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Foster AA, Hoffmann JA, Crady R, Hewes HA, Li J, Cook LJ, Duffy S, Johnson M, Schreiber M, Saidinejad M. Association of emergency department characteristics with presence of recommended pediatric-specific behavioral health policies. J Am Coll Emerg Physicians Open 2024; 5:e13266. [PMID: 39224419 PMCID: PMC11367733 DOI: 10.1002/emp2.13266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/10/2024] [Accepted: 07/18/2024] [Indexed: 09/04/2024] Open
Abstract
Objectives In the United States, pediatric emergency department (ED) visits for behavioral health (BH) are increasing. We sought to determine ED-level characteristics associated with having recommended BH-related policies. Methods We conducted a retrospective serial cross-sectional study of National Pediatric Readiness Project assessments administered to US EDs in 2013 and 2021. Changes in responses related to BH items over time were examined. Multivariable logistic regression models examined ED characteristics associated with the presence of specific BH-related policies in 2021. Results Of 3554 EDs that completed assessments in 2021, 73.0% had BH-related policies, 66.5% had transfer guidelines for children with BH issues, and 38.6% had access to BH resources in a disaster. Of 2570 EDs that completed assessments in both 2013 and 2021, presence of specific BH-related policies increased from 48.6% to 72.0% and presence of appropriate transfer guidelines increased from 56.2% to 64.9%. The adjusted odd ratios (aORs) of having specific BH-related policies were lower in rural (aOR 0.73; 95% confidence interval [CI] 0.57, 0.92) and remote EDs (aOR 0.65; 95% CI 0.48, 0.88) compared to urban EDs; lower among EDs with versus without trauma center designation (aOR 0.80; 95% CI 0.67, 0.95); and higher among EDs with a nurse and physician pediatric emergency care coordinator (PECC) (aOR 1.89; 95% CI 1.54, 2.33) versus those without a PECC. Conclusion Although pediatric readiness for BH conditions increased from 2013 to 2021, gaps remain, particularly among rural EDs and designated trauma centers. Having nurse and physician PECCs is a modifiable strategy to increase ED pediatric readiness pertaining to BH.
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Affiliation(s)
- Ashley A. Foster
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Jennifer A. Hoffmann
- Division of Emergency MedicineAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
- Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Rachel Crady
- Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Hilary A. Hewes
- Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Joyce Li
- Division of Emergency MedicineBoston Children's HospitalBostonMassachusettsUSA
- Department of Emergency Medicine and PediatricsHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Susan Duffy
- Department of Emergency MedicineBrown UniversityProvidenceRhode IslandUSA
| | - Mark Johnson
- Alaska EMS for Children Advisory CommitteeAnchorageAlaskaUSA
| | - Merritt Schreiber
- David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
- The Lundquist Institute for Biomedical Innovation at Harbor UCLATorranceCaliforniaUSA
| | - Mohsen Saidinejad
- David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
- The Lundquist Institute for Biomedical Innovation at Harbor UCLATorranceCaliforniaUSA
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Shieh A, Rogers AJ, Chen CM, Ramgopal S. Comparing the performance of pediatric weight estimation methods. Am J Emerg Med 2024; 82:26-32. [PMID: 38759251 DOI: 10.1016/j.ajem.2024.04.053] [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: 02/17/2024] [Revised: 04/04/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Weight estimation is essential in the care of ill children when a weight cannot be obtained. This is particularly important for children with medical complexity, who are at higher risk for adverse drug events. Our objective was to compare the accuracy of different methods of weight estimation in children and stratify by the presence of medical complexity. METHODS We performed a retrospective cross-sectional study of children (<18 years) seen in the emergency department (ED) or ambulatory clinic from January 1, 2013 to December 31, 2022 at a tertiary academic pediatric center. We compared the performance of nine age-based formulae and two length-based methods using metrics of mean average error (MAE), root mean square error (RMSE), and agreement within 10% and 20% of measured weight. We additionally evaluated the approaches stratified by body mass index (BMI) and the presence of medical complexity. RESULTS Of 361,755 children (median age 8.2 years, IQR 2.5-14.2 years; 51.5% male), 59,283 (16.4%) were seen in the ED. Length was measured or available in 21,330 (36.0%) patients in the ED and 293,410 (97%) patients in clinics. The Broselow tape outperformed all methods, with 50.7% estimates within 10% of measured weight, 80.0% estimates within 20% of measured weight, the lowest MAE (2.5 kg), and lowest RMSE (4.5 kg). The Antevy formula was the most accurate age-based formula, with 49.2% estimates within 10% of measured weight, 80.1% estimates within 20% of measured weight, MAE of 2.8 kg, and RMSE of 4.7 kg. Estimates became less accurate as BMI and estimated weight increased for all methods. Among children with medical complexity (14.1%), the Broselow tape consistently outperformed age-based formulae, with 47.7% estimates within 10% of measured weight, 77.1% estimates within 20% of measured weight, MAE of 2.6 kg, and RMSE of 5.4 kg. The Antevy formula remained the most accurate age-based method among children with medical complexity. CONCLUSION The Broselow tape predicted weight most accurately in this large sample of children, including among those with medical complexity. The Antevy formula is the most accurate age-based method for pediatric weight estimation.
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Affiliation(s)
- Andrew Shieh
- Department of Emergency Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States of America.
| | - Alexander J Rogers
- Department of Emergency Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States of America; Department of Pediatrics, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States of America
| | - Chiu-Mei Chen
- Department of Emergency Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States of America
| | - Sriram Ramgopal
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave., Chicago, IL 60611, United States of America
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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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Abu-Sultanah M, Lutfi R, Abu-Sultaneh S, Pearson KJ, Montgomery EE, Whitfill T, Auerbach MA, Abulebda K. The Effect of a Collaborative Pediatric Emergency Readiness Improvement Intervention on Patients' Hospital Outcomes. Acad Pediatr 2024:S1876-2859(24)00149-9. [PMID: 38657901 DOI: 10.1016/j.acap.2024.04.006] [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] [Received: 12/02/2023] [Revised: 04/07/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE We hypothesized that collaborative intervention to improve weighted pediatric readiness score (WPRS) will be associated with decreased pediatric intensive care (PICU) mortality, PICU and hospital length of stay. METHODS This study analyzes the transfer of acutely ill and injured patients from general emergency departments (GEDs) to our institution. The intervention involved customized assessment reports focusing on team performance and systems improvement for pediatric readiness, sharing best practices and clinical resources, designation of a nurse pediatric emergency care coordinator (PECC) at each GED and ongoing interactions at 2 and 4 months. Data was collected from charts before and after the intervention, focusing on patients transferred to our pediatric emergency department (ED) or directly admitted to our PICU from the GEDs. Clinical outcomes such as PICU length of stay (LOS), hospital LOS, and PICU mortality were assessed. Descriptive statistics were used for demographics, and various statistical tests were employed to analyze the data. Bivariate analyses and multivariable models were utilized to examine patient outcomes and the association between the intervention and outcomes. RESULTS There were 278 patients in the pre-intervention period and 314 patients in the post-intervention period. Multivariable analyses revealed a significant association between the change in WPRS and decreased PICU LOS (β = -0.05 [95% CI: -0.09, -0.01), P = .02), and hospital LOS (β = -0.12 [95% CI: -0.21, -0.04], P = .04), but showed no association between the intervention and other patient outcomes. CONCLUSIONS In this cohort, improving pediatric readiness scores in GEDs was associated with significant improvements in PICU and hospital length of stay. Future initiatives should focus on disseminating pediatric readiness efforts to improve outcomes of critically ill children nationally.
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Affiliation(s)
- Mohannad Abu-Sultanah
- The Department of Pediatrics (M Abu-Sultanah, R Lutfi, S Abu-Sultaneh, and K Abulebda), Division of Pediatric Critical Care Medicine, Riley Hospital for Children at Indiana University Indianapolis
| | - Riad Lutfi
- The Department of Pediatrics (M Abu-Sultanah, R Lutfi, S Abu-Sultaneh, and K Abulebda), Division of Pediatric Critical Care Medicine, Riley Hospital for Children at Indiana University Indianapolis
| | - Samer Abu-Sultaneh
- The Department of Pediatrics (M Abu-Sultanah, R Lutfi, S Abu-Sultaneh, and K Abulebda), Division of Pediatric Critical Care Medicine, Riley Hospital for Children at Indiana University Indianapolis
| | - Kellie J Pearson
- LifeLine Critical Care Transport (KJ Pearson and EE Montgomery), Indiana University Health, Indianapolis, Ind
| | - Erin E Montgomery
- LifeLine Critical Care Transport (KJ Pearson and EE Montgomery), Indiana University Health, Indianapolis, Ind
| | - Travis Whitfill
- Department of Pediatrics (T Whitfill), Yale University School of Medicine, New Haven, Conn
| | - Marc A Auerbach
- Department of Pediatrics (MA Auerbach), Division of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Conn
| | - Kamal Abulebda
- The Department of Pediatrics (M Abu-Sultanah, R Lutfi, S Abu-Sultaneh, and K Abulebda), Division of Pediatric Critical Care Medicine, Riley Hospital for Children at Indiana University Indianapolis.
