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Kothari K, Shah MI, Genovesi AL, Gausche-Hill M, Owusu-Ansah S, Hewes H, Moore B, Remick K. Development of the National Prehospital Pediatric Readiness Project assessment. Acad Emerg Med 2024. [PMID: 39300687 DOI: 10.1111/acem.15012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/29/2024] [Accepted: 08/20/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION In the United States (US), the quality of care provided to children during emergencies is highly variable. Following implementation of the National Pediatric Readiness Project (NPRP), inclusive of two national online assessments of Emergency Departments (EDs), national organizations involved in Emergency Medical Services (EMS) systems convened to launch the Prehospital Pediatric Readiness Project (PPRP). The PPRP seeks to ensure high-quality pediatric prehospital emergency care for all children. One of the first priorities of PPRP is to assess the current level of pediatric readiness in EMS systems. The development of the first comprehensive national assessment of pediatric readiness in EMS systems is described. METHODS The 2020 joint policy statement, "Pediatric Readiness in Emergency Medical Services Systems" and the associated prehospital pediatric readiness checklist served as the foundation for the PPRP assessment. Assessment questions and scoring algorithm were developed using a modified Delphi process. The PPRP Assessment was converted into an online format comprising a website (EMSpedsReady.org), the online assessment, a personalized gap report, and non-public Tableau data-monitoring dashboards. A directory of all eligible EMS agencies in the United Staters was created to track participation. A diverse cohort of 15 EMS agencies piloted of the assessment questions and the online version of the assessment. Feedback from the pilot was integrated. CONCLUSION The inaugural PPRP Assessment was open access May through July 2024, and the results will be used to guide future PPRP efforts.
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Affiliation(s)
- Kathryn Kothari
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Manish I Shah
- Stanford University School of Medicine, Stanford, California, USA
| | - Andrea L Genovesi
- Emergency Medical Services (EMS) for Children Data Center, Salt Lake City, Utah, USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marianne Gausche-Hill
- Departments of Emergency Medicine and Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA
- Departments of Emergency Medicine and Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- The Lundquist Institute at Harbor-UCLA, Torrance, California, USA
- Department of Health Services, Emergency Medical Services Agency, Los Angeles, California, USA
| | - Sylvia Owusu-Ansah
- Division of Emergency Medical Services, Department of Pediatrics and Emergency Department, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hilary Hewes
- Emergency Medical Services (EMS) for Children Data Center, Salt Lake City, Utah, USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Brian Moore
- Baylor Scott and White McLane Children's Medical Center, Temple, Texas, USA
| | - Katherine Remick
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
- Emergency Medical Services for Children Innovation and Improvement Center, Austin, Texas, USA
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Marcin JP, Lieng MK, Mouzoon J, Sauers-Ford HS, Tancredi D, Cabri A, Pandya VA, Park AS, Kuppermann N. Telemedicine vs Telephone Consultations and Medication Prescribing Errors Among Referring Physicians: A Cluster Randomized Crossover Trial. JAMA Netw Open 2024; 7:e240275. [PMID: 38421649 PMCID: PMC10905304 DOI: 10.1001/jamanetworkopen.2024.0275] [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: 09/01/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024] Open
Abstract
Importance Critically ill children presenting to emergency departments (EDs) in non-children's hospitals are at high risk for experiencing medical errors, including medication errors. Video telemedicine consultations with pediatric specialists have the potential to reduce the risk of medication errors beyond the current standard of care, telephone consultations. Objective To compare the rates of ED physician-related medication errors among critically ill children randomized to receive either video telemedicine or telephone consultations. Design, Setting, and Participants This cluster randomized, unbalanced crossover trial was conducted at 15 community EDs in northern California between September 2014 and March 2018. Analyses were conducted from May 2022 to January 2023. Participants included acutely ill children younger than 15 years presenting to a participating ED. Interventions Participating EDs were randomized to use video telemedicine or telephone for consultations with pediatric critical care physicians according to 1 of 4 unbalanced (3 telemedicine to 1 telephone) crossover treatment assignment sequences. Main Outcomes and Measures Pharmacists reviewed medical records to document physician-related medication errors using a previously validated instrument. Multilevel logistic regression analyses were performed to create models with the medication order as the unit of analysis and adjusting for age, the log-transformed Revised Pediatric Emergency Assessment Tool score, and hospital study period. Results A total of 696 patient encounters were included in the trial (mean [SD] age, 4.2 [4.6] years; median [IQR] age, 2.1 [0.5-2.1] years; 304 female [43.7%]), with 537 patient encounters (77.2%) assigned to video telemedicine and 159 patient encounters (22.8%) assigned to telephone. At least 1 physician-related medication error occurred for 87 patients (12.5%), including 20 of 159 patients (12.6%) in the telephone cohort and 67 of 537 patients (12.5%) in the telemedicine cohort. Of the 2414 medication orders, errors occurred in 124 cases (5.1%), including 26 of 513 orders (5.1%) in the telephone cohort and 98 of 1901 orders (5.2%) in the telemedicine cohort. In the multivariable analysis, the adjusted odds ratio of experiencing a medication error among those assigned to telemedicine was 0.86 (95% CI, 0.49-1.52; P = .61). Conclusions and Relevance This cluster randomized crossover trial found no statistically significant differences in physician-related medication errors between critically ill children assigned to receive telephone consultations vs video telemedicine consultations. Trial Registration ClinicalTrials.gov Identifier: NCT02877810.
