 18 years, and "young adult" if 19 to 40 years. Associations between mode of arrival, ED type, and disposition were analyzed through χ 2 and analysis of variance. RESULTS The study population included 37,866 small children, 19,108 large children, and 68,293 young adults. When compared with EMS/police transports, a private arrival mode was selected by 96.1% of small children, 90.0% of large children, and 85.4% of young adults ( P < 0.0001). For the admission/transfer patients, private transportation was selected by 87.4% of small children, 73.8% of large children, and 78.8% of young adults ( P < 0.0001). For admitted/transferred children, the private mode was used by 80.4% of those in the general ED and 81.9% in the pediatric ED ( P > 0.41). CONCLUSIONS Pediatric patients seeking ED care overwhelmingly arrive through a private mode regardless of the severity of their problem or type of ED in which treated. Emergency Medical Services programs and state hospital regulatory agencies need to recognize this practice and assure the pediatric competence of every ED within their system.
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Affiliation(s)
- Alfred Sacchetti
- From the Department of Emergency Medicine, Virtua Our Lady of Lourdes Hospital, Camden, NJ
| | - Eric Hicken
- New Jersey Office of Emergency Medical Services, Trenton, NJ
| | - W Richard Bukata
- Department of Emergency Medicine, Keck School of Medicine, USC Medical Center, Los Angeles, CA
| | - Dana Durso
- Department of Information Services, Virtua Health System, Marlton, NJ
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Boggs KM, Voligny E, Auerbach M, Espinola JA, Samuels-Kalow ME, Sullivan AF, Camargo CA. A Comparison of State-Specific Pediatric Emergency Medical Facility Recognition Programs, 2020. Pediatr Emerg Care 2024; 40:141-146. [PMID: 38295194 PMCID: PMC10832299 DOI: 10.1097/pec.0000000000003119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Prior research suggests that the presence of state-specific pediatric emergency medical facility recognition programs (PFRPs) is associated with high emergency department (ED) pediatric readiness. The PFRPs aim to improve the quality of pediatric emergency care, but individual state programs differ. We aimed to describe the variation in PFRP characteristics and verification requirements and to describe the availability of pediatric emergency care coordinators (PECCs) in states with PFRPs. METHODS In mid-2020, we collected information about each PFRP from 3 sources: the state Emergency Medical Services for Children (EMSC) website, the EMSC Innovation and Improvement Center website, or via communication with the state's EMSC program manager. For each state with a PFRP, we documented program characteristics, including program start date, number of tiers, whether participation was required/optional, and requirements for verification. RESULTS Overall, we identified 17 states with active PFRPs. Five states had only 1 tier or level of recognition whereas the others had multiple. All programs did require presence of a PECC for verification. However, some PRFPs with multiple verification tiers did not require presence of a PECC to achieve each level of verification. In states with PFRPs, EDs with higher total visit volumes, a separate pediatric ED area, located in the Northeast, and earlier program start date were all more likely to have a PECC. CONCLUSIONS There is variation in state PFRPs, although all prioritize the presence of a PECC. We encourage further research on the effect of different aspects of PFRPs on patient outcomes.
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Affiliation(s)
- Krislyn M. Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Emma Voligny
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Marc Auerbach
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | | | | | - Ashley F. Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
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Iyer MS, Nagler J, Mink RB, Gonzalez Del Rey J. Child Health Needs and the Pediatric Emergency Medicine Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678I. [PMID: 38300011 DOI: 10.1542/peds.2023-063678i] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Approximately 30 million ill and injured children annually visit emergency departments (EDs) in the United States. Data suggest that patients seen in pediatric EDs by board-certified pediatric emergency medicine (PEM) physicians receive higher-quality care than those cared for by non-PEM physicians. These benefits, coupled with the continued growth in PEM since its inception in the early 1990s, have impacted child health broadly. This article is part of a Pediatrics supplement focused on predicting the future pediatric subspecialty workforce supply by drawing on the American Board of Pediatrics workforce data and a microsimulation model of the future pediatric subspecialty workforce. The article discusses the utilization of acute care services in EDs, reviews the current state of the PEM subspecialty workforce, and presents projected numbers of PEM subspecialists at the national, census region, and census division on the basis of this pediatric subspecialty workforce supply model through 2040. Implications of this model on education and training, clinical practice, policy, and future workforce research are discussed. Findings suggest that, if the current growth in the field of PEM continues on the basis of the increasing number and size of fellowship programs, even with a potential reduction in percentage of clinical time and attrition of senior physicians, the PEM workforce is anticipated to increase nationally. However, the maldistribution of PEM physicians is likely to be perpetuated with the highest concentration in New England and Mid-Atlantic regions and "PEM deserts" in less populated areas.
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Affiliation(s)
- Maya S Iyer
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Nationwide Children's Hospital, Columbus, Ohio
| | - Joshua Nagler
- Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts
| | - Richard B Mink
- The Lundquist Institute for Biomedical Innovation at Harbor, University of California Los Angeles Medical Center, Torrance, California
| | - Javier Gonzalez Del Rey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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10
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Flatley M, Sams VG, Biscotti M, Deshpande SJ, Usman AA, Cannon JW. ECMO in trauma care: What you need to know. J Trauma Acute Care Surg 2024; 96:186-194. [PMID: 37843631 DOI: 10.1097/ta.0000000000004152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
ABSTRACT Over the past 10 years, extracorporeal membrane oxygenation (ECMO) use in trauma patients has increased significantly. This includes adult and pediatric trauma patients and even combat casualties. Most ECMO applications are in a venovenous (VV ECMO) configuration for acute hypoxemic respiratory failure or anatomic injuries that require pneumonectomy or extreme lung rest in a patient with insufficient respiratory reserve. In this narrative review, we summarize the most common indications for VV ECMO and other forms of ECMO support used in critically injured patients, underscore the importance of early ECMO consultation or regional referral, review the technical aspects of ECMO cannulation and management, and examine the expected outcomes for these patients. In addition, we evaluate the data where it exists to try to debunk some common myths surrounding ECMO management.
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Affiliation(s)
- Meaghan Flatley
- From the Department of Surgery (M.F.), Brooke Army Medical Center, Fort Sam Houston, Texas; Division of Trauma and Surgical Critical Care, Department of Surgery (V.G.S.), The University of Cincinnati Medical Center, Cincinnati, Ohio; Department of Surgery (M.B.III), Columbia University Medical Center, New York, New York; Department of Anesthesiology and Critical Care Medicine (S.J.D.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Anesthesiology and Critical Care (A.A.U.), Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery (J.W.C.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics (J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Surgery (J.W.C.), F. Edward Hébert School of Medicine at the Uniformed Services University, Bethesda, Maryland
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Nocera Kelley M, Lynders W, Pelletier E, Petrucelli M, Emerson B, Tiyyagura GK, Goldman MP. Increasing the use of anxiolysis and analgesia for paediatric procedures in a community emergency department network: a quality improvement initiative. Emerg Med J 2024; 41:116-122. [PMID: 38050053 DOI: 10.1136/emermed-2023-213232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/09/2023] [Indexed: 12/06/2023]
Abstract
Prior reports describe the care children receive in community EDs (CEDs) compared with paediatric EDs (PEDs) as uneven. The Emergency Medical Services for Children (EMSC) initiative works to close these gaps using quality improvement (QI) methodology. Project champion from a community hospital network identified the use of safe pharmacological and non-pharmacological anxiolysis and analgesia (A&A) as one such gap and partnered with EMSC to address it. Our primary Specific, Measurable, Achievable, Relevant and Time-Bound (SMART) aim was to increase intranasal midazolam (INM) use for common, anxiety-provoking procedures on children <8 years of age from 2% to 25% in a year.EMSC facilitated a QI team with representation from the CED and regional children's hospitals. Following the model for improvement, we initiated a process analysis of this CED A&A practice. Review of all paediatric procedural data identified common anxiety-provoking simple procedures as laceration repairs, abscess drainage and foreign body removal. Our SMART aims were benchmarked to two regional PEDs and tracked through statistical process control. A balancing metric was ED length of stay (ED LOS) for patients <8 years of age requiring a laceration repair. Additionally, we surveyed CED frontline staff and report perceptions of changes in A&A knowledge, attitudes and practice patterns. These data prioritised and informed our key driver diagram which guided the Plan-Do-Study-Act (PDSA) cycles, including guideline development, staff training and cognitive aids.Anxiety-provoking simple procedures occurred on average 10 times per month in children <8 years of age. Through PDSA cycles, the monthly average INM use increased from 2% to 42%. ED LOS was unchanged, and the perceptions of provider's A&A knowledge, attitudes and practice patterns improved.A CED-initiated QI project increased paediatric A&A use in a CED network. An A&A toolkit outlines our approach and may simplify spread from academic children's hospitals to the community.