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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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Foster AA, Li J, Wilkinson MH, Ely M, Gausche‐Hill M, Newgard C, Remick K. Pediatric emergency care coordinator workforce: A survey study. J Am Coll Emerg Physicians Open 2023; 4:e13006. [PMID: 37469489 PMCID: PMC10353296 DOI: 10.1002/emp2.13006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 07/21/2023] Open
Abstract
Objectives The appointment of pediatric emergency care coordinators (PECC) in emergency departments (EDs) enhances pediatric readiness, yet little is understood regarding this workforce. We describe PECC role characteristics, responsibilities, barriers, and threats to the role among a national cohort. Methods We surveyed a sample of PECCs from all regions of the United States who participated in the Emergency Medical Services for Children PECC Workforce and Trauma Collaboratives (2021-2022). EDs were categorized by annual pediatric patient volume: low (<1800), medium (1800-4999), medium-high (5000-9999), and high (≥10,000). Trend tests were performed to explore the relationship between pediatric volume and PECC characteristics. Results Among 187 PECCs, 114 (61.0%) responded. The majority (75.2%) identified as a nurse. There was a significant difference in median hours per week spent on PECC activities by pediatric volume ranging from a median of 2 hours (interquartile range [IQR] 0.0-2.3) for low pediatric volume to 16 hours (IQR 4.0-37.0) for high pediatric volume (P < 0.001). Most respondents reported more time was needed for PECC activities (58.4%), and desired additional training to support the role (70.8%). Most (74.6%) felt the PECC position should be paid, yet 30.7% reported the role was voluntary. The most frequently assigned responsibilities were education of staff (77.2%) and oversight of quality improvement (QI) efforts (72.8%). Conclusion Characteristics of PECC workforce vary but PECC activities of education and QI work are common among all. There is a reported need for additional training and support. Further studies will determine the impact of PECC characteristics on pediatric readiness.
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Affiliation(s)
- Ashley A. Foster
- Department of Emergency MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Joyce Li
- Division of Emergency MedicineBoston Children's HospitalBostonMassachusettsUSA
| | - Matthew H. Wilkinson
- Department of Pediatrics, Dell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
| | - Michael Ely
- Emergency Medical Services for Children Data CenterSalt Lake CityUtahUSA
- Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
- Division of Critical CareUniversity of UtahSalt Lake CityUtahUSA
| | - Marianne Gausche‐Hill
- Los Angeles County EMS AgencyLos AngelesCaliforniaUSA
- Departments of Emergency Medicine and PediatricsDavid Geffen School of Medicine at University of California Los AngelesLos AngelesCaliforniaUSA
- Departments of Emergency Medicine and PediatricsHarbor‐University of California Los Angeles Medical CenterTorranceCaliforniaUSA
| | - Craig Newgard
- Center for Policy and Research in Emergency Medicine, Department of Emergency MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Katherine Remick
- Department of Pediatrics, Dell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
- Department of Surgery, Dell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
- Emergency Medical Services for Children Innovation and Improvement Center, University of Texas at AustinDell Medical SchoolAustinTexasUSA
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Pollack BE, Barbaro RP, Gorga SM, Carlton EF, Gaies M, Kohne JG. Hospital ECMO capability is associated with survival in pediatric cardiac arrest. Resuscitation 2023; 188:109853. [PMID: 37245647 PMCID: PMC10576981 DOI: 10.1016/j.resuscitation.2023.109853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/01/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
AIM Extracorporeal membrane oxygenation (ECMO) provides temporary support in severe cardiac or respiratory failure and can be deployed in children who suffer cardiac arrest. However, it is unknown if a hospital's ECMO capability is associated with better outcomes in cardiac arrest. We evaluated the association between pediatric cardiac arrest survival and the availability of pediatric extracorporeal membrane oxygenation (ECMO) at the treating hospital. METHODS We identified cardiac arrest hospitalizations, including in- and out-of-hospital, in children (0-18 years old) using data from the Health Care Utilization Project (HCUP) National Inpatient Sample (NIS) between 2016 and 2018. The primary outcome was in-hospital survival. Hierarchical logistic regression models were built to test the association between hospital ECMO capability and in-hospital survival. RESULTS We identified 1276 cardiac arrest hospitalizations. Survival of the cohort was 44%; 50% at ECMO-capable hospitals and 32% at non-ECMO hospitals. After adjusting for patient-level factors and hospital factors, receipt of care at an ECMO- capable hospital was associated with higher in-hospital survival, with an odds ratio of 1.49 [95% CI 1.09, 2.02]. Patients who received treatment at ECMO-capable hospitals were younger (median 3 years vs 11 years, p < 0.001) and more likely to have a complex chronic condition, specifically congenital heart disease. A total of 10.9% (88/811) of patients at ECMO-capable hospitals received ECMO support. CONCLUSION A hospital's ECMO capability was associated with higher in-hospital survival among children suffering cardiac arrest in this analysis of a large United States administrative dataset. Future work to understand care delivery differences and other organizational factors in pediatric cardiac arrest is necessary to improve outcomes.
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Affiliation(s)
- Blythe E Pollack
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, United States.
| | - Ryan P Barbaro
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, United States; Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Stephen M Gorga
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, United States
| | - Erin F Carlton
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, United States; Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Michael Gaies
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Joseph G Kohne
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, United States; Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, MI, United States
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Leung JS, Foohey S, Burns R, Bank I, Nemeth J, Sanseau E, Auerbach M. Implementation of a North American pediatric emergency medicine simulation curriculum using the virtual resuscitation room. AEM EDUCATION AND TRAINING 2023; 7:e10868. [PMID: 37215281 PMCID: PMC10199309 DOI: 10.1002/aet2.10868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/20/2023] [Accepted: 03/26/2023] [Indexed: 05/24/2023]
Abstract
Background Simulation provides consistent opportunities for residents to practice high-stakes, low-frequency events such as pediatric resuscitations. To increase standardization across North American residency programs, the Emergency Medicine Resident Simulation Curriculum for Pediatrics (EM ReSCu Peds) was developed. However, access to high-quality simulation/pediatric expertise is not uniform. As the concurrent COVID-19 pandemic necessitated new virtual simulation methods, we adapted the Virtual Resus Room (VRR) to teach EM ReSCu Peds. VRR is an award-winning, low-resource, open-access distance telesimulation platform we hypothesize will be effective and scalable for teaching this curriculum. Methods EM residents completed six VRR EM ReSCu Peds simulation cases and received immediate facilitator-led teledebriefing. Learners completed retrospective pre-post surveys after each case. Learners and facilitators completed end-of-day surveys. Primary outcomes were learning effectiveness measured by a composite of the Simulation Effectiveness in Teaching Modified (SET-M) tool and self-reported changes in learner comfort with case objectives. Secondary outcome was VRR scalability to teach EM ReSCu Peds using a composite outcome of net promoter scores (NPS), resource utilization, open-text feedback, and technical issues. Results Learners reported significantly increased comfort with 95% (54/57) of EM ReSCu Peds-defined case objectives (91% cognitive, 9% psychomotor), with moderate (Cohen's d 0.71, 95% CI 0.67-0.76) overall effect size. SET-M responses indicated simulation effectiveness, particularly with debriefing. Ninety EM residents from three North American residency programs were taught by 59 pediatric faculty from six programs over 4 days-more than possible if simulations were conducted in person. Learners (39) and faculty (68) NPS were above software industry benchmarks (13). Minor, quickly resolved, technical issues were reported by 18% and 29% of learners and facilitators, respectively. Conclusions Learners and facilitators report that the VRR is an effective and scalable platform to teach EM ReSCu Peds. This low-cost, accessible distance simulation intervention could increase equitable, global access to high-quality pediatric emergency education.
