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Pirrocco FA, Temkit H, Mechem C, Yeager K. Trends in pediatric emergency department transfers from Indian Health Service and tribal health systems. Acad Emerg Med 2024; 31:584-589. [PMID: 38644585 DOI: 10.1111/acem.14878] [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: 05/29/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE To describe the frequency and observed trends for all Indian Health Service (IHS) and tribal emergency department (ED) transfers to a pediatric referral center from January 1, 2017, to December 31, 2020, with a secondary analysis to describe trends in final dispositions, lengths of stay (LOS), and the most common primary ICD-10 diagnoses. METHODS We performed a retrospective chart review of IHS and tribal ED transfers to a pediatric referral center from 2017 to 2020 (n = 2433). The data were summarized using frequencies and percentages and we used generalized estimating equations to analyze patient characteristics over time. RESULTS IHS and tribal ED transfers accounted for 6.5%-7.1% of all transfers each year between 2017 and 2020 without significant changes over time. Within this group, 60% were admitted and 62% experienced a LOS greater than 24 h. The most common diagnostic code groups for these patients were respiratory conditions, injuries and poisonings, nonspecific abnormal clinical findings and labs, digestive system diseases, and nervous system diseases. CONCLUSIONS This study addresses important knowledge gaps regarding transfers from IHS and tribal EDs, highlights potential high-impact areas for pediatric readiness, and emphasizes the need for more granular data to inform resource allocation and educational interventions. Further studies are needed to delineate potentially avoidable transfers seen within this population.
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Affiliation(s)
- Fiona A Pirrocco
- Pediatric Emergency Department, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Hamy Temkit
- Clinical Research Department, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Cherisse Mechem
- Pediatric Emergency Department, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Karen Yeager
- Pediatric Emergency Department, Phoenix Children's Hospital, Phoenix, Arizona, USA
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Harper JA, Coyle AC, Tam C, Skakum M, Ragheb M, Wilson L, Lê ML, Klassen TP, Aregbesola A. Readiness of emergency departments for pediatric patients and pediatric mortality: a systematic review. CMAJ Open 2023; 11:E956-E968. [PMID: 37848258 PMCID: PMC10586495 DOI: 10.9778/cmajo.20210337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Most children who need emergency care visit general emergency departments and urgent care centres; the weighted pediatric readiness score (WPRS) is currently used to evaluate emergency departments' readiness for pediatric patients. The aim of this study was to determine whether a higher WPRS was associated with decreased mortality and improved health care outcomes and utilization. METHODS We conducted a systematic review of cohort and cross-sectional studies on emergency departments that care for children (age ≤ 21 yr). We searched MEDLINE (Ovid), Embase (Ovid), the Cochrane Library (Wiley), CINAHL (EBSCO), Global Health (Ovid) and Scopus from inception until July 29, 2022. Articles identified were screened for inclusion by 2 independent reviewers. The primary outcome was mortality, and the secondary outcomes were health care outcomes and utilization. We used the Newcastle-Ottawa Scale to assess for quality and bias of the included studies. The I 2 statistic was calculated to quantify study heterogeneity. RESULTS We identified 1789 articles. Eight articles were included in the final analysis. Three studies showed an inverse association between highest WPRS quartile and pediatric mortality (pooled odds ratio [OR] 0.45, 95% confidence interval [CI] 0.26 to 0.78; I 2 = 89%, low certainty of evidence) in random-effects meta-analysis. Likewise, 1 study not included in the meta-analysis also reported an inverse association with a 1-point increase in WPRS (OR 0.93, 95% CI 0.88 to 0.98). One study reported that the highest WPRS quartile was associated with shorter length of stay in hospital (β -0.36 days, 95% CI -0.61 to -0.10). Three studies concluded that the highest WPRS quartile was associated with fewer interfacility transfers. The certainty of evidence is low for mortality and moderate for the studied health care outcomes and utilization. INTERPRETATION The data suggest a potential inverse association between the WPRS of emergency departments and mortality risk in children. More studies are needed to refute or confirm these findings. PROTOCOL REGISTRATION PROSPERO-CRD42020191149.
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Affiliation(s)
- Jessica A Harper
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man.