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Affiliation(s)
- Mariann Nocera Kelley
- Division of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine/Traumatology, University of Connecticut School of Medicine, Connecticut Children's Hospital, Hartford, Connecticut, USA
- Emergency Medical Services for Children, Connecticut, New Haven, Connecticut, USA
| | - Willliam Lynders
- Emergency Medical Services for Children, Connecticut, New Haven, Connecticut, USA
- Emergency Medicine, Middlesex Health, Middletown, Connecticut, USA
| | - Emily Pelletier
- Emergency Medicine, Middlesex Health, Middletown, Connecticut, USA
| | - Megan Petrucelli
- Emergency Medical Services for Children, Connecticut, New Haven, Connecticut, USA
- Emergency Medicine, Middlesex Health, Middletown, Connecticut, USA
| | - Beth Emerson
- Department of Pediatrics and the Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gunjan K Tiyyagura
- Department of Pediatrics and the Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Paul Goldman
- Emergency Medical Services for Children, Connecticut, New Haven, Connecticut, USA
- Department of Pediatrics and the Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Schoppel K, Spector J, Okafor I, Church R, Deblois K, Della‐Giustina D, Kellogg A, MacVane C, Pirotte M, Snow D, Hays G, Mariorenzi A, Connelly H, Sheng A. Gaps in pediatric emergency medicine education of emergency medicine residents: A needs assessment of recent graduates. AEM EDUCATION AND TRAINING 2023; 7:e10918. [PMID: 38037628 PMCID: PMC10685395 DOI: 10.1002/aet2.10918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 12/02/2023]
Abstract
Background More than 90% of pediatric patients presenting to emergency departments (EDs) in the United States are evaluated and treated in community-based EDs. Recent evidence suggests that mortality outcomes may be worse for critically ill pediatric patients treated at community EDs. The disparate mortality outcomes may be due to inconsistency in pediatric-specific education provided to emergency medicine (EM) trainees during residency training. There are few studies surveying recently graduated EM physicians assessing perceived gaps in the pediatric emergency medicine (PEM) education they received during residency. Methods This was a prospective, survey-based, descriptive cohort study of EM residency graduates from 10 institutions across the United States who were <5 years out from residency training. Deidentified surveys were distributed via email. Results A total of 222 responses were obtained from 570 eligible participants (39.1%). Non-ED pediatric rotations during residency training included pediatric intensive care (60%), pediatric anesthesia (32.4%), neonatal intensive care unit (26.1%), and pediatric wards (17.1%). A large percentage (42.8%) of respondents felt uncomfortable managing neonates and performing tube thoracostomy on pediatric patients (56.3%). The EM graduate's satisfaction with pediatric simulation-based training during residency was positively associated with comfort caring for neonates and infants (p < 0.0070 and p < 0.0002) and performing endotracheal intubation (p < 0.0027), lumbar puncture (p < 0.0004), and Pediatric Advanced Life Support resuscitation (p < 0.0001). Conclusions/discussion This survey-based cohort study found considerable variation in pediatric-specific experiences during EM residency training and in perceived comfort managing pediatric patients. In general, participants were more comfortable managing older children. This study suggests that the greatest perceived knowledge gaps in PEM were neonatal medicine/resuscitation and pediatric cardiac arrest. Future research will continue to address larger cohorts, representative of the PEM education provided to EM physicians in the United States to promote future educational initiatives.
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Affiliation(s)
- Kyle Schoppel
- Indiana University School of Medicine, Riley Hospital for ChildrenIndianapolisIndianaUSA
| | - Jordan Spector
- Boston University Chobanian & Avedisian School of MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Ijeoma Okafor
- Boston University Chobanian & Avedisian School of MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Richard Church
- University of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | | | | | | | - Casey MacVane
- Maine Medical CenterTufts University School of MedicinePortlandMaineUSA
| | | | - David Snow
- Loyola University Medical CenterMaywoodIllinoisUSA
| | - Geoffrey Hays
- Indiana University School of Medicine, Riley Hospital for ChildrenIndianapolisIndianaUSA
| | - Amy Mariorenzi
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Haley Connelly
- Boston University Chobanian & Avedisian School of MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Alexander Sheng
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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13
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Harper JA, Coyle AC, Tam C, Skakum M, Ragheb M, Wilson L, Lê ML, Klassen TP, Aregbesola A. Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review. CMAJ Open 2023; 11:E956-E968. [PMID: 37848258 PMCID: PMC10586495 DOI: 10.9778/cmajo.20210337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Most children who need emergency care visit general emergency departments and urgent care centres; the weighted pediatric readiness score (WPRS) is currently used to evaluate emergency departments' readiness for pediatric patients. The aim of this study was to determine whether a higher WPRS was associated with decreased mortality and improved health care outcomes and utilization. METHODS We conducted a systematic review of cohort and cross-sectional studies on emergency departments that care for children (age ≤ 21 yr). We searched MEDLINE (Ovid), Embase (Ovid), the Cochrane Library (Wiley), CINAHL (EBSCO), Global Health (Ovid) and Scopus from inception until July 29, 2022. Articles identified were screened for inclusion by 2 independent reviewers. The primary outcome was mortality, and the secondary outcomes were health care outcomes and utilization. We used the Newcastle-Ottawa Scale to assess for quality and bias of the included studies. The I 2 statistic was calculated to quantify study heterogeneity. RESULTS We identified 1789 articles. Eight articles were included in the final analysis. Three studies showed an inverse association between highest WPRS quartile and pediatric mortality (pooled odds ratio [OR] 0.45, 95% confidence interval [CI] 0.26 to 0.78; I 2 = 89%, low certainty of evidence) in random-effects meta-analysis. Likewise, 1 study not included in the meta-analysis also reported an inverse association with a 1-point increase in WPRS (OR 0.93, 95% CI 0.88 to 0.98). One study reported that the highest WPRS quartile was associated with shorter length of stay in hospital (β -0.36 days, 95% CI -0.61 to -0.10). Three studies concluded that the highest WPRS quartile was associated with fewer interfacility transfers. The certainty of evidence is low for mortality and moderate for the studied health care outcomes and utilization. INTERPRETATION The data suggest a potential inverse association between the WPRS of emergency departments and mortality risk in children. More studies are needed to refute or confirm these findings. PROTOCOL REGISTRATION PROSPERO-CRD42020191149.
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Affiliation(s)
- Jessica A Harper
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man.
| | - Amanda C Coyle
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Clara Tam
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Megan Skakum
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Mirna Ragheb
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Lucy Wilson
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Mê-Linh Lê
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Terry P Klassen
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Alex Aregbesola
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
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14
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Ross SW, Campion E, Jensen AR, Gray L, Gross T, Namias N, Goodloe JM, Bulger EM, Fischer PE, Fallat ME. Prehospital and emergency department pediatric readiness for injured children: A statement from the American College of Surgeons Committee on Trauma Emergency Medical Services Committee. J Trauma Acute Care Surg 2023; 95:e6-e10. [PMID: 37125944 DOI: 10.1097/ta.0000000000003997] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
ABSTRACT Injury is the leading cause of death in children older than 1 year, and children make up 22% of the population. Pediatric readiness (PR) of the nation's emergency departments and state trauma and emergency medical services (EMS) systems is conceptually important and vital to mitigate mortality and morbidity in this population. The extension of PR to the trauma community has become a focused area for training, staffing, education, and equipment at all levels of trauma center designation, and there is evidence that a higher level of emergency department PR is independently associated with long-term survival among injured children. Although less well studied, there is an associated need for EMS PR, which is relevant to the injured child who needs assessment, treatment, triage, and transport to a trauma center. We outline a blueprint along with recommendations for incorporating PR into trauma system development in this opinion from the EMS Committee of the American College of Surgeons Committee on Trauma. These recommendations are particularly pertinent in the rural and underserved areas of the United States but are directed toward all levels of professionals who care for an injured child along the trauma continuum of care.