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Affiliation(s)
| | - Sarah Foohey
- University of TorontoTorontoOntarioCanada
- Present address:
Queen's UniversityKingstonOntarioCanada
| | | | | | | | | | - Marc Auerbach
- Departments of Pediatrics and Emergency MedicineYale UniversityNew HavenConnecticutUSA
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9
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Alsaedi H, Lutfi R, Abu-Sultaneh S, Montgomery EE, Pearson KJ, Weinstein E, Whitfill T, Auerbach MA, Abulebda K. Improving the Quality of Clinical Care of Children with Diabetic Ketoacidosis in General Emergency Departments Following a Collaborative Improvement Program with an Academic Medical Center. J Pediatr 2022; 240:235-240.e1. [PMID: 34481806 DOI: 10.1016/j.jpeds.2021.08.081] [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] [Received: 03/05/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the impact of a collaborative initiative between a group of general emergency departments (EDs) and an academic medical center (AMC) on the process of care provided to patients with diabetic ketoacidosis (DKA) across these EDs. STUDY DESIGN A retrospective cohort study (January 2015 to December 2018) of all pediatric patients <18 years who presented with DKA to participating EDs and were subsequently admitted to the pediatric intensive care unit at the AMC. Our multifaceted intervention included simulation with postsimulation debriefing, targeted assessment reports, distribution of DKA best practices, pediatric DKA module, and scheduled check-in visits. The process of clinical care was measured by adherence to the pediatric DKA 9-item checklist. Adherence was scored based on the number of items performed correctly and calculated using equal weight for items and dividing by the total number of items. Patients' clinical outcomes also were collected. RESULTS A total of 85 patients with DKA were included in the analysis; 38 patients were in the preintervention, and 47 were in the postintervention. There was a statistically significant improvement in adherence to the DKA checklist from 77.8% to 88.9%. Two of the 9 checklist items (hourly glucose check and appropriate fluid rate) showed statistically significant improvement. No significant change in patient clinical outcomes was noted. CONCLUSIONS Our collaborative initiative resulted in significant improvements in adherence to pediatric DKA best practices across a group of general EDs. A collaborative approach between general EDs and AMCs is an effective improvement strategy for pediatric emergency care.
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Affiliation(s)
- Hani Alsaedi
- 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
| | - 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
| | - Erin E Montgomery
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
| | - Kellie J Pearson
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
| | - Elizabeth Weinstein
- Division of Emergency Medicine, Indiana University School of Medicine, 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
| | - 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
| | - 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.
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10
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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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11
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Lutfi R, Berrens ZJ, Ackerman LL, Montgomery EE, Mustafa M, Kirby ML, Pearson KJ, Abu-Sultaneh S, Abulebda K. Quality of Resuscitative Care Provided to an Infant With Abusive Head Trauma in Community Emergency Departments: An In Situ, Prospective, Simulation-Based Study. Pediatr Emerg Care 2022; 38:e337-e342. [PMID: 33148953 DOI: 10.1097/pec.0000000000002277] [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: 11/26/2022]
Abstract
OBJECTIVES Abusive head trauma (AHT) is a very common and serious form of physical abuse, and a major cause of mortality and morbidity for young children. Early Recognition and supportive care of children with AHT is a common challenge in community emergency department (CEDs). We hypothesized that standardized, in situ simulation can be used to measure and compare the quality of resuscitative measures provided to children with AHT in a diverse set of CEDs. METHODS This prospective, simulation-based study measured teams' performance across CEDs. The primary outcome was overall adherence to AHT using a 15-item performance assessment checklist based on the number of tasks performed correctly on the checklist. RESULTS Fifty-three multiprofessional teams from 18 CEDs participated in the study. Of 270 participants, 20.7% were physicians, 65.2% registered nurses, and 14.1% were other providers. Out of all tasks, assessment of airway/breathing was the most successfully conducted task by 53/53 teams (100%). Although 43/53 teams (81%) verbalized the suspicion for AHT, only 21 (39.6%) of 53 teams used hyperosmolar agent, 4 (7.5%) of 53 teams applied cervical spine collar stabilization, and 6 (11.3%) of 53 teams raised the head of the bed. No significant difference in adherence to the checklist was found in the CEDs with an inpatient pediatric service or these with designated adult trauma centers compared with CEDs without. Community emergency departments closer to the main academic center outperformed CEDs these that are further away. CONCLUSIONS This study used in situ simulation to describe quality of resuscitative care provided to an infant presenting with AHT across a diverse set of CEDs, revealing variability in the initial recognition and stabilizing efforts and provided and targets for improvement. Future interventions focusing on reducing these gaps could improve the performance of CED providers and lead to improved patient outcomes.
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Affiliation(s)
- Riad Lutfi
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - Zachary J Berrens
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - Laurie L Ackerman
- Department of Neurosurgery, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health
| | - Erin E Montgomery
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
| | - Manahil Mustafa
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - Michele L Kirby
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
| | - Kellie J Pearson
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
| | - Samer Abu-Sultaneh
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - Kamal Abulebda
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics
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12
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Alsaedi H, Berrens ZJ, Lutfi R, Weinstein E, Montgomery EE, Pearson KJ, Kirby ML, Abu-Sultaneh S, Abulebda K, Thammasitboon S. Simulation-based assessment of care for infant cardiogenic shock in the emergency department. Nurs Crit Care 2021; 28:353-361. [PMID: 34699685 DOI: 10.1111/nicc.12716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is the leading cause of infant deaths associated with birth defects. Neonates with undiagnosed CHD often present to general emergency departments (GEDs) for initial resuscitation that are less prepared than paediatric centres, resulting in disparities in the quality of care. Neonates with undiagnosed CHD represent a challenge; thus, it is necessary for GEDs to be prepared for this population. AIM To evaluate the process of resuscitative care provided to a neonate in cardiogenic shock due to CHD in the GEDs in a simulated setting and to describe the impact of teams and GED variables on the process of care. METHODS This is a prospective simulation-based assessment of the process of care provided to a neonate with coarctation of the aorta in cardiogenic shock. Simulation sessions were conducted at participating GEDs utilizing each GED's interdisciplinary team and resources. The primary outcome was adherence to best practice, as measured by a 15-item overall composite adherence score (CAS). In addition, we stratified the overall CAS into CHD-critical items and the general resuscitation items CAS. The secondary outcome was the impact of the team's and GED's characteristics on the scores. FINDINGS This study enrolled 32 teams from 12 GEDs. Among 161 participants, 103 (63.97%) were registered nurses, 33 (20.50%) were physicians, 17 (10.56%) were respiratory therapists, and 8 (4.97%) were other medical professionals. The overall median CAS was 84, with the CHD-critical items having a median CAS of 34.5. The most underperformed tasks are checking pulses on the upper and lower extremities (44%), obtaining blood pressure in the upper and lower extremities (25%), and administering prostaglandin E1 (22%). CONCLUSIONS Using in situ simulation in a set of GEDs, we revealed gaps in the resuscitation care of neonates with CHD in cardiogenic shock. RELEVANCE TO CLINICAL PRACTICE These findings highlight the importance of targeted improvement programs for high-stakes illnesses in GED.
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Affiliation(s)
- Hani Alsaedi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Zachary J Berrens
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - 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, Indiana, USA
| | - Elizabeth Weinstein
- Department of Emergency Medicine, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Erin E Montgomery
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, Indiana, USA
| | - Kellie J Pearson
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, Indiana, USA
| | - Michelle L Kirby
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, Indiana, USA
| | - 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, Indiana, USA
| | - 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, Indiana, USA
| | - Satid Thammasitboon
- Associate Professor of Pediatrics, Critical Care Medicine Section, Director, Center for Research, Innovation and Scholarship in Medical Education (CRIS), Chair, Resident Scholarship Program Executive Committee, Texas Children's Hospital Baylor College of Medicine, Houston, Texas, USA
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13
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Pediatric sepsis survival in pediatric and general emergency departments. Am J Emerg Med 2021; 51:53-57. [PMID: 34673476 DOI: 10.1016/j.ajem.2021.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Understanding differences in mortality rate secondary to sepsis between pediatric and general emergency departments (EDs) would help identify strategies to improve pediatric sepsis care. We aimed to determine if pediatric sepsis mortality differs between pediatric and general EDs. METHODS We performed a nationally representative, retrospective cohort study using the 2008-2017 Nationwide Emergency Department Sample (NEDS) to examine visits by patients less than 19 years old with a diagnostic code of severe sepsis or septic shock. We generated national estimates of study outcomes using NEDS survey weights. We compared pediatric to general EDs on the outcomes of ED mortality and hospital mortality. We determined adjusted mortality risk using logistic regression, controlling for age, gender, complex care code, and geographic region. RESULTS There were 54,129 weighted pediatric ED visits during the study period with a diagnosis code of severe sepsis or septic shock. Of these visits, 285 died in the ED (0.58%) and 5065 died during their hospital stay (9.8%). Mortality risk prior to ED disposition in pediatric and general EDs was 0.31% and 0.72%, respectively (adjusted odds ratio (aOR), 95% confidence interval (CI): 0.36 (0.14-0.93)). Mortality risk prior to hospital discharge in pediatric and general EDs was 7.5% and 10.9%, respectively (aOR, 95% CI: 0.55 (0.41-0.72)). CONCLUSIONS In a nationally representative sample, pediatric mortality from severe sepsis or septic shock was lower in pediatric EDs than in general EDs. Identifying features of pediatric ED care associated with improved sepsis mortality could translate into improved survival for children wherever they present with sepsis.