| | - Amanda C Coyle
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Clara Tam
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Megan Skakum
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Mirna Ragheb
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Lucy Wilson
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Mê-Linh Lê
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Terry P Klassen
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
| | - Alex Aregbesola
- Department of Pediatrics and Child Health (Harper, Klassen, Aregbesola), University of Manitoba; Children's Hospital Research Institute of Manitoba (Coyle, Tam, Skakum, Ragheb, Wilson, Klassen, Aregbesola), University of Manitoba, Winnipeg, Man.; Faculty of Medicine and Dentistry (Coyle), University of Alberta, Edmonton, Alta.; Max Rady College of Medicine (Skakum, Ragheb, Wilson); Neil John Maclean Health Sciences Library (Lê); Centre for Healthcare Innovation (Klassen), University of Manitoba, Winnipeg, Man
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Ross SW, Campion E, Jensen AR, Gray L, Gross T, Namias N, Goodloe JM, Bulger EM, Fischer PE, Fallat ME. Prehospital and emergency department pediatric readiness for injured children: A statement from the American College of Surgeons Committee on Trauma Emergency Medical Services Committee. J Trauma Acute Care Surg 2023; 95:e6-e10. [PMID: 37125944 DOI: 10.1097/ta.0000000000003997] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
ABSTRACT Injury is the leading cause of death in children older than 1 year, and children make up 22% of the population. Pediatric readiness (PR) of the nation's emergency departments and state trauma and emergency medical services (EMS) systems is conceptually important and vital to mitigate mortality and morbidity in this population. The extension of PR to the trauma community has become a focused area for training, staffing, education, and equipment at all levels of trauma center designation, and there is evidence that a higher level of emergency department PR is independently associated with long-term survival among injured children. Although less well studied, there is an associated need for EMS PR, which is relevant to the injured child who needs assessment, treatment, triage, and transport to a trauma center. We outline a blueprint along with recommendations for incorporating PR into trauma system development in this opinion from the EMS Committee of the American College of Surgeons Committee on Trauma. These recommendations are particularly pertinent in the rural and underserved areas of the United States but are directed toward all levels of professionals who care for an injured child along the trauma continuum of care.
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Affiliation(s)
- Samuel Wade Ross
- From the Division of Acute Care Surgery, Department of Surgery (S.W.R.), F.H. "Sammy" Ross, Jr. Trauma Center, Atrium Health Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, North Carolina; Division of GI, Trauma, and Endocrine Surgery, Department of Surgery (E.C.), University of Colorado, Denver, Colorado; Division of Pediatric Surgery, Department of Surgery (A.R.J.), UCSF School of Medicine, San Francisco, California; Department of Pediatrics (L.G.), The University of Texas at Austin Dell Medical School, Austin, Texas; Department of Pediatrics (T.G.), Children's Hospital New Orleans, Tulane University School of Medicine; LSU Health Sciences Center (T.G.), New Orleans, Louisiana; Division of Trauma, Burns, and Surgical Critical Care, Daughtry Family Department of Surgery (N.N.), Ryder Trauma Center, University of Miami Miller School of Medicine, Miami, Florida; Department of Emergency Medicine (J.M.G.), University of Oklahoma School of Community Medicine, Tulsa, Oklahoma; Division of Trauma, Burns, and Critical Care, Department of Surgery (E.M.B.), University of Washington, Seattle, Washington; Division of Trauma Surgical Critical Care, Department of Surgery (P.E.F.), University of Tennessee Health Science Center, Memphis, Tennessee; and Hiram C. Polk, Jr. Department of Surgery (M.E.F.), University of Louisville and Norton Children's Hospital, Louisville, Kentucky
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Remick KE, Hewes HA, Ely M, Schmuhl P, Crady R, Cook LJ, Ludwig L, Gausche-Hill M. National Assessment of Pediatric Readiness of US Emergency Departments During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2321707. [PMID: 37418265 PMCID: PMC10329204 DOI: 10.1001/jamanetworkopen.2023.21707] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/10/2023] [Indexed: 07/08/2023] Open
Abstract
Importance The National Pediatric Readiness Project assessment provides a comprehensive evaluation of the readiness of US emergency departments (EDs) to care for children. Increased pediatric readiness has been shown to improve survival for children with critical illness and injury. Objectives To complete a third assessment of pediatric readiness of US EDs during the COVID-19 pandemic, to examine changes in pediatric readiness from 2013 to 2021, and to evaluate factors associated with current pediatric readiness. Design, Setting, and Participants In this survey study, a 92-question web-based open assessment of ED leadership in US hospitals (excluding EDs not open 24 h/d and 7 d/wk) was sent via email. Data were collected from May to August 2021. Main Outcomes and Measures Weighted pediatric readiness score (WPRS) (range, 0-100, with higher scores indicating higher readiness); adjusted WPRS (ie, normalized to 100 points), calculated excluding points received for presence of a pediatric emergency care coordinator (PECC) and quality improvement (QI) plan. Results Of the 5150 assessments sent to ED leadership, 3647 (70.8%) responded, representing 14.1 million annual pediatric ED visits. A total of 3557 responses (97.5%) contained all scored items and were included in the analysis. The majority of EDs (2895 [81.4%]) treated fewer than 10 children per day. The median (IQR) WPRS was 69.5 (59.0-84.0). Comparing common data elements from the 2013 and 2021 NPRP assessments demonstrated a reduction in median WPRS (72.1 vs 70.5), yet improvements across all domains of readiness were noted except in the administration and coordination domain (ie, PECCs), which significantly decreased. The presence of both PECCs was associated with a higher adjusted median (IQR) WPRS (90.5 [81.4-96.4]) compared with no PECC (74.2 [66.2-82.5]) across all pediatric volume categories (P < .001). Other factors associated with higher pediatric readiness included a full pediatric QI plan vs no plan (adjusted median [IQR] WPRS: 89.8 [76.9-96.7] vs 65.1 [57.7-72.8]; P < .001) and staffing with board-certified emergency medicine and/or pediatric emergency medicine physicians vs none (median [IQR] WPRS: 71.5 [61.0-85.1] vs 62.0 [54.3-76.0; P < .001). Conclusions and Relevance These data demonstrate improvements in key domains of pediatric readiness despite losses in the health care workforce, including PECCs, during the COVID-19 pandemic, and suggest organizational changes in EDs to maintain pediatric readiness.