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Affiliation(s)
- Samuel Wade Ross
- From the Division of Acute Care Surgery, Department of Surgery (S.W.R.), F.H. "Sammy" Ross, Jr. Trauma Center, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, North Carolina; Division of GI, Trauma, and Endocrine Surgery, Department of Surgery (E.C.), University of Colorado, Denver, Colorado; Division of Pediatric Surgery, Department of Surgery (A.R.J.), UCSF School of Medicine, San Francisco, California; Department of Pediatrics (L.G.), The University of Texas at Austin Dell Medical School, Austin, Texas; Department of Pediatrics (T.G.), Children's Hospital New Orleans, Tulane University School of Medicine; LSU Health Sciences Center (T.G.), New Orleans, Louisiana; Division of Trauma, Burns, and Surgical Critical Care, Daughtry Family Department of Surgery (N.N.), Ryder Trauma Center, University of Miami Miller School of Medicine, Miami, Florida; Department of Emergency Medicine (J.M.G.), University of Oklahoma School of Community Medicine, Tulsa, Oklahoma; Division of Trauma, Burns, and Critical Care, Department of Surgery (E.M.B.), University of Washington, Seattle, Washington; Division of Trauma Surgical Critical Care, Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; and Hiram C. Polk, Jr. Department of Surgery (M.E.F.), University of Louisville and Norton Children's Hospital, Louisville, Kentucky
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15
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Remick KE, Hewes HA, Ely M, Schmuhl P, Crady R, Cook LJ, Ludwig L, Gausche-Hill M. National Assessment of Pediatric Readiness of US Emergency Departments During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2321707. [PMID: 37418265 PMCID: PMC10329204 DOI: 10.1001/jamanetworkopen.2023.21707] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/10/2023] [Indexed: 07/08/2023] Open
Abstract
Importance The National Pediatric Readiness Project assessment provides a comprehensive evaluation of the readiness of US emergency departments (EDs) to care for children. Increased pediatric readiness has been shown to improve survival for children with critical illness and injury. Objectives To complete a third assessment of pediatric readiness of US EDs during the COVID-19 pandemic, to examine changes in pediatric readiness from 2013 to 2021, and to evaluate factors associated with current pediatric readiness. Design, Setting, and Participants In this survey study, a 92-question web-based open assessment of ED leadership in US hospitals (excluding EDs not open 24 h/d and 7 d/wk) was sent via email. Data were collected from May to August 2021. Main Outcomes and Measures Weighted pediatric readiness score (WPRS) (range, 0-100, with higher scores indicating higher readiness); adjusted WPRS (ie, normalized to 100 points), calculated excluding points received for presence of a pediatric emergency care coordinator (PECC) and quality improvement (QI) plan. Results Of the 5150 assessments sent to ED leadership, 3647 (70.8%) responded, representing 14.1 million annual pediatric ED visits. A total of 3557 responses (97.5%) contained all scored items and were included in the analysis. The majority of EDs (2895 [81.4%]) treated fewer than 10 children per day. The median (IQR) WPRS was 69.5 (59.0-84.0). Comparing common data elements from the 2013 and 2021 NPRP assessments demonstrated a reduction in median WPRS (72.1 vs 70.5), yet improvements across all domains of readiness were noted except in the administration and coordination domain (ie, PECCs), which significantly decreased. The presence of both PECCs was associated with a higher adjusted median (IQR) WPRS (90.5 [81.4-96.4]) compared with no PECC (74.2 [66.2-82.5]) across all pediatric volume categories (P < .001). Other factors associated with higher pediatric readiness included a full pediatric QI plan vs no plan (adjusted median [IQR] WPRS: 89.8 [76.9-96.7] vs 65.1 [57.7-72.8]; P < .001) and staffing with board-certified emergency medicine and/or pediatric emergency medicine physicians vs none (median [IQR] WPRS: 71.5 [61.0-85.1] vs 62.0 [54.3-76.0; P < .001). Conclusions and Relevance These data demonstrate improvements in key domains of pediatric readiness despite losses in the health care workforce, including PECCs, during the COVID-19 pandemic, and suggest organizational changes in EDs to maintain pediatric readiness.
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Affiliation(s)
- Katherine E. Remick
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin
- National Emergency Medical Services for Children Innovation and Improvement Center, Austin, Texas
| | - Hilary A. Hewes
- Emergency Medical Services (EMS) for Children Data Center, Salt Lake City, Utah
- University of Utah, Department of Pediatrics, Salt Lake City
| | - Michael Ely
- Emergency Medical Services (EMS) for Children Data Center, Salt Lake City, Utah
- University of Utah, Department of Pediatrics, Salt Lake City
| | - Patricia Schmuhl
- Emergency Medical Services (EMS) for Children Data Center, Salt Lake City, Utah
- University of Utah, Department of Pediatrics, Salt Lake City
| | - Rachel Crady
- Emergency Medical Services (EMS) for Children Data Center, Salt Lake City, Utah
- University of Utah, Department of Pediatrics, Salt Lake City
| | - Lawrence J. Cook
- Emergency Medical Services (EMS) for Children Data Center, Salt Lake City, Utah
- University of Utah, Department of Pediatrics, Salt Lake City
| | - Lorah Ludwig
- EMS for Children Branch, Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland
| | - Marianne Gausche-Hill
- Departments of Emergency Medicine and Pediatrics, Harbor-UCLA Medical Center, Torrance, California
- The Lundquist Institute at Harbor-UCLA, Torrance, California
- Departments of Emergency Medicine and Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
- The Los Angeles County EMS Agency, Los Angeles, California
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16
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Boggs KM, Espinola JA, Sullivan AF, Li J, Auerbach M, Hasegawa K, Samuels-Kalow ME, Camargo CA. Availability of Pediatric Emergency Care Coordinators in US Emergency Departments in 2018. Pediatr Emerg Care 2023; 39:385-389. [PMID: 37104702 DOI: 10.1097/pec.0000000000002953] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVES In 2007, the US Institute of Medicine recommended that every emergency department (ED) appoint pediatric emergency care coordinators (PECCs). Despite this recommendation, our national surveys showed that few (17%) US EDs reported at least 1 PECC in 2015. This number increased slightly to 19% in 2016 and 20% in 2017. The current study objectives were to determine the following: percent of US EDs with at least 1 PECC in 2018, factors associated with availability of at least 1 PECC in 2018, and factors associated with addition of at least 1 PECC between 2015 and 2018. METHODS In 2019, we conducted a survey of all US EDs to characterize emergency care in 2018. Using the National ED Inventory-USA database, we identified 5514 EDs open in 2018. This survey collected availability of at least 1 PECC in 2018. A similar survey was administered in 2016 and identified availability of at least 1 PECC in 2015. RESULTS Overall, 4781 (87%) EDs responded to the 2018 survey. Among 4764 EDs with PECC data, 1037 (22%) reported having at least 1 PECC. Three states (Connecticut, Massachusetts, and Rhode Island) had PECCs in 100% of EDs. The EDs in the Northeast and with higher visit volumes were more likely to have at least 1 PECC in 2018 (all P < 0.001). Similarly, EDs in the Northeast and with higher visit volumes were more likely to add a PECC between 2015 and 2018 (all P < 0.05). CONCLUSIONS The availability of PECCs in EDs remains low (22%), with a small increase in national prevalence between 2015 and 2018. Northeast states report a high PECC prevalence, but more work is needed to appoint PECCs in all other regions.