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14
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Mitchell HK, Reddy A, Perry MA, Gathers CA, Fowler JC, Yehya N. Racial, ethnic, and socioeconomic disparities in paediatric critical care in the USA. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:739-750. [PMID: 34370979 DOI: 10.1016/s2352-4642(21)00161-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022]
Abstract
In an era of tremendous medical advancements, it is important to characterise and address inequities in the provision of health care and in outcomes. There is a large body of evidence describing such disparities by race or ethnicity and socioeconomic position in critically ill adults; however, this important issue has received less attention in children and adolescents (aged ≤21 years). This Review presents a summary of the available evidence on disparities in outcomes in paediatric critical illness in the USA as a result of racism and socioeconomic privilege. The majority of evidence of racial and socioeconomic disparities in paediatric critical care originates from the USA and is retrospective, with only one prospective intervention-based study. Although there is mixed evidence of disparities by race or ethnicity and socioeconomic position in general paediatric intensive care unit admissions and outcomes in the USA, there are striking trends within some disease processes. Notably, there is evidence of disparities in management and outcomes for out-of-hospital cardiac arrest, asthma, severe trauma, sepsis, and oncology, and in families' perceptions of care. Furthermore, there is clear evidence that critical care research is limited by under-enrolment of participants from minority race or ethnicity groups. We advocate for rigorous research standards and increases in the recruitment and enrolment of a diverse range of participants in paediatric critical care research to better understand the disparities observed, including the effects of racism and poverty. A clearer understanding of when, where, and how such disparities affect patients will better enable the development of effective strategies to inform practice, interventions, and policy.
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Affiliation(s)
- Hannah K Mitchell
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Anireddy Reddy
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA
| | - Mallory A Perry
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cody-Aaron Gathers
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jessica C Fowler
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nadir Yehya
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA
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Vora S, Li J, Kou M, Ng V, Price A, Claudius I, Kant S, Sanseau E, Madhok M, Auerbach M. ACEP SimBox: A Pediatric Simulation-Based Training Innovation. Ann Emerg Med 2021; 78:346-354. [PMID: 34154842 DOI: 10.1016/j.annemergmed.2021.03.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 11/27/2022]
Abstract
Thirty million pediatric visits (<18 years old) occur across 5,000 US emergency departments (EDs) each year, with most of these cases presenting to community EDs. Simulation-based training is an effective method to improve and sustain EDs' readiness to triage and stabilize critically ill infants and children, but large simulation centers are mostly concentrated at academic hospitals. The use of pediatric simulation-based training has been limited in the community ED setting due to the high cost of equipment and limited access to content experts in pediatric critical care. We designed an innovative "off-the-shelf" simulation-based training resource, "American College of Emergency Physicians (ACEP) SimBox," that provides a free low-technology manikin along with teaching aids and train-the-trainer materials to community EDs to run a simulation drill in their own workspaces with local educators. The goal was to develop an "off-the-shelf," free, open-access, simulation-based resource to improve the readiness of community EDs to triage, resuscitate, and transfer critically ill infants as measured by presimulation and postsimulation surveys measuring opinions regarding the scenario, session experience, and most valuable aspect of the session. Between January 2018 and December 2019, 179 ACEP SimBoxes were shipped across the United States, reaching 36 of 50 states. Facilitators and participants who completed the postsimulation survey evaluated the session as a valuable use of their time. All facilitator respondents reported that the low-technology manikins, paired with their institution-specific equipment, were sufficient for learning, thus reducing costs. All participant respondents reported an increased commitment to pediatric readiness for their ED after completing the simulation session. This innovation resulted in the implementation of a unique simulation-based training intervention across many community EDs in the United States. The ACEP SimBox innovation demonstrates that an easy to use and unique simulation-based training tool can be developed, distributed, and implemented across many community EDs in the United States to help improve community ED pediatric readiness.
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Affiliation(s)
- Samreen Vora
- Department of Emergency Medicine, Children's Minnesota Hospital, Minneapolis, MN.
| | - Joyce Li
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Maybelle Kou
- Department of Emergency Medicine, Inova Fairfax Medical Campus/Inova Children's Hospital, Falls Church, VA
| | - Vivienne Ng
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ
| | - Amanda Price
- Division of Pediatric Emergency Medicine, Medical University South Carolina, Charleston, SC
| | - Ilene Claudius
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Shruti Kant
- Department of Emergency Medicine, Benioff Children's Hospital, San Francisco, CA
| | - Elizabeth Sanseau
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Manu Madhok
- Department of Emergency Medicine, Children's Minnesota Hospital, Minneapolis, MN
| | - Marc Auerbach
- Department of Pediatrics, Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
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16
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Mustafa K, Buckley H, Feltbower R, Kumar R, Scholefield BR. Epidemiology of Cardiopulmonary Resuscitation in Critically Ill Children Admitted to Pediatric Intensive Care Units Across England: A Multicenter Retrospective Cohort Study. J Am Heart Assoc 2021; 10:e018177. [PMID: 33899512 PMCID: PMC8200770 DOI: 10.1161/jaha.120.018177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Cardiopulmonary arrests are a major contributor to mortality and morbidity in pediatric intensive care units (PICUs). Understanding the epidemiology and risk factors for CPR may inform national quality improvement initiatives. Methods and Results A retrospective cohort analysis using prospectively collected data from the Paediatric Intensive Care Audit Network database. The Paediatric Intensive Care Audit Network contains data on all PICU admissions in the United Kingdom. We identified children who received cardiopulmonary resuscitation (CPR) in 23 PICUs in England (2013-2017). Incidence rates of CPR and associated factors were analyzed. Logistic regression was used to estimate the size and precision of associations. Cumulative incidence of CPR was 2.2% for 68 114 admissions over 5 years with an incidence rate of 4.9 episodes/1000 bed days. Cardiovascular diagnosis (odds ratio [OR], 2.30; 95% CI, 2.02-2.61), age <1 year (OR, 1.84; 95% CI, 1.65-2.04), the Paediatric Index of Mortality 2 score on admission (OR, 1.045; 95% CI, 1.042-1.047) and longer length of stay (OR, 1.013; 95% CI, 1.012-1.014) were associated with increased odds of receiving CPR. We also found a higher risk of CPR associated with a history of preadmission cardiac arrest (OR, 20.69; [95% CI, 18.16-23.58) and for children with a cardiac condition admitted to a noncardiac PICU (OR, 2.75; 95% CI, 1.91-3.98). Children from Black (OR, 1.68; 95% CI, 1.36-2.07) and Asian (OR, 1.49; 95% CI, 1.28-1.74) racial/ethnic backgrounds were at higher risk of receiving CPR in PICU than White children. Conclusions Data from this first multicenter study from England provides a foundation for further research and evidence for benchmarking and quality improvement for prevention of cardiac arrests in PICU.
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Affiliation(s)
- Khurram Mustafa
- Paediatric Intensive Care Leeds Children's Hospital United Kingdom
| | | | | | - Ramesh Kumar
- Paediatric Intensive Care Leeds Children's Hospital United Kingdom
| | - Barnaby R Scholefield
- Birmingham Acute Care Research Group Institute of Inflammation and AgeingUniversity of Birmingham United Kingdom.,Paediatric Intensive Care Birmingham Women and Children's Hospital NHS Foundation Trust United Kingdom
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17
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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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Abulebda K, Thomas A, Whitfill T, Montgomery EE, Auerbach MA. Simulation Training for Community Emergency Preparedness. Pediatr Ann 2021; 50:e19-e24. [PMID: 33450035 DOI: 10.3928/19382359-20201212-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Most infants and children who are ill and injured are cared for in community-based settings across the emergency continuum. These settings are often less prepared for pediatric patients than dedicated pediatric settings such as academic medical centers. Disparities in health outcomes exist and are associated with gaps in community emergency preparedness. Simulation is an effective technique to enhance emergency preparedness to ensure the highest quality of care is provided to all pediatric patients. In this article, we summarize the pediatric emergency care provided across the emergency continuum and outline the key features of simulation used to measure and improve pediatric preparedness in community settings. First, we discuss the use of simulation as a training tool and as an investigative methodology to enhance emergency preparedness across the continuum. Next, we present two examples of successful simulation-based programs that have led to improved emergency preparedness. [Pediatr Ann. 2021;50(1):e19-e24.].