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Affiliation(s)
- Katherine E. Remick
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin
- National Emergency Medical Services for Children Innovation and Improvement Center, Austin, Texas
| | - Hilary A. Hewes
- Emergency Medical Services (EMS) for Children Data Center, Salt Lake City, Utah
- University of Utah, Department of Pediatrics, Salt Lake City
| | - Michael Ely
- Emergency Medical Services (EMS) for Children Data Center, Salt Lake City, Utah
- University of Utah, Department of Pediatrics, Salt Lake City
| | - Patricia Schmuhl
- Emergency Medical Services (EMS) for Children Data Center, Salt Lake City, Utah
- University of Utah, Department of Pediatrics, Salt Lake City
| | - Rachel Crady
- Emergency Medical Services (EMS) for Children Data Center, Salt Lake City, Utah
- University of Utah, Department of Pediatrics, Salt Lake City
| | - Lawrence J. Cook
- Emergency Medical Services (EMS) for Children Data Center, Salt Lake City, Utah
- University of Utah, Department of Pediatrics, Salt Lake City
| | - Lorah Ludwig
- EMS for Children Branch, Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland
| | - Marianne Gausche-Hill
- Departments of Emergency Medicine and Pediatrics, Harbor-UCLA Medical Center, Torrance, California
- The Lundquist Institute at Harbor-UCLA, Torrance, California
- Departments of Emergency Medicine and Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
- The Los Angeles County EMS Agency, Los Angeles, California
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Lieng MK, Marcin JP, Dayal P, Tancredi DJ, Swanson MB, Haynes SC, Romano PS, Sigal IS, Rosenthal JL. Emergency Department Pediatric Readiness and Potentially Avoidable Transfers. J Pediatr 2021; 236:229-237.e5. [PMID: 34000284 PMCID: PMC8830940 DOI: 10.1016/j.jpeds.2021.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the association between potentially avoidable transfers (PATs) and emergency department (ED) pediatric readiness scores and the score's associated components. STUDY DESIGN This cross-sectional study linked the 2012 National Pediatric Readiness Project assessment with individual encounter data from California's statewide ED and inpatient databases during the years 2011-2013. A probabilistic linkage, followed by deterministic heuristics, linked pretransfer, and post-transfer encounters. Applying previously published definitions, a transferred child was considered a PAT if they were discharged within 1 day from the ED or inpatient care and had no specialized procedures. Analyses were stratified by injured and noninjured children. We compared PATs with necessary transfers using mixed-effects logistic regression models with random intercepts for hospital and adjustment for patient and hospital covariates. RESULTS After linkage, there were 6765 injured children (27% PATs) and 18 836 noninjured children (14% PATs) who presented to 283 hospitals. In unadjusted analyses, a 10-point increase in pediatric readiness was associated with lower odds of PATs in both injured (OR 0.93, 95% CI 0.90-0.96) and noninjured children (OR 0.90, 95% CI 0.88-0.93). In adjusted analyses, a similar association was detected in injured patients (aOR 0.92, 95% CI 0.86-0.98) and was not detected in noninjured patients (aOR 0.94, 95% CI 0.88-1.00). Components associated with decreased PATs included having a nurse pediatric emergency care coordinator and a quality improvement plan. CONCLUSIONS Hospital ED pediatric readiness is associated with lower odds of a PAT. Certain pediatric readiness components are modifiable risk factors that EDs could target to reduce PATs.
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Affiliation(s)
- Monica K Lieng
- Department of Pediatrics, University of California, Davis Health, Sacramento, CA.
| | - James P Marcin
- Department of Pediatrics, University of California, Davis Health, Sacramento, CA
| | - Parul Dayal
- Department of Pediatrics, University of California, Davis Health, Sacramento, CA
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis Health, Sacramento, CA
| | - Morgan B Swanson
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Sarah C Haynes
- Department of Pediatrics, University of California, Davis Health, Sacramento, CA
| | - Patrick S Romano
- Department of Pediatrics, University of California, Davis Health, Sacramento, CA
| | - Ilana S Sigal
- Department of Pediatrics, University of California, Davis Health, Sacramento, CA
| | - Jennifer L Rosenthal
- Department of Pediatrics, University of California, Davis Health, Sacramento, CA
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