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Affiliation(s)
- Krislyn M Boggs
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Janice A Espinola
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Ashley F Sullivan
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Joyce Li
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Marc Auerbach
- Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Kohei Hasegawa
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Carlos A Camargo
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
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17
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McCahill C, Laycock HC, Guris RJD, Chigaru L. State-of-the-art management of the acutely unwell child. Anaesthesia 2022; 77:1288-1298. [PMID: 36089884 PMCID: PMC9826095 DOI: 10.1111/anae.15816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 01/11/2023]
Abstract
Children make up around one-fifth of all emergency department visits in the USA and UK, with an increasing trend of emergency admissions requiring intensive care. Anaesthetists play a vital role in the management of paediatric emergencies contributing to stabilisation, emergency anaesthesia, transfers and non-technical skills that optimise team performance. From neonates to adolescents, paediatric patients have diverse physiology and present with a range of congenital and acquired pathologies that often differ from the adult population. With increasing centralisation of paediatric services, staff outside these centres have less exposure to caring for children, yet are often the first responders in managing these high stakes situations. Staying abreast of the latest evidence for managing complex low frequency emergencies is a challenge. This review focuses on recent evidence and pertinent clinical updates within the field. The challenges of maintaining skills and training are explored as well as novel advancements in care.
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Affiliation(s)
- C. McCahill
- Department of AnaesthesiaGreat Ormond Street HospitalLondonUK
| | - H. C. Laycock
- Department of AnaesthesiaGreat Ormond Street HospitalLondonUK,Department of Surgery and CancerImperial CollegeLondonUK
| | - R. J. Daly Guris
- Department of Anesthesiology and Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA,Department of Anesthesiology and Critical CareUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - L. Chigaru
- Department of AnaesthesiaGreat Ormond Street HospitalLondonUK,Children's Acute Transport ServiceLondonUK
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18
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Scott HF, Kempe A, Bajaj L, Lindberg DM, Dafoe A, Dorsey Holliman B. "These Are Our Kids": Qualitative Interviews With Clinical Leaders in General Emergency Departments on Motivations, Processes, and Guidelines in Pediatric Sepsis Care. Ann Emerg Med 2022; 80:347-357. [PMID: 35840434 PMCID: PMC9529081 DOI: 10.1016/j.annemergmed.2022.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/02/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE Sepsis is a leading cause of pediatric death requiring emergency resuscitation. Most children with sepsis are treated in general emergency departments (EDs); however, research has focused on pediatric EDs. We sought to identify barriers and facilitators to pediatric sepsis care in general EDs, including care processes, the role of guidelines, and incentivized metrics. METHODS In this qualitative study, we conducted semistructured interviews with key informant physician and nurse leaders overseeing pediatric sepsis in general EDs in 2021, including medical directors, nurse managers, and quality coordinators. Interviews were audio-recorded, transcribed, and coded using deductive domains based on steps of sepsis care, pediatric readiness, and structural dynamics. Domains were analyzed across interviews in matrices, using thematic analysis within domains. RESULTS Twenty-one clinical leaders representing 26 hospitals, including trauma levels I to IV, were interviewed. The themes included the following: (1) motivation to improve pediatric sepsis care based on moral imperative and location; (2) need for actionable pediatric sepsis guidelines; (3) children's hospitals' role in education, protocols, transfer, and consultation; and (4) mixed feelings about reportable metrics, particularly in EDs with low pediatric volume. Sepsis care process challenges included diagnosis, intravenous access, and antibiotic delivery but varied among hospitals. CONCLUSION Leaders in general EDs were motivated to provide high-quality pediatric sepsis care but disagreed on whether reportable metrics would drive improvements. They universally sought direct support from their nearest children's hospitals and actionable guidelines. Efforts to address pediatric sepsis quality in general EDs should prioritize guideline design, responsive pediatric transfer and consultation systems, and locally specific process improvement.
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Affiliation(s)
- Halden F Scott
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO; Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO.
| | - Allison Kempe
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO; Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO
| | - Lalit Bajaj
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO
| | - Daniel M Lindberg
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Ashley Dafoe
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO
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19
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Remick KE, Bartley KA, Gonzales L, MacRae KS, Edgerton EA. Consensus-driven model to establish paediatric emergency care measures for low-volume emergency departments. BMJ Open Qual 2022; 11:bmjoq-2021-001803. [PMID: 35803615 PMCID: PMC9272131 DOI: 10.1136/bmjoq-2021-001803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/19/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Katherine E Remick
- Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Krystle A Bartley
- Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Louis Gonzales
- Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Kate S MacRae
- Gonzaga University College of Arts and Sciences, Spokane, Washington, USA
| | - Elizabeth A Edgerton
- Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
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20
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Abulebda K, Whitfill T, Mustafa M, Montgomery EE, Lutfi R, Abu-Sultaneh S, Nitu ME, Auerbach MA. Improving Pediatric Readiness and Clinical Care in General Emergency Departments: A Multicenter Retrospective Cohort Study. J Pediatr 2022; 240:241-248.e1. [PMID: 34499944 DOI: 10.1016/j.jpeds.2021.08.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the impact of a collaborative initiative between general emergency departments (EDs) and the pediatric academic medical center on the process of clinical care in a group of general EDs. STUDY DESIGN This retrospective cohort study assessed the process of clinical care delivered to critically ill children presenting to 3 general EDs. Our previous multifaceted intervention included the following components: postsimulation debriefing, designation of a pediatric champion, customized performance reports, pediatric resources toolkit, and ongoing interactions. Five pediatric emergency care physicians conducted chart reviews and scored encounters using the Pediatric Emergency Care Research Network's Quality of Care Implicit Review Instrument, which assigns scores between 5 and 35 across 5 domains. In addition, safety metrics were collected for medication, imaging, and laboratory orders. RESULTS A total of 179 ED encounters were reviewed, including 103 preintervention and 76 postintervention encounters, with an improvement in mean total quality score from 23.30 (SD 5.1) to 24.80 (4.0). In the domain of physician initial treatment plan and initial orders, scores increased from a mean of 4.18 (0.13) to 4.61 (0.15). In the category of safety, administration of wrong medications decreased from 28.2% to 11.8% after the intervention. CONCLUSION A multifaceted collaborative initiative involving simulation and enhanced pediatric readiness was associated with improvement in the processes of care in general EDs. This work provides evidence that innovative collaborations between academic medical centers and general EDs may serve as an effective strategy to improve pediatric care.
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Affiliation(s)
- Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
| | - Travis Whitfill
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Manahil Mustafa
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Erin E Montgomery
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
| | - Riad Lutfi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Samer Abu-Sultaneh
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Mara E Nitu
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Marc A Auerbach
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
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21
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Shankar LG, Habich M, Rosenman M, Arzu J, Lales G, Hoffmann JA. Mental Health Emergency Department Visits by Children Before and During the COVID-19 Pandemic. Acad Pediatr 2022; 22:1127-1132. [PMID: 35667622 PMCID: PMC9164513 DOI: 10.1016/j.acap.2022.05.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To describe pediatric mental health emergency department (ED) visit rates and visit characteristics before and during the COVID-19 pandemic. METHODS We conducted a cross-sectional study of ED visits by children 5-17 years old with a primary mental health diagnosis from March 2018 to February 2021 at a 10-hospital health system and a children's hospital in the Chicago area. We compared demographic and clinical characteristics of children with mental health ED visits before and during the pandemic. We conducted an interrupted time series analysis to determine changes in visit rates. RESULTS We identified 8,127 pediatric mental health ED visits (58.5% female, 54.3% White, Not Hispanic/Latino and 42.4% age 13-15). During the pandemic, visits for suicide or self-injury increased 6.69% (95% CI 4.73, 8.65), and visits for disruptive, impulse control, conduct disorders increased 1.94% (95% CI 0.85, 3.03). Mental health ED visits by children with existing mental health diagnoses increased 2.29% (95% CI 0.34, 4.25). Mental health ED visits that resulted in medical admission increased 4.32% (95% CI 3.11, 5.53). The proportion of mental health ED visits at community hospitals increased by 5.49% (95% CI 3.31, 7.67). Mental health ED visit rates increased at the onset of the pandemic (adjusted incidence rate ratio [aIRR] 1.27, 95% CI 1.06, 1.50), followed by a monthly increase thereafter (aIRR 1.04, 95% CI 1.02, 1.06). CONCLUSION Mental health ED visit rates by children increased during the COVID-19 pandemic. Changes in mental health ED visit characteristics during the pandemic may inform interventions to improve children's mental health.