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Tan JCL, Ang PH, Chong SL, Lee KP, Ong GYK, Zakaria NDB, Pek JH. Differences in Utilisation of the General and Paediatric Emergency Departments by Paediatric Patients. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020; 49:948-954. [PMID: 33463652 DOI: 10.47102/annals-acadmedsg.2020327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Paediatric patients presenting to the general emergency departments (EDs) differ from those presenting to paediatric EDs. General EDs vary in preparedness to manage paediatric patients, which may affect delivery of emergency care with varying clinical outcomes. We aimed to elucidate the differences in utilisation patterns of paediatric and general EDs by paediatric patients. METHODS This study was conducted in a public healthcare cluster in Singapore consisting of 4 hospitals. A retrospective review of the medical records of paediatric patients, defined as age younger than 16 years old, who attended the EDs from 1 January 2015 to 31 December 2018, was performed. Data were collected using a standardised form and analysed. RESULTS Of the 704,582 attendances, 686,546 (97.4%) were seen at the paediatric ED. General EDs saw greater number of paediatric patients in the emergent (P1) category (921 [5.1%] versus 14,829 [2.2%]; P<0.01) and those with trauma-related presentations (6,669 [37.0%] vs 108,822 [15.9%]; P<0.01). The mortality of paediatric patients was low overall but significantly higher in general EDs (39 [0.2%] vs 32 [0.005%]; P<0.01). Seizure, asthma/bronchitis/bronchiolitis, allergic reaction, cardiac arrest and burns were the top 5 diagnoses that accounted for 517 (56.1%) of all emergent (P1) cases seen at general EDs. CONCLUSION General EDs need to build their capabilities and enhance their preparedness according to the paediatric population they serve so that optimal paediatric emergency care can be delivered, especially for critically ill patients who are most in need of life-saving and timely treatment.
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Mitzman J, Bank I, Burns RA, Nguyen MC, Zaveri P, Falk MJ, Madhok M, Dietrich A, Wall J, Waseem M, Wu T, McQueen A, Peng CR, Phillips B, Bullaro FM, Chang CD, Shahid S, Way DP, Auerbach M. A Modified Delphi Study to Prioritize Content for a Simulation-based Pediatric Curriculum for Emergency Medicine Residency Training Programs. AEM EDUCATION AND TRAINING 2020; 4:369-378. [PMID: 33150279 PMCID: PMC7592831 DOI: 10.1002/aet2.10412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Pediatric training is an essential component of emergency medicine (EM) residency. The heterogeneity of pediatric experiences poses a significant challenge to training programs. A national simulation curriculum can assist in providing a standardized foundation of pediatric training experience to all EM trainees. Previously, a consensus-derived set of content for a pediatric curriculum for EM was published. This study aimed to prioritize that content to establish a pediatric simulation-based curriculum for all EM residency programs. METHODS Seventy-three participants were recruited to participate in a three-round modified Delphi project from 10 stakeholder organizations. In round 1, participants ranked 275 content items from a published set of pediatric curricular items for EM residents into one of four categories: definitely must, probably should, possibly could, or should not be taught using simulation in all residency programs. Additionally, in round 1 participants were asked to contribute additional items. These items were then added to the survey in round 2. In round 2, participants were provided the ratings of the entire panel and asked to rerank the items. Round 3 involved participants dichotomously rating the items. RESULTS A total of 73 participants participated and 98% completed all three rounds. Round 1 resulted in 61 items rated as definitely must, 72 as probably should, 56 as possibly could, 17 as should not, and 99 new items were suggested. Round 2 resulted in 52 items rated as definitely must, 91 as probably should, 120 as possibly could, and 42 as should not. Round 3 resulted in 56 items rated as definitely must be taught using simulation in all programs. CONCLUSIONS The completed modified Delphi process developed a consensus on 56 pediatric items that definitely must be taught using simulation in all EM residency programs (20 resuscitation, nine nonresuscitation, and 26 skills). These data will serve as a targeted needs assessment to inform the development of a standard pediatric simulation curriculum for all EM residency programs.
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Affiliation(s)
- Jennifer Mitzman
- The Ohio State University Wexner Medical Center/Nationwide Children's HospitalColumbusOH
| | - Ilana Bank
- Institute of Health Sciences EducationSteinberg Centre for Simulation and Interactive Learning/Institute of Pediatric SimulationMontreal Children's HospitalMcGill UniversityMontrealQuebecCanada
| | - Rebekah A. Burns
- Seattle Children's HospitalUniversity of Washington School of MedicineSeattleWA
| | | | - Pavan Zaveri
- George Washington University School of Medicine and Health Sciences/Children's National Health SystemWashingtonDC
| | - Michael J. Falk
- George Washington University School of Medicine and Health Sciences/Children's National Health SystemWashingtonDC
| | | | - Ann Dietrich
- College of MedicineOhio University HeritageDublinOH
| | - Jessica Wall
- Seattle Children's HospitalUniversity of Washington School of MedicineSeattleWA
| | | | - Teresa Wu
- College of Medicine‐PhoenixUniversity of ArizonaPhoenixAZ
- Banner University Medical Center–PhoenixPhoenixAZ
| | - Alisa McQueen
- Comer Children's HospitalThe University of ChicagoChicagoIL
| | | | | | | | | | - Sam Shahid
- American College of Emergency PhysiciansIrvingTX
| | - David P. Way
- The Ohio State University Wexner Medical CenterColumbusOH
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21
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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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22
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4927] [Impact Index Per Article: 1231.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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23
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Walsh BM, Auerbach MA, Gawel MN, Brown LL, Byrne BJ, Calhoun A. Community-based in situ simulation: bringing simulation to the masses. Adv Simul (Lond) 2019; 4:30. [PMID: 31890313 PMCID: PMC6925415 DOI: 10.1186/s41077-019-0112-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
Simulation-based methods are regularly used to train inter-professional groups of healthcare providers at academic medical centers (AMC). These techniques are used less frequently in community hospitals. Bringing in-situ simulation (ISS) from AMCs to community sites is an approach that holds promise for addressing this disparity. This type of programming allows academic center faculty to freely share their expertise with community site providers. By creating meaningful partnerships community-based ISS facilitates the communication of best practices, distribution of up to date policies, and education/training. It also provides an opportunity for system testing at the community sites. In this article, we illustrate the process of implementing an outreach ISS program at community sites by presenting four exemplar programs. Using these exemplars as a springboard for discussion, we outline key lessons learned discuss barriers we encountered, and provide a framework that can be used to create similar simulation programs and partnerships. It is our hope that this discussion will serve as a foundation for those wishing to implement community-based, outreach ISS.