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Affiliation(s)
- James P. Marcin
- Department of Pediatrics, University of California School of Medicine, Davis Health, Sacramento
| | - Monica K. Lieng
- Department of Pediatrics, University of California School of Medicine, Davis Health, Sacramento
| | - Jamie Mouzoon
- Department of Pediatrics, University of California School of Medicine, Davis Health, Sacramento
| | - Hadley S. Sauers-Ford
- Department of Pediatrics, University of California School of Medicine, Davis Health, Sacramento
| | - Daniel Tancredi
- Department of Pediatrics, University of California School of Medicine, Davis Health, Sacramento
| | - Annie Cabri
- Department of Pharmacy, University of California, Davis Health, Sacramento
| | - Vaibhavi A. Pandya
- Department of Pharmacy, University of California, Davis Health, Sacramento
| | - Alex S. Park
- Department of Pharmacy, University of California, Davis Health, Sacramento
| | - Nathan Kuppermann
- Department of Pediatrics, University of California School of Medicine, Davis Health, Sacramento
- Department of Emergency Medicine, University of California, Davis Health, Sacramento
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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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Paediatric patients in mass casualty incidents: a comprehensive review and call to action. Br J Anaesth 2021; 128:e109-e119. [PMID: 34862001 DOI: 10.1016/j.bja.2021.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 12/16/2022] Open
Abstract
The paediatric population is disproportionately affected during mass casualty incidents (MCIs). Several unique characteristics of children merit special attention during natural and man-made disasters because of their age, physiology, and vulnerability. Paediatric anaesthesiologists play a critical part of MCI care for this population, yet there is a deficit of publications within the anaesthesia literature addressing paediatric-specific MCI concerns. This narrative review article analyses paediatric MCI considerations and compares differing aspects between care provision in Australia, the UK, and the USA. We integrate some of the potential roles for anaesthesiologists with paediatric experience, which include preparation, command consultation, in-field care, pre-hospital transport duties, and emergency department, operating theatre, and ICU opportunities. Finally, we propose several methods by which anaesthesiologists can improve their contribution to paediatric MCI care through personal education, training, and institutional involvement.
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Brown KM, Ackerman AD, Ruttan TK, Snow SK. Access to Optimal Emergency Care for Children. Ann Emerg Med 2021; 77:523-531. [PMID: 33902828 DOI: 10.1016/j.annemergmed.2021.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Kathleen M Brown
- Department of Pediatrics and Emergency Medicine, The George Washington University School of Medicine, and Children's National Medical Center, Washington, District of Columbia
| | - Alice D Ackerman
- Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Timothy K Ruttan
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Dell Children's Medical Center of Central Texas, Pediatric Emergency Medicine, Austin, Texas
| | - Sally K Snow
- Emergency Nurses Association, Schaumburg, Illinois
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Brown KM, Ackerman AD, Ruttan TK, Snow SK. Access to Optimal Emergency Care for Children. Pediatrics 2021; 147:peds.2021-050787. [PMID: 33883245 DOI: 10.1542/peds.2021-050787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Every year, millions of pediatric patients seek emergency care. Significant barriers limit access to optimal emergency services for large numbers of children. The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association have a strong commitment to identifying these barriers, working to overcome them, and encouraging, through education and system changes, improved access to emergency care for all children.
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Affiliation(s)
- Kathleen M Brown
- Departments of Pediatrics and Emergency Medicine and Children's National Medical Center, School of Medicine of Health Sciences, George Washington University, Washington, DC;
| | - Alice D Ackerman
- Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Timothy K Ruttan
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Department of Pediatrics, Dell Children's Medical Center of Central Texas, Pediatric Emergency Medicine, Austin, Texas; and
| | - Sally K Snow
- Emergency Nurses Association, Schaumburg, Illinois
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