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Affiliation(s)
- Lavanya G. Shankar
- Division of Hospital Medicine Outreach (LG Shankar), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill,Department of Pediatrics (LG Shankar), Northwestern Medicine Central DuPage Hospital, Winfield, Ill,Address correspondence to Lavanya G. Shankar, Department of Pediatrics, Northwestern Medicine Central DuPage Hospital, 25 N. Winfield Rd, Winfield, Ill 60190
| | - Michele Habich
- Department of Professional Practice (M Habich), Northwestern Medicine Central DuPage Hospital, Winfield, Ill
| | - Marc Rosenman
- Ann & Robert H. Lurie Children's Hospital of Chicago (M Rosenman), Chicago, Ill,Northwestern University Feinberg School of Medicine (M Rosenman, JA Hoffmann), Chicago, Ill
| | - Jennifer Arzu
- Department of Preventive Medicine (J Arzu), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - George Lales
- Ann & Robert H. Lurie Children's Hospital of Chicago (G Lales and JA Hoffmann), Chicago, Ill
| | - Jennifer A. Hoffmann
- Northwestern University Feinberg School of Medicine (M Rosenman, JA Hoffmann), Chicago, Ill,Ann & Robert H. Lurie Children's Hospital of Chicago (G Lales and JA Hoffmann), Chicago, Ill
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The COVID-19 pandemic and pediatric mental health: advocating for improved access and recognition. Pediatr Res 2022; 91:1018-1020. [PMID: 35102301 PMCID: PMC8801557 DOI: 10.1038/s41390-022-01952-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/19/2021] [Indexed: 02/01/2023]
Abstract
Pediatric mental health has been poorly addressed and access to quality psychiatric care is limited in many countries around the world including wealthy nations. The novel coronavirus disease 2019 (COVID-19) pandemic caused a strain on pediatric mental health resources across the globe. This was primarily due to the stress of lockdowns, loss of caregivers, and school interruptions, which further exacerbated the mental health needs of children. Despite their unreadiness, emergency departments have been utilized to address those needs. Kostopoulou et al. reported that, although emergency departments’ pediatric visits have decreased earlier during the pandemic, mental health visits increased during the same period.
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Availability of Pediatric Emergency Care Coordinators in United States Emergency Departments. J Pediatr 2021; 235:163-169.e1. [PMID: 33577802 DOI: 10.1016/j.jpeds.2021.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the availability of pediatric emergency care coordinators (PECCs) in US emergency departments (EDs) in 2015, and to determine the change in availability of PECCs in US EDs from 2015 to 2017. STUDY DESIGN As part of the National Emergency Department Inventory-USA, we administered a survey to all 5326 US EDs open in 2015; all 5431 in 2016; and all 5489 in 2017. Through these surveys, we assessed the availability of PECCs. Descriptive statistics characterized EDs with and without PECCs; multivariable logistic regressions identified characteristics independently associated with PECC availability. RESULTS Among the 4443 (83%) EDs with 2015 data, 763 (17.2%) reported the availability of at least 1 PECC. The states with the largest proportion of EDs with PECCs were Delaware (78%, 7/9 EDs) and Maryland (48%, 20/42 EDs), and no PECCs were reported in Mississippi, North Dakota, or Wyoming. Availability of a PECC was associated (P < .001) with larger annual total ED visit volume and a dedicated pediatric ED area. Compared with the 17.2% of EDs reporting a PECC in 2015, 833 (18.6%) reported 1 in 2016, and 917 (19.8%) reported 1 in 2017 (P < .001). CONCLUSIONS Availability of at least 1 PECC increased slightly (2.6%) between 2015 and 2017, but ∼80% of EDs continue without one.
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To YH, Ong YKG, Chong SL, Ang PH, Bte Zakaria ND, Lee KP, Pek JH. Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Paediatr Anaesth 2021; 31:713-719. [PMID: 33774880 DOI: 10.1111/pan.14185] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/26/2021] [Accepted: 03/22/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Intubation is a life-saving intervention at the Emergency Department (ED). However, general and pediatric EDs may vary in their preparedness to manage children with airway emergencies. AIMS We aimed to compare rates of first-pass intubation and adverse tracheal intubation-associated events between general and pediatric EDs. METHODS A retrospective review of medical records was conducted at a pediatric ED and three general EDs from January 1, 2015, to December 31, 2018. Information about the intubation process involving pediatric patients (less than 16 years old), as well as eventual outcomes of first-pass intubation and adverse tracheal intubation-associated events were collected and analyzed. RESULTS There were 180 pediatric intubations, of which 115 (63.9%) were performed in pediatric ED. The median age was 2 years old (interquartile range 0-6). Intubation was most commonly performed for patients with cardiac arrest (88, 48.9%). Direct laryngoscopy was used in 178 (98.9%) cases and uncuffed tube was used in 135 (75.0%) cases. Apneic oxygenation was performed in 26 (14.4%) cases-all in pediatric ED. Intubation was predominantly performed by senior clinicians (162, 90.0%). Overall, intubation was performed successfully in 175 (97.2%) cases, with a first-pass intubation rate of 82.2% which was similar between pediatric (96, 83.5%) and general EDs (52, 80%) (Odds ratio [OR] 1.26, 95% confidence interval [CI] 0.58 to 2.76, p = .558). There were 68 adverse tracheal intubation-associated events with right mainstem intubation being the most common (23, 12.8%). Pediatric EDs (44, 38.3%) had a higher rate of adverse tracheal intubation-associated events than general EDs (15, 23.1%) (OR 2.07, 95% CI 1.04 to 4.11; p = .037). CONCLUSIONS Differences exist in intubation outcomes between pediatric and general EDs. Quality improvement efforts should focus on standardizing intubation practices across both pediatric and general EDs.