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Affiliation(s)
- Barbara M Walsh
- 1Department of Pediatrics, Division of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, 818 Harrison Ave, Vose 5, Boston, MA 02118 USA
| | - Marc A Auerbach
- 2Department of Pediatrics, Yale University School of Medicine, New Haven, USA
| | | | - Linda L Brown
- 4Department of Pediatrics and Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | - Bobbi J Byrne
- 5Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Aaron Calhoun
- 6Department of Pediatrics, University of Louisville School of Medicine, Louisville, USA
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24
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5401] [Impact Index Per Article: 1080.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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25
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Probst J, Zahnd W, Breneman C. Declines In Pediatric Mortality Fall Short For Rural US Children. Health Aff (Millwood) 2019; 38:2069-2076. [DOI: 10.1377/hlthaff.2019.00892] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Janice Probst
- Janice Probst is a distinguished professor emerita in the Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, in Columbia
| | - Whitney Zahnd
- Whitney Zahnd is a research assistant professor in the Rural and Minority Health Research Center of the University of South Carolina
| | - Charity Breneman
- Charity Breneman was a postdoctoral fellow in the Rural and Minority Health Research Center of the University of South Carolina at the time the study was performed
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26
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Ames SG, Davis BS, Marin JR, Fink EL, Olson LM, Gausche-Hill M, Kahn JM. Emergency Department Pediatric Readiness and Mortality in Critically Ill Children. Pediatrics 2019; 144:peds.2019-0568. [PMID: 31444254 PMCID: PMC6856787 DOI: 10.1542/peds.2019-0568] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Emergency departments (EDs) vary in their level of readiness to care for pediatric emergencies. We evaluated the effect of ED pediatric readiness on the mortality of critically ill children. METHODS We conducted a retrospective cohort study in Florida, Iowa, Massachusetts, Nebraska, and New York, focusing on patients aged 0 to 18 years with critical illness, defined as requiring intensive care admission or experiencing death during the encounter. We used ED and inpatient administrative data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project linked to hospital-specific data from the 2013 National Pediatric Readiness Project. The relationship between hospital-specific pediatric readiness and encounter mortality in the entire cohort and in condition-specific subgroups was evaluated by using multivariable logistic regression and fractional polynomials. RESULTS We studied 20 483 critically ill children presenting to 426 hospitals. The median weighted pediatric readiness score was 74.8 (interquartile range: 59.3-88.0; range: 29.6-100). Unadjusted in-hospital mortality decreased with increasing readiness score (mortality by lowest to highest readiness quartile: 11.1%, 5.4%, 4.9%, and 3.4%; P < .001 for trend). Adjusting for age, chronic complex conditions, and severity of illness, presentation to a hospital in the highest readiness quartile was associated with decreased odds of in-hospital mortality (adjusted odds ratio compared with the lowest quartile: 0.25; 95% confidence interval: 0.18-0.37; P < .001). Similar results were seen in specific subgroups. CONCLUSIONS Presentation to hospitals with a high pediatric readiness score is associated with decreased mortality. Efforts to increase ED readiness for pediatric emergencies may improve patient outcomes.
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Affiliation(s)
- Stefanie G. Ames
- Division of Pediatric Critical Care, Departments of
Pediatrics and
| | - Billie S. Davis
- Critical Care Medicine and The Clinical Research,
Investigation, and Systems Modeling of Acute Illness Center, School of Medicine
and
| | | | - Ericka L. Fink
- Departments of Pediatrics,,Critical Care Medicine and The Clinical Research,
Investigation, and Systems Modeling of Acute Illness Center, School of Medicine
and
| | - Lenora M. Olson
- Division of Critical Care and Department of
Pediatrics, National Emergency Medical Services for Children Data Analysis
Resource Center, School of Medicine, The University of Utah, Salt Lake City,
Utah
| | - Marianne Gausche-Hill
- Emergency Medicine and Pediatrics, David Geffen
School of Medicine, University of California, Los Angeles, Los Angeles,
California;,Department of Emergency Medicine,
Harbor–University of California, Los Angeles Medical Center, Torrance,
California; and,Los Angeles County Emergency Medical Services Agency,
Santa Fe Springs, California
| | - Jeremy M. Kahn
- Critical Care Medicine and The Clinical Research,
Investigation, and Systems Modeling of Acute Illness Center, School of Medicine
and,Department of Health Policy and Management, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh,
Pennsylvania
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27
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Amagasa S, Kashiura M, Moriya T, Uematsu S, Shimizu N, Sakurai A, Kitamura N, Tagami T, Takeda M, Miyake Y. Relationship between institutional case volume and one-month survival among cases of paediatric out-of-hospital cardiac arrest. Resuscitation 2019; 137:161-167. [PMID: 30802557 DOI: 10.1016/j.resuscitation.2019.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
AIM To evaluate volume-outcome relationship in paediatric out-of-hospital cardiac arrest (OHCA). METHODS This post hoc analysis of the SOS-KANTO 2012 study included data of paediatric OHCA patients <18 years old who were transported to the 53 emergency hospitals in the Kanto region of Japan between January 2012 and March 2013. Based on the paediatric OHCA case volume, the higher one-third of institutions (more than 10 paediatric OHCA cases during the study period) were defined as high-volume centres, the middle one-third institutions (6-10 cases) were defined as middle-volume centres and the lower one-third of institutions (less than 6 cases) were defined as low-volume centres. The primary outcome measurement was survival at 1 month after cardiac arrest. Multivariate logistic regression analysis for 1-month survival and paediatric OHCA case volume were performed after adjusting for multiple propensity scores. To estimate the multiple propensity score, we fitted a multinomial logistic regression model, which fell into one of the three groups as patient demographics and prehospital factors. RESULTS Among the eligible 282 children, 112, 82 and 88 patients were transported to the low-volume (36 institutions), middle-volume (11 institutions) and high-volume (6 institutions) centres, respectively. Transport to a high-volume centre was significantly associated with a better 1-month survival after adjusting for multiple propensity score (adjusted odds ratio, 2.55; 95% confidence interval, 1.05-6.17). CONCLUSION There may be a relationship between institutional case volume and survival outcomes in paediatric OHCA.
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Affiliation(s)
- Shunsuke Amagasa
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan; Division of Emergency and Transport Services, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Takashi Moriya
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Satoko Uematsu
- Division of Emergency and Transport Services, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Naoki Shimizu
- Department of Critical Care and Emergency Medicine, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1, Oyagutikamichou, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, 1010, Sakurai, Kisarazushi, Chiba, 292-8535, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1, Nagayama, Tama-shi, Tokyo, 206-8512, Japan
| | - Munekazu Takeda
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yasufumi Miyake
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
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28
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Ishimine P, Adelgais K, Barata I, Klig J, Kou M, Mahajan P, Merritt C, Stoner MJ, Cloutier R, Mistry R, Denninghoff KR. Executive Summary: The 2018 Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps. Acad Emerg Med 2018; 25:1317-1326. [PMID: 30461127 DOI: 10.1111/acem.13667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
Abstract
Emergency care providers share a compelling interest in developing an effective patient-centered, outcomes-based research agenda that can decrease variability in pediatric outcomes. The 2018 Academic Emergency Medicine Consensus Conference "Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps (AEMCC)" aimed to fulfill this role. This conference convened major thought leaders and stakeholders to introduce a research, scholarship, and innovation agenda for pediatric emergency care specifically to reduce health outcome gaps. Planning committee and conference participants included emergency physicians, pediatric emergency physicians, pediatricians, and researchers with expertise in research dissemination and translation, as well as comparative effectiveness, in collaboration with patients, patient and family advocates from national advocacy organizations, and trainees. Topics that were explored and deliberated through subcommittee breakout sessions led by content experts included 1) pediatric emergency medical services research, 2) pediatric emergency medicine (PEM) research network collaboration, 3) PEM education for emergency medicine providers, 4) workforce development for PEM, and 5) enhancing collaboration across emergency departments (PEM practice in non-children's hospitals). The work product of this conference is a research agenda that aims to identify areas of future research, innovation, and scholarship in PEM.