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Affiliation(s)
- Yi Hui To
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Yong-Kwang Gene Ong
- Department of Emergency Medicine, KK Women's and Children's Hospital, SingHealth, Singapore City, Singapore
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, SingHealth, Singapore City, Singapore
| | - Peck Har Ang
- Accident & Emergency Department, Changi General Hospital, SingHealth, Singapore City, Singapore
| | - Nur Diana Bte Zakaria
- Department of Emergency Medicine, Singapore General Hospital, SingHealth, Singapore City, Singapore
| | - Khai Pin Lee
- Department of Emergency Medicine, KK Women's and Children's Hospital, SingHealth, Singapore City, Singapore
| | - Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, SingHealth, Singapore City, Singapore
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Bennett CL, Espinola JA, Sullivan AF, Boggs KM, Clay CE, Lee MO, Samuels-Kalow ME, Camargo CA. Evaluation of the 2020 Pediatric Emergency Physician Workforce in the US. JAMA Netw Open 2021; 4:e2110084. [PMID: 34003272 PMCID: PMC8132138 DOI: 10.1001/jamanetworkopen.2021.10084] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Given the mortality disparities among children and adolescents in rural vs urban areas, the unique health care needs of pediatric patients, and the annual emergency department volume for this patient population, understanding the availability of pediatric emergency physicians (EPs) is important. Information regarding the available pediatric EP workforce is limited, however. OBJECTIVE To describe the demographic characteristics, training, board certification, and geographic distribution of the 2020 clinically active pediatric EP workforce in the US. DESIGN, SETTING, AND PARTICIPANTS This national cross-sectional study of the 2020 pediatric EP workforce used the American Medical Association Physician Masterfile database, which was linked to American Board of Medical Specialties board certification information. Self-reported training data in the database were analyzed to identify clinically active physicians who self-reported pediatric emergency medicine (EM) as their primary or secondary specialty. The Physician Masterfile data were obtained on March 11, 2020. MAIN OUTCOMES AND MEASURES The Physician Masterfile was used to identify all clinically active pediatric EPs in the US. The definition of EM training was completion of an EM program (inclusive of both an EM residency and/or a pediatric EM fellowship) or a combined EM program (internal medicine and EM, family medicine and EM, or pediatrics and EM). Physician location was linked and classified by county-level Urban Influence Codes. Pediatric EP density was calculated and mapped using US Census Bureau population estimates. RESULTS A total of 2403 clinically active pediatric EPs were working in 2020 (5% of all clinically active emergency physicians), of whom 1357 were women (56%) and the median (interquartile range) age was 46 (40-55) years. The overall pediatric EP population included 1718 physicians (71%) with EM training and 641 (27%) with pediatric training. Overall, 1639 (68%) were board certified in pediatric EM, of whom 1219 (74%) reported EM training and 400 (24%) reported pediatrics training. Nearly all pediatric EPs worked in urban areas (2369 of 2402 [99%]), and pediatric EPs in urban compared with rural areas were younger (median [interquartile range] age, 46 [40-55] years vs 59 [48-65] years). Pediatric EPs who completed their training 20 years ago or more compared with those who completed training more recently were less likely to work in urban settings (633 [97%] vs 0-4 years: 440 [99%], 5-9 years: 547 [99%], or 10-19 years: 723 [99%]; P = .006). Three states had 0 pediatric EPs (Montana, South Dakota, and Wyoming), and 3 states had pediatric EPs in only 1 county (Alaska, New Mexico, and North Dakota). Less than 1% of counties had 4 or more pediatric EPs per 100 000 population. CONCLUSIONS AND RELEVANCE This study found that almost all pediatric EPs worked in urban areas, leaving rural areas of the US with limited availability of pediatric emergency care. This finding may have profound implications for children and adolescents needing emergency care.
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Affiliation(s)
- Christopher L. Bennett
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Janice A. Espinola
- Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ashley F. Sullivan
- Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Krislyn M. Boggs
- Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carson E. Clay
- Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Moon O. Lee
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Margaret E. Samuels-Kalow
- Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos A. Camargo
- Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Yoong SYC, Ang PH, Chong SL, Ong YKG, Zakaria NDB, Lee KP, Pek JH. Common diagnoses among pediatric attendances at emergency departments. BMC Pediatr 2021; 21:172. [PMID: 33853569 PMCID: PMC8045375 DOI: 10.1186/s12887-021-02646-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pediatric patients present to Emergency Departments (EDs) with a variety of medical conditions. An appreciation of the common presenting conditions can aid EDs in the provision of pediatric emergency care. In this study, we established the common pediatric diagnoses seen at the general EDs, with reference to a pediatric ED. METHODS A retrospective review of medical records was performed for patients less than 16 years old at a pediatric ED and two general EDs from 1 January to 31 December 2018. Information including patient demographics, triage category, case type and diagnoses were collected. RESULTS There were 159,040 pediatric attendances, of which 3477 (2.2%) were seen at the general EDs. Non-traumatic conditions were most prevalent at both general (N = 1933, 55.6%) and pediatric (N = 128,415, 82.5%) EDs. There was a higher proportion of trauma related conditions seen at the general EDs (N = 1544, 44.4%) compared to the pediatric ED (N = 27,148, 17.5%; p < 0.01). Across all EDs, upper respiratory tract infection, unspecified musculoskeletal pain and gastroenteritis were the three most common non-trauma related diagnoses, while fracture, wound and contusion were the three most common trauma related diagnoses. There was a greater proportion of emergent (P1) cases seen at the general EDs (N = 233, 6.7%) than the pediatric ED (N = 3821, 2.5%; p < 0.01). Respiratory conditions including bronchiolitis, asthma and bronchitis were the most common emergent (P1) diagnoses. CONCLUSIONS The common diagnoses among pediatric attendances varied between pediatric and general EDs. Therefore, general EDs should focus their efforts on these common diagnoses, especially the emergent (P1) ones, so that they can enhance their preparedness and work towards providing quality pediatric emergency care.
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Affiliation(s)
- Shuen Yin Celine Yoong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Peck Har Ang
- Accident and Emergency Department, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore
| | - Yong-Kwang Gene Ong
- Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore
| | - Nur Diana Bte Zakaria
- Department of Emergency Medicine, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Khai Pin Lee
- Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore
| | - Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, 110 Sengkang E Way, Singapore, 544886, Singapore.
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Non-Pediatric Nurses' Willingness to Provide Care to Pediatric Patients during a Disaster: An Assessment of Pediatric Surge Capacity in Four Midwestern Hospitals. Disaster Med Public Health Prep 2021; 16:1053-1058. [PMID: 33726878 DOI: 10.1017/dmp.2021.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess non-pediatric nurses' willingness to provide care to pediatric patients during a mass casualty event (MCE). METHODS Nurses from 4 non-pediatric hospitals in a major metropolitan Midwestern region were surveyed in the fall of 2018. Participants were asked about their willingness to provide MCE pediatric care. Hierarchical logistical regression was used to describe factors associated with nurses' willingness to provide MCE pediatric care. RESULTS In total, 313 nurses were approached and 289 completed a survey (response rate = 92%). A quarter (25.3%, n = 73) would be willing to provide MCE care to a child of any age; 12% (n = 35) would provide care only to newborns in the labor and delivery area, and 16.6% (n = 48) would only provide care to adults. Predictors of willingness to provide care to a patient of any age during an MCE included providing care to the youngest-age children during routine duties, reporting confidence in calculating doses and administering pediatric medications, working in the emergency department, being currently or previously certified in PALS, and having access to pediatric-sized equipment in the unit or hospital. CONCLUSION Pediatric surge capacity is lacking among nurses. Increasing nurses' pediatric care self-efficacy could improve pediatric surge capacity and minimize morbidity and mortality during MCEs.
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Abulebda K, Whitfill T, Montgomery EE, Thomas A, Dudas RA, Leung JS, Scherzer DJ, Aebersold M, Van Ittersum WL, Kant S, Walls TA, Sessa AK, Janofsky S, Fenster DB, Kessler DO, Chatfield J, Okada P, Arteaga GM, Berg MD, Knight LJ, Keilman A, Makharashvili A, Good G, Bingham L, Mathias EJ, Nagy K, Hamilton MF, Vora S, Mathias K, Auerbach MA. Improving Pediatric Readiness in General Emergency Departments: A Prospective Interventional Study. J Pediatr 2021; 230:230-237.e1. [PMID: 33137316 DOI: 10.1016/j.jpeds.2020.10.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the impact of a national interventional collaborative on pediatric readiness within general emergency departments (EDs). STUDY DESIGN A prospective, multicenter, interventional study measured pediatric readiness in general EDs before and after participation in a pediatric readiness improvement intervention. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) on a 100-point scale. The study protocol extended over 6 months and involved 3 phases: (1) a baseline on-site assessment of pediatric readiness and simulated quality of care; (2) pediatric readiness interventions; and (3) a follow-up on-site assessment of WPRS. The intervention phase included a benchmarking performance report, resources toolkits, and ongoing interactions between general EDs and academic medical centers. RESULTS Thirty-six general EDs were enrolled, and 34 (94%) completed the study. Four EDs (11%) were located in Canada, and the rest were in the US. The mean improvement in WPRS was 16.3 (P < .001) from a baseline of 62.4 (SEM = 2.2) to 78.7 (SEM = 2.1), with significant improvement in the domains of administration/coordination of care; policies, protocol, and procedures; and quality improvement. Six EDs (17%) were fully adherent to the protocol timeline. CONCLUSIONS Implementing a collaborative intervention model including simulation and quality improvement initiatives is associated with improvement in WPRS when disseminated to a diverse group of general EDs partnering with their regional pediatric academic medical centers. This work provides evidence that innovative collaboration facilitated by academic medical centers can serve as an effective strategy to improve pediatric readiness and processes of care.
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Affiliation(s)
- Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
| | - Travis Whitfill
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Erin E Montgomery
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
| | - Anita Thomas
- Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
| | - Robert A Dudas
- Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - James S Leung
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Daniel J Scherzer
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH
| | | | - Wendy L Van Ittersum
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Akron Children's Hospital, Northeast Ohio Medical University, Akron, OH
| | - Shruti Kant
- Department of Emergency Medicine and Pediatrics, University of California San Francisco, San Francisco, CA
| | - Theresa A Walls
- Department of Pediatrics, Division of Emergency Medicine, The Children's Hospital of Philadelphia at the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Anna K Sessa
- Office of Emergency Medical Services, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Stephen Janofsky
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Daniel B Fenster
- Department of Emergency Medicine, Morgan Stanley Children's Hospital of New York Presbyterian at Columbia University Medical Center, New York, NY
| | - David O Kessler
- Department of Emergency Medicine, Morgan Stanley Children's Hospital of New York Presbyterian at Columbia University Medical Center, New York, NY
| | - Jenny Chatfield
- KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Pamela Okada
- Department of Pediatrics, University of Texas Southwestern School of Medicine, Dallas, TX
| | - Grace M Arteaga
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Critical Care, Mayo Clinic, Rochester, MN
| | - Marc D Berg
- Davison of Critical Care Medicine, Lucile Packard children's Hospital Stanford, Stanford University College of Medicine, Palo Alto, CA
| | - Lynda J Knight
- Davison of Critical Care Medicine, Lucile Packard children's Hospital Stanford, Stanford University College of Medicine, Palo Alto, CA
| | - Ashley Keilman
- Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
| | - Ana Makharashvili
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Grace Good
- Department of Pediatrics, Division of Emergency Medicine, The Children's Hospital of Philadelphia at the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ladonna Bingham
- Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Emily J Mathias
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Kristine Nagy
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Akron Children's Hospital, Northeast Ohio Medical University, Akron, OH
| | - Melinda F Hamilton
- Department of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Marc A Auerbach
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
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Pediatric Preparedness of the Emergency Departments. Pediatr Emerg Care 2020; 36:602-605. [PMID: 33086361 DOI: 10.1097/pec.0000000000002257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Emergency departments (EDs) varied in their preparedness to provide pediatric emergency care, with mortality rates being higher when EDs were unprepared. Guidelines are available to aid EDs in their preparedness. We aimed to determine the preparedness of EDs in our healthcare cluster using the guidelines from the Royal College of Pediatrics and Child Health (RCPCH) and International Federation for Emergency Medicine (IFEM) as references for audit. METHODS This was a cross-sectional study involving a pediatric ED and 3 general EDs within a healthcare cluster. A survey was completed by a pediatric representative at each ED who assessed his/her own ED's effort against each recommended standard with reference to calendar year of 2018. The availability of pediatric equipment, supplies, and medications was checked against the items recommended list by the IFEM. RESULTS The response rate was 100%. The proportion of agreement with reference standards was lower for general EDs (RCPCH: 11.4%-70.0% and IFEM: 39.6%-84.0%) than pediatric ED (RCPCH: 85.7% and IFEM: 91.7%). Unmet standards were predominantly in the categories of management of pediatric patients with complex medical needs, management of pediatric death, adolescents, mental health and substance misuse, protection and safeguarding of pediatric patients, as well as advanced training and research. The proportion of available equipment, supplies, and medications was also lower for general EDs (77.2%-82.0%) than pediatric ED (89.4%). CONCLUSIONS The standards of pediatric emergency care were met to different extents in the healthcare cluster. Using available references, EDs should identify lapses unique to their own settings to improve the delivery of pediatric emergency care.
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Wall JJ, MacNeill E, Fox SM, Kou M, Ishimine P. Incentives and barriers to pursuing pediatric emergency medicine fellowship: A cross-sectional survey of emergency residents. J Am Coll Emerg Physicians Open 2020; 1:1505-1511. [PMID: 33392557 PMCID: PMC7771800 DOI: 10.1002/emp2.12234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pediatric emergency physicians complete either a pediatric or emergency residency before fellowship training. Fewer emergency graduates are pursuing a pediatric emergency fellowship during the past decade, and the reasons for this decrease are unclear. OBJECTIVES The purpose of this study was to explore emergency residents' incentives and barriers to pursuing a fellowship in pediatric emergency medicine (PEM). METHODS This was a cross-sectional survey-based study. In 2016, we emailed the study survey to all Emergency Medicine Residents' Association (EMRA) members. Survey questions included respondents' interest in a PEM fellowship and perceived incentives and barriers to PEM. RESULTS Of 6620 EMRA members in 2016, 322 (5.0%) responded to the survey. Respondents were 59.6% male, with a mean age of 30.6 years. A total of 105 respondents (32.6%) were in their first year of emergency medicine residency, 92 (28.6%) were in their second year, 77 (23.9%) were in their third year, and 48 (14.9%) were in their fourth or fifth year. A total of 102 (31.8%) respondents planned to pursue fellowship training, whereas 120 (37.4%) were undecided. A total of 140 (43.8%) respondents reported considering a PEM fellowship at some point. Among these respondents, the most common incentives for PEM fellowship were (1) a desire to improve pediatric care in community emergency departments (86, 26.7%), (2) to develop an academic focus (54, 16.8%), and (3) because a mentor encouraged a PEM fellowship (40, 12.4%). A perceived lack of financial benefit (142, 44.1%) and length of PEM fellowship training (89, 27.6%) were the most commonly reported barriers. CONCLUSION In a cross-sectional survey of EMRA members, almost half of the respondents considered a PEM fellowship. PEM leaders who want to promote emergency medicine to pediatric emergency residents will need to leverage the incentives and mitigate the perceived barriers to a PEM fellowship to increase the number of emergency residency applicants.
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Affiliation(s)
- Jessica J. Wall
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Emily MacNeill
- Department of Emergency MedicineCarolinas Medical CenterCharlotteNorth CarolinaUSA
| | - Sean M. Fox
- Department of Emergency MedicineCarolinas Medical CenterCharlotteNorth CarolinaUSA
| | - Maybelle Kou
- Division of Emergency MedicineInova Children's HospitalAnnandaleVirginiaUSA
| | - Paul Ishimine
- Division of Pediatric Emergency MedicineRady Children's Hospital‐San DiegoSan DiegoCaliforniaUSA
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Abulebda K, Lutfi R, Petras EA, Berrens ZJ, Mustafa M, Pearson KJ, Kirby ML, Abu-Sultaneh S, Montgomery EE. Evaluation of a Nurse Pediatric Emergency Care Coordinator-Facilitated Program on Pediatric Readiness and Process of Care in Community Emergency Departments After Collaboration With a Pediatric Academic Medical Center. J Emerg Nurs 2020; 47:167-180. [PMID: 33036776 DOI: 10.1016/j.jen.2020.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/18/2020] [Accepted: 06/14/2020] [Indexed: 11/26/2022]
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Carlson JN, Zocchi MS, Allen C, Denmark TK, Fisher JD, Wilkinson M, Remick K, Sullivan A, Pines JM, Venkat A. Critical procedure performance in pediatric patients: Results from a national emergency medicine group. Am J Emerg Med 2020; 38:1703-1709. [PMID: 32721781 DOI: 10.1016/j.ajem.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022] Open
Abstract
STUDY OBJECTIVE We sought to examine the frequency of pediatric critical procedures performed in a national group of emergency physicians. METHODS We performed a retrospective analysis of an administrative billing and coding dataset for procedural performance documentation verification from 2014 to 2018. We describe and compare incident rates of pediatric (age <18 years) patient critical procedure performance by emergency physicians in general emergency departments (EDs), pediatric EDs, and freestanding ED/urgent care centers. Critical procedures were endotracheal intubation, electrical cardioversion, central venous placement, intraosseous access, and chest tube insertion. RESULTS Among 2290 emergency physicians working in 186 EDs (1844 working in 129 general EDs, 125 in 8 pediatric EDs, and 321 in 49 freestanding EDs/urgent cares), a total of 2233 pediatric critical procedures were performed during the study period. Many physicians at general EDs and freestanding EDs/urgent cares performed zero pediatric procedures per year (53.9% and 89% respectively). Per 1000 ED visits seen (All patient ages), physicians working in general EDs performed fewer pediatric critical procedures than physicians in pediatric EDs (0.12/1000 visits vs 0.68/1000 visits; rate difference = 0.56, 95% confidence interval [CI] 0.51-0.61). Per 1000 clinical hours worked, physicians working in general EDs performed 0.26 procedures compared to 1.66 for physicians in pediatric EDs (rate difference = 1.39; 95% CI 1.27-1.52). CONCLUSION Pediatric critical procedures are rarely performed by emergency physicians and are exceedingly rare in general EDs and freestanding EDs/urgent cares. The rarity of performance of these skills has implications for ED pediatric readiness.