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Affiliation(s)
- Paul Ishimine
- Departments of Emergency Medicine and Pediatrics University of California at San Diego School of Medicine San Diego CA
| | - Kathleen Adelgais
- Department of Pediatrics and Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Isabel Barata
- Departments of Pediatrics and Emergency Medicine Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead NY
| | - Jean Klig
- Departments of Emergency Medicine and Pediatrics Harvard Medical School Boston MA
| | - Maybelle Kou
- Department of Emergency Medicine George Washington University School of Medicine and Health Sciences Washington DC
| | - Prashant Mahajan
- Departments of Emergency Medicine and Pediatrics University of Michigan Medical School Ann Arbor MI
| | - Chris Merritt
- Departments of Emergency Medicine and Pediatrics Alpert Medical School of Brown University Providence RI
| | - Michael J. Stoner
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH
| | - Robert Cloutier
- Departments of Emergency Medicine and Pediatrics Oregon Health & Science University Portland OR
| | - Rakesh Mistry
- Department of Pediatrics and Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Kurt R. Denninghoff
- Department of Emergency Medicine University of Arizona College of Medicine Tucson AZ
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29
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Auerbach M, Brown L, Whitfill T, Baird J, Abulebda K, Bhatnagar A, Lutfi R, Gawel M, Walsh B, Tay KY, Lavoie M, Nadkarni V, Dudas R, Kessler D, Katznelson J, Ganghadaran S, Hamilton MF. Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty Emergency Departments: A Prospective, In Situ, Simulation-based Study. Acad Emerg Med 2018; 25:1396-1408. [PMID: 30194902 DOI: 10.1111/acem.13564] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/09/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Pediatric out-of-hospital cardiac arrest survival outcomes are dismal (<10%). Care that is provided in adherence to established guidelines has been associated with improved survival. Lower mortality rates have been reported in higher-volume hospitals, teaching hospitals, and trauma centers. The primary objective of this article was to explore the relationship of hospital characteristics, such as annual pediatric patient volume, to adherence to pediatric cardiac arrest guidelines during an in situ simulation. Secondary objectives included comparing adherence to other team, provider, and system factors. METHODS This prospective, multicenter, observational study evaluated interprofessional teams in their native emergency department (ED) resuscitation bays caring for a simulated 5-year-old child presenting in cardiac arrest. The primary outcome, adherence to the American Heart Association pediatric guidelines, was assessed using a 14-item tool including three component domains: basic life support (BLS), pulseless electrical activity (PEA), and ventricular fibrillation (VF). Provider, team, and hospital-level data were collected as independent data. EDs were evaluated in four pediatric volume groups (low < 1,800/year; medium 1,800-4,999; medium-high 5,000-9,999; high > 10,000). Cardiac arrest adherence and domains were evaluated by pediatric patient volume and other team and hospital-level characteristics, and path analyses were performed to evaluate the contribution of patient volume, systems readiness, and teamwork on BLS, PEA, and VF adherence. RESULTS A total of 101 teams from a spectrum of 50 EDs participated including nine low pediatric volume (<1,800/year), 36 medium volume (1,800-4,999/year), 24 medium-high (5,000-9,999/year), and 32 high volume (≥10000/year). The median total adherence score was 57.1 (interquartile range = 50.0-78.6). This was not significantly different across the four volume groups. The highest level of adherence for BLS and PEA domains was noted in the medium-high-volume sites, while no difference was noted for the VF domain. The lowest level of BLS adherence was noted in the lowest-volume EDs. Improved adherence was not directly associated with higher pediatric readiness survey (PRS) score provider experience, simulation teamwork performance, or more providers with Pediatric Advanced Life Support (PALS) training. EDs in teaching hospitals with a trauma center designation that served only children demonstrated higher adherence compared to nonteaching hospitals (64.3 vs 57.1), nontrauma centers (64.3 vs. 57.1), and mixed pediatric and adult departments (67.9 vs. 57.1), respectively. The overall effect sizes for total cardiac adherence score are ED type γ = 0.47 and pediatric volume (low and medium vs. medium-high and high) γ = 0.41. A series of path analyses models was conducted that indicated that overall pediatric ED volume predicted significantly better guideline adherence, but the effect of volume on performance was only mediated by the PRS for the VF domain. CONCLUSIONS This study demonstrated variable adherence to pediatric cardiac arrest guidelines across a spectrum of EDs. Overall adherence was not associated with ED pediatric volume. Medium-high-volume EDs demonstrated the highest levels of adherence for BLS and PEA. Lower-volume EDs were noted to have lower adherence to BLS guidelines. Improved adherence was not directly associated with higher PRS score provider experience, simulation teamwork performance, or more providers with PALS training. This study demonstrates that current approaches optimizing the care of children in cardiac arrest in the ED (provider training, teamwork training, environmental preparation) are insufficient.
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Affiliation(s)
- Marc Auerbach
- Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Linda Brown
- Department of Emergency Medicine, Alpert School of Medicine at Brown University, Providence, RI
| | - Travis Whitfill
- Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Janette Baird
- Department of Emergency Medicine, Alpert School of Medicine at Brown University, Providence, RI
| | - Kamal Abulebda
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Ambika Bhatnagar
- Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Riad Lutfi
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Marcie Gawel
- Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Barbara Walsh
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Boston University, Boston, MA
| | - Khoon-Yen Tay
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Megan Lavoie
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robert Dudas
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Kessler
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Jessica Katznelson
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sandeep Ganghadaran
- Department of Critical Care Medicine and Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - Melinda Fiedor Hamilton
- Department of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
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Mikhail JN, Nemeth LS, Mueller M, Pope C, NeSmith EG. The Social Determinants of Trauma: A Trauma Disparities Scoping Review and Framework. J Trauma Nurs 2018; 25:266-281. [DOI: 10.1097/jtn.0000000000000388] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Whitfill T, Auerbach M, Scherzer DJ, Shi J, Xiang H, Stanley RM. Emergency Care for Children in the United States: Epidemiology and Trends Over Time. J Emerg Med 2018; 55:423-434. [PMID: 29793812 DOI: 10.1016/j.jemermed.2018.04.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/09/2018] [Accepted: 04/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The emergency care system for children in the United States is fragmented. A description of epidemiological trends based on emergency department (ED) volume over time could help focus efforts to improve emergency care for children. OBJECTIVES To describe the trends of emergency care for children in the United States from 2006-2014 in EDs across different pediatric volumes. METHODS We analyzed pediatric visits to EDs using the Health Care Utilization Project Nationwide Emergency Department Sample in a representative sample of 1,000 EDs annually from 2006-2014. We report trends in disease severity, mortality, and transfers based on strata by pediatric volume and other hospital characteristics. RESULTS From 2006-2014, there were 318,114,990 pediatric ED visits. Pediatric visits remained steady but declined as a percentage of total visits (-3.91%, p = 0.0007). The majority (92.7%) of children were cared for in lower-volume EDs (<50,000 pediatric visits/year), where mortality was higher vs. the highest-volume EDs. Mortality decreased over time (0.34/1,000 to 0.27, p = 0.0099), whereas interhospital transfers increased (p = 0.0020). ED visits increased for children with Medicaid insurance (40.7% to 56.7%, p < 0.0001), whereas rates of self-pay insurance decreased (13.6% to 9.45%, p = 0.0006). The most common reasons for pediatric ED visits were trauma (25.6%); ear, nose, and throat; dental/mouth disorders (21.8%); gastrointestinal diseases (17.0%); and respiratory diseases (15.6%). CONCLUSIONS Overall, pediatric ED visits have remained stable, with lower mortality rates, whereas Medicaid-funded pediatric visits have increased over time. Most children still seek care in lower-volume EDs. Efforts to improve pediatric care could be best focused on lower-volume EDs and interhospital transfers.
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Affiliation(s)
- Travis Whitfill
- Department of Pediatrics, Section of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Marc Auerbach
- Department of Pediatrics, Section of Emergency Medicine, Yale University, New Haven, Connecticut; Department of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Daniel J Scherzer
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Junxin Shi
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio
| | - Henry Xiang
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio
| | - Rachel M Stanley
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
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Chang BL, Mercer MP, Bosson N, Sporer KA. Variations in Cardiac Arrest Regionalization in California. West J Emerg Med 2018; 19:259-265. [PMID: 29560052 PMCID: PMC5851497 DOI: 10.5811/westjem.2017.10.34869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/14/2017] [Accepted: 10/11/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction The development of cardiac arrest centers and regionalization of systems of care may improve survival of patients with out-of-hospital cardiac arrest (OHCA). This survey of the local EMS agencies (LEMSA) in California was intended to determine current practices regarding the treatment and routing of OHCA patients and the extent to which EMS systems have regionalized OHCA care across California. Methods We surveyed all of the 33 LEMSA in California regarding the treatment and routing of OHCA patients according to the current recommendations for OHCA management. Results Two counties, representing 29% of the California population, have formally regionalized cardiac arrest care. Twenty of the remaining LEMSA have specific regionalization protocols to direct all OHCA patients with return of spontaneous circulation to designated percutaneous coronary intervention (PCI)-capable hospitals, representing another 36% of the population. There is large variation in LEMSA ability to influence inhospital care. Only 14 agencies (36%), representing 44% of the population, have access to hospital outcome data, including survival to hospital discharge and cerebral performance category scores. Conclusion Regionalized care of OHCA is established in two of 33 California LEMSA, providing access to approximately one-third of California residents. Many other LEMSA direct OHCA patients to PCI-capable hospitals for primary PCI and targeted temperature management, but there is limited regional coordination and system quality improvement. Only one-third of LEMSA have access to hospital data for patient outcomes.