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Affiliation(s)
- Jestin N Carlson
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Mark S Zocchi
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America
| | - Coburn Allen
- US Acute Care Solutions, Canton, OH, United States of America; Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America
| | - T Kent Denmark
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Oklahoma State University, Tulsa, OK, United States of America
| | - Jay D Fisher
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, United States of America
| | - Matthew Wilkinson
- US Acute Care Solutions, Canton, OH, United States of America; Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America
| | - Katherine Remick
- US Acute Care Solutions, Canton, OH, United States of America; Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America; Department of Surgery and Perioperative Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America; Emergency Medical Services for Children Innovation and Improvement Center, Baylor College of Medicine, Houston, TX, United States of America
| | - Abbie Sullivan
- US Acute Care Solutions, Canton, OH, United States of America
| | - Jesse M Pines
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Arvind Venkat
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, United States of America.
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Remick K, Cramer A. Hear Our Voice: Every Child, Every Day; Pediatric Emergency Care Services in the United States. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Standards of care for children in emergency departments: executive summary. CAN J EMERG MED 2020; 22:280-284. [DOI: 10.1017/cem.2020.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Pediatric Readiness in the Emergency Department and Its Association With Patient Outcomes in Critical Care: A Prospective Cohort Study. Pediatr Crit Care Med 2020; 21:e213-e220. [PMID: 32132503 DOI: 10.1097/pcc.0000000000002255] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pediatric mortality in Latvia remains one of the highest among Europe. The purpose of this study was to assess the quality of pediatric acute care and pediatric readiness and determine their association with patient outcomes using a patient registry. DESIGN This was a prospective cohort study. Pediatric readiness was measured using the weighted pediatric readiness score based on a 100-point scale. The processes of care were measured using in situ simulations to generate a composite quality score. Clinical outcome data-including PICU and hospital length of stay as well as 6-month mortality-were collected from the Pediatric Intensive Care Audit Network registry. The associations between composite quality score and weighted pediatric readiness score on patient outcomes were explored with mixed-effects regressions. SETTING This study was conducted in all Latvian Emergency Departments and in the national PICU. PATIENTS All patients who were transferred into the national PICU were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All (16/16) Latvian Emergency Departments participated with a mean composite quality score of 35.3 of 100 and a median weighted pediatric readiness score of 31 of 100. A total of 254 patients were included in the study and followed up for a mean of 436 days, of which nine died (3.5%). Higher weighted pediatric readiness score was associated significantly with lower length of stay in both the PICU and hospital (adjusted ß, -0.06; p = 0.021 and -0.36; p = 0.011, respectively) and lower 6-month mortality (adjusted odds ratio, 0.93; 95% CI, 0.88-0.98). CONCLUSIONS These data provide a national assessment of pediatric emergency care in a European country. Pediatric readiness in the emergency department was associated with patient outcomes in this population of pediatric patients transferred to the national PICU.
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Whitfill TM, Remick KE, Olson LM, Richards R, Brown KM, Auerbach MA, Gausche-Hill M. Statewide Pediatric Facility Recognition Programs and Their Association with Pediatric Readiness in Emergency Departments in the United States. J Pediatr 2020; 218:210-216.e2. [PMID: 31757472 DOI: 10.1016/j.jpeds.2019.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/10/2019] [Accepted: 10/09/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the relationship between statewide pediatric facility recognition (PFR) programs and pediatric readiness in emergency departments (EDs) in the US. STUDY DESIGN Data were extracted from the 2013 National Pediatric Readiness Project assessment (4083 EDs). Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) based on a 100-point scale. Descriptive statistics were used to compare WPRS between recognized and nonrecognized EDs and between states with or without a PFR program. A linear mixed model with WPRS was used to evaluate state PFR programs on pediatric readiness. RESULTS Eight states were identified with a PFR program. EDs in states with a PFR program had a higher WPRS compared with states without a PFR program (overall a 9.1-point higher median WPRS; P < .001); EDs recognized in a PFR program had a 21.7-point higher median WPRS compared with nonrecognized EDs (P < .001); and between states with a statewide PFR program, there was high variability of participation within the states. We found state-level PFR programs predicted a higher WPRS compared with states without a PFR program (β = 5.49; 95% CI 2.76-8.23). CONCLUSIONS Statewide PFR programs are based on national guidelines and identify those EDs that adhere to a standard level of readiness for children. These statewide PFR initiatives are associated with higher pediatric readiness. As scalable strategies are needed to improve emergency care for children, our study suggests that statewide PFR programs may be one way to improve pediatric readiness and underscores the need for further implementation and evaluation.
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Affiliation(s)
- Travis M Whitfill
- Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, CT.
| | - Katherine E Remick
- Office of the Medical Director, Austin-Travis County EMS System, Austin, TX; Dell Medical School at the University of Texas, Austin, TX; San Marcos/Hays County EMS System, San Marcos, TX; EMS for Children Innovation and Improvement Center, Houston, TX
| | - Lenora M Olson
- National Emergency Medical Services for Children Data Analysis Resource Center, Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, UT
| | - Rachel Richards
- National Emergency Medical Services for Children Data Analysis Resource Center, Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, UT
| | - Kathleen M Brown
- Department of Emergency Medicine, The George Washington University School of Medicine, Washington, DC; Children's National Medical Center, Washington, DC
| | - Marc A Auerbach
- Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Marianne Gausche-Hill
- Departments of Emergency Medicine and Pediatrics, Harbor-UCLA Medical Center, Torrance, CA; Departments of Emergency Medicine and Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA; Emergency Medical Services Agency, Department of Health Services, Los Angeles County, Los Angeles, CA
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Gausche-Hill M. Emergency and Definitive Care for Children in the United States: The Perfect Storm. Pediatrics 2020; 145:peds.2019-3372. [PMID: 31882441 DOI: 10.1542/peds.2019-3372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Marianne Gausche-Hill
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California; Departments of Emergency Medicine and Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and Harbor-UCLA Medical Center, Torrance, California
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Young TP, Borkowski CS, Main RN, Kuntz HM. Dextrose dilution for pediatric hypoglycemia. Am J Emerg Med 2019; 37:1971-1973. [PMID: 30961921 DOI: 10.1016/j.ajem.2019.03.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 03/31/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Timothy P Young
- Loma Linda University Medical Simulation Center, Loma Linda, CA, USA; Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA.
| | - Caitlin S Borkowski
- Loma Linda University Medical Simulation Center, Loma Linda, CA, USA; Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Rhiannon N Main
- Loma Linda University Medical Simulation Center, Loma Linda, CA, USA; Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Heather M Kuntz
- Loma Linda University Medical Simulation Center, Loma Linda, CA, USA; Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
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