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Affiliation(s)
- Brian L Chang
- University of California San Francisco School of Medicine, Department of Emergency Medicine, San Francisco, California
| | - Mary P Mercer
- University of California San Francisco School of Medicine, Department of Emergency Medicine, San Francisco, California
| | - Nichole Bosson
- Los Angeles County Emergency Medical Service Agency, Los Angeles, California.,Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute, Carson, California
| | - Karl A Sporer
- University of California San Francisco School of Medicine, Department of Emergency Medicine, San Francisco, California.,Alameda County Emergency Medical Service Agency, Alameda, California
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Michelson KA, Hudgins JD, Monuteaux MC, Bachur RG, Finkelstein JA. Cardiac Arrest Survival in Pediatric and General Emergency Departments. Pediatrics 2018; 141:peds.2017-2741. [PMID: 29367204 PMCID: PMC5810601 DOI: 10.1542/peds.2017-2741] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric out-of-hospital cardiac arrest (OHCA) has a low rate of survival to hospital discharge. Understanding whether pediatric emergency departments (EDs) have higher survival than general EDs may help identify ways to improve care for all patients with OHCA. We sought to determine if OHCA survival differs between pediatric and general EDs. METHODS We used the 2009-2014 Nationwide Emergency Department Sample to study children under 18 with cardiac arrest. We compared pediatric EDs (those with >75% pediatric visits) to general EDs on the outcome of survival to hospital discharge or transfer. We determined unadjusted and adjusted survival, accounting for age, region, and injury severity. Analyses were stratified by nontraumatic versus traumatic cause. RESULTS The incidences of nontraumatic and traumatic OHCA were 7.91 (95% confidence interval [CI]: 7.52-8.30) and 2.67 (95% CI: 2.49-2.85) per 100 000 person years. In nontraumatic OHCA, unadjusted survival was higher in pediatric EDs than general EDs (33.8% vs 18.9%, P < .001). The adjusted odds ratio of survival in pediatric versus general EDs was 2.2 (95% CI: 1.7-2.8). Children with traumatic OHCA had similar survival in pediatric and general EDs (31.7% vs 26.1%, P = .14; adjusted odds ratio = 1.3 [95% CI: 0.8-2.1]). CONCLUSIONS In a nationally representative sample, survival from nontraumatic OHCA was higher in pediatric EDs than general EDs. Survival did not differ in traumatic OHCA. Identifying the features of pediatric ED OHCA care leading to higher survival could be translated into improved survival for children nationally.
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Shelton SK, Chukwulebe SB, Gaieski DF, Abella BS, Carr BG, Perman SM. Validation of an ICD code for accurately identifying emergency department patients who suffer an out-of-hospital cardiac arrest. Resuscitation 2018; 125:8-11. [PMID: 29341874 DOI: 10.1016/j.resuscitation.2018.01.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/11/2017] [Accepted: 01/12/2018] [Indexed: 11/19/2022]
Abstract
AIM International classification of disease (ICD-9) code 427.5 (cardiac arrest) is utilized to identify cohorts of patients who suffer out-of-hospital cardiac arrest (OHCA), though the use of ICD codes for this purpose has never been formally validated. We sought to validate the utility of ICD-9 code 427.5 by identifying patients admitted from the emergency department (ED) after OHCA. METHODS Adult visits to a single ED between January 2007 and July 2012 were retrospectively examined and a keyword search of the electronic medical record (EMR) was used to identify patients. Cardiac arrest was confirmed; and ICD-9 information and location of return of spontaneous circulation (ROSC) were collected. Separately, the EMR was searched for patients who received ICD-9 code 427.5. The kappa coefficient (κ) was calculated, as was the sensitivity and specificity of the code for identifying OHCA. RESULTS The keyword search identified 1717 patients, of which 385 suffered OHCA and 333 were assigned the code 427.5. The agreement between ICD-9 code and cardiac arrest was excellent (κ = 0.895). The ICD-9 code 427.5 was both specific (99.4%) and sensitive (86.5%). Of the 52 cardiac arrests that were not identified by ICD-9 code, 33% had ROSC before arrival to the ED. When searching independently on ICD-9 code, 347 patients with ICD-9 code 427.5 were found, of which 320 were "true" arrests. This yielded a positive predictive value of 92% for ICD-9 code 427.5 in predicting OHCA. CONCLUSIONS ICD-9 code 427.5 is sensitive and specific for identifying ED patients who suffer OHCA with a positive predictive value of 92%.
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Affiliation(s)
- Shelby K Shelton
- University of Colorado School of Medicine, Department of Emergency Medicine. Aurora, CO, United States
| | - Steve B Chukwulebe
- Northwestern University, Department of Emergency Medicine, United States
| | - David F Gaieski
- Jefferson University Sidney Kimmel School of Medicine, Department of Emergency Medicine. Philadelphia, PA, United States
| | - Benjamin S Abella
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Department of Emergency Medicine. Philadelphia PA, United States
| | - Brendan G Carr
- Jefferson University Sidney Kimmel School of Medicine, Department of Emergency Medicine. Philadelphia, PA, United States
| | - Sarah M Perman
- University of Colorado School of Medicine, Department of Emergency Medicine. Aurora, CO, United States.
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Postreanimationsbehandlung. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VRM, Deakin CD, Bottiger BW, Friberg H, Sunde K, Sandroni C. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2016; 95:202-22. [PMID: 26477702 DOI: 10.1016/j.resuscitation.2015.07.018] [Citation(s) in RCA: 746] [Impact Index Per Article: 93.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jerry P Nolan
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK.
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Alain Cariou
- Cochin University Hospital (APHP) and Paris Descartes University, Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Véronique R M Moulaert
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care and NIHR Southampton Respiratory Biomedical Research Unit, University Hospital, Southampton, UK
| | - Bernd W Bottiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Hans Friberg
- Department of Clinical Sciences, Division of Anesthesia and Intensive Care Medicine, Lund University, Lund, Sweden
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
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Abstract
OBJECTIVES To describe the creation of the first known combined Pediatric Emergency Medicine-Global Health (PEM-GH) fellowship for graduates of pediatric or emergency medicine residency programs. METHODS We detail the necessary infrastructure for a successfully combined PEM-GH fellowship including goals, objectives, curriculum, timeline, and funding. The fellowship is jointly supported by the department of pediatrics, section of pediatric emergency medicine (PEM), and the hospital. Fellows complete all requirements for the PEM fellowship and Global Health, the latter requiring an additional 12 months of training. Components of the Global Health fellowship include international fieldwork, scholarly activity abroad, advanced degree coursework, disaster training, and didactic curricula. RESULTS Since 2005, 9 fellows (8 pediatric-trained and 1 emergency medicine-trained) have completed or are enrolled in the PEM-GH fellowship; 3 have graduated. All fellows have completed or are working toward advanced degrees and have or will participate in the disaster management course. Fellows have had 7 presentations at national or international meetings and have published 6 articles in peer-reviewed journals. Of the three graduates, all are working in academic PEM-GH programs and work internationally in Africa and/or Latin America. CONCLUSIONS Our response to a global trend toward improvement in PEM care was the development of the first combined PEM-GH fellowship program. Recognizing the value of this program within our own institution, we now offer it as a model for building such programs in the future. This fellowship program promises to be a paradigm that can be used nationally and internationally, and it establishes a foundation for a full-fledged accredited and certified subspecialty.
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Teamwork skills in actual, in situ, and in-center pediatric emergencies: performance levels across settings and perceptions of comparative educational impact. Simul Healthc 2016; 10:76-84. [PMID: 25830819 DOI: 10.1097/sih.0000000000000081] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pediatric emergencies require effective teamwork. These skills are developed and demonstrated in actual emergencies and in simulated environments, including simulation centers (in center) and the real care environment (in situ). Our aims were to compare teamwork performance across these settings and to identify perceived educational strengths and weaknesses between simulated settings. We hypothesized that teamwork performance in actual emergencies and in situ simulations would be higher than for in-center simulations. METHODS A retrospective, video-based assessment of teamwork was performed in an academic, pediatric level 1 trauma center, using the Team Emergency Assessment Measure (TEAM) tool (range, 0-44) among emergency department providers (physicians, nurses, respiratory therapists, paramedics, patient care assistants, and pharmacists). A survey-based, cross-sectional assessment was conducted to determine provider perceptions regarding simulation training. RESULTS One hundred thirty-two videos, 44 from each setting, were reviewed. Mean total TEAM scores were similar and high in all settings (31.2 actual, 31.1 in situ, and 32.3 in-center, P = 0.39). Of 236 providers, 154 (65%) responded to the survey. For teamwork training, in situ simulation was considered more realistic (59% vs. 10%) and more effective (45% vs. 15%) than in-center simulation. DISCUSSION In a video-based study in an academic pediatric institution, ratings of teamwork were relatively high among actual resuscitations and 2 simulation settings, substantiating the influence of simulation-based training on instilling a culture of communication and teamwork. On the basis of survey results, providers favored the in situ setting for teamwork training and suggested an expansion of our existing in situ program.
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Kronick SL, Kurz MC, Lin S, Edelson DP, Berg RA, Billi JE, Cabanas JG, Cone DC, Diercks DB, Foster J(J, Meeks RA, Travers AH, Welsford M. Part 4: Systems of Care and Continuous Quality Improvement. Circulation 2015; 132:S397-413. [DOI: 10.1161/cir.0000000000000258] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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