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Gardiner LA, Godfred-Cato S, Needle S. The Role of Clinic Preparedness to Support Patients and Strengthen the Medical System During and After a Pandemic. Pediatr Clin North Am 2024; 71:383-394. [PMID: 38754931 DOI: 10.1016/j.pcl.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Pediatric clinic preparedness is essential to improve the care and health outcomes for children during a pandemic and to decrease the burden on hospital systems. Clinic preparedness is a process that involves a well thought out plan that includes coordination with staff, open communication between the clinic and patient families, and collaboration with community partners. Planning for disasters can decrease some of the risks for our most vulnerable patients, including children and youth with special health care needs. There are plans, coalitions, and community partners that can help clinics in their preparedness journey.
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Affiliation(s)
- Lesley A Gardiner
- Department of Primary Care & Clinical Medicine, Sam Houston State University - College of Osteopathic Medicine, 925 City Central Avenue, Conroe, TX 77304, USA
| | - Shana Godfred-Cato
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Spencer Fox Eccles School of Medicine at the University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA
| | - Scott Needle
- Woodland Clinic Medical Group, 1207 Fairchild Court, Woodland, CA 95695, USA.
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Yaskey R, Dahl-Grove D. Pediatric Pandemics and Disasters - A Summary. Pediatr Clin North Am 2024; 71:353-370. [PMID: 38754929 DOI: 10.1016/j.pcl.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Children make up approximately 25% of the population in the United States and are particularly vulnerable to the impact of disasters. The creation of federally-funded programs and advisory committees has had a positive impact on addressing the needs of children and families in disasters by identifying best practices, disseminating information, identifying gaps, and providing information with future investments that will contribute to expanding disaster science for children and their families.
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Affiliation(s)
- Regina Yaskey
- UH Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Deanna Dahl-Grove
- UH Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Curto C. Celebrating Magnet® Nursing Excellence-Meet the Recipients of the 2023 National Magnet Nurse of the Year® Awards and ANCC Magnet Prize®. J Nurs Adm 2024; 54:133-136. [PMID: 38381567 DOI: 10.1097/nna.0000000000001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
ABSTRACT This month's Magnet® Perspectives column spotlights the recipients of the 2023 American Nurses Credentialing Center (ANCC) Magnet Program® National Magnet Nurse of the Year® (MNOY) awards and the ANCC Magnet Prize®, sponsored by Press Ganey, recognized during the colocated ANCC National Magnet Conference® and the ANCC Pathway to Excellence Conference® in Chicago, Illinois, October 12 to 14, 2023. The MNOY awards recognize 5 clinical nurses in Magnet designated organizations who demonstrate outstanding contributions in innovation, consultation, leadership, and professional risk taking. The ANCC Magnet Prize, sponsored by Press Ganey, recognizes a Magnet organization whose nursing team spearheaded exemplary achievements including initiative(s) in healthcare delivery and research leading to innovations in patient care services. Press Ganey sponsors the Magnet Prize by providing a $125 000 purse to further develop and advance its innovative program/project.
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Affiliation(s)
- Christine Curto
- Author Affiliation: Assistant Director, Magnet Recognition Program , American Nurses Credentialing Center, Silver Spring, Maryland
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Honcoop A, McCulloh RJ, Kerns E, Lowndes B, Simon T, McCawley N, Flores R, Clarke M. An assessment of information needs and workflows for emergency service providers and caregivers of children with medical complexity. BMC Health Serv Res 2023; 23:453. [PMID: 37158902 PMCID: PMC10166030 DOI: 10.1186/s12913-023-09366-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/04/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The goal of Project Austin, an initiative to improve emergency care for rural children who are medically complex (CMC), is to provide an Emergency Information Form (EIF) to their parents/caregivers, to local Emergency Medical Services, and Emergency Departments. EIFs are standard forms recommended by the American Academy of Pediatrics that provide pre-planned rapid response instructions, including medical conditions, medications, and care recommendations, for emergency providers. Our objective is to describe the workflows and perceived utility of the provided emergency information forms (EIFs) in the acute medical management of CMC. METHODS We sampled from two key stakeholder groups in the acute management of CMC: four focus groups with emergency medical providers from rural and urban settings and eight key informant interviews with parents/caregivers enrolled in an emergency medical management program for CMC. Transcripts were thematically analyzed in NVivo© by two coders using a content analysis approach. The thematic codes were combined into a codebook and revised the themes present through combining relevant themes and developing of sub-themes until they reached consensus. RESULTS All parents/caregivers interviewed were enrolled in Project Austin and had an EIF. Emergency medical providers and parents/caregivers supported the usage of EIFs for CMC. Parents/caregivers also felt EIFs made emergency medical providers more prepared for their child. Providers identified that EIFs helped provide individualized care, however they were not confident the data was current and so felt unsure they could rely on the recommendations on the EIF. CONCLUSION EIFs are an easy way to engage parents, caregivers, and emergency medical providers about the specifics of a care for CMC during an emergency. Timely updates and electronic access to EIFs could improve their value for medical providers.
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Affiliation(s)
- Aubree Honcoop
- University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, USA.
| | - Russell J McCulloh
- University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, USA
- Children's Hospital and Medical Center, Omaha, NE, USA
| | - Ellen Kerns
- University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, USA
- Children's Hospital and Medical Center, Omaha, NE, USA
| | - Bethany Lowndes
- University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, USA
| | - Tiffany Simon
- Children's Hospital and Medical Center, Omaha, NE, USA
| | | | | | - Martina Clarke
- University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, USA
- University of Nebraska Omaha, Omaha, NE, USA
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Callahan JM, Baldwin S, Bodnar C, Fuchs S, Krug S, Lightfoot C, Raskas M, Weinberg S. Access to Critical Health Information for Children During Emergencies: Emergency Information Forms and Beyond. Ann Emerg Med 2023; 81:e27-e36. [PMID: 36813444 DOI: 10.1016/j.annemergmed.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 02/22/2023]
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Pulcini CD, Dubuque A, Lamberson M, Macy ML, Mistry RD, Pruitt CM, Schnadower D, Zorc JJ, Stevens MW. Pediatric Emergency Medicine Physicians' Perspectives on Emergency Care of Children With Medical Complexity: A Multi-institution Mixed-Methods Assessment. Pediatr Emerg Care 2022; 38:e1423-e1427. [PMID: 35436769 DOI: 10.1097/pec.0000000000002712] [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: 11/25/2022]
Abstract
OBJECTIVE Children with medical complexity (CMC) compose 1% of the pediatric population but account for 20% of pediatric emergency department (ED) visits. Previous descriptions of challenges and interventions to ensure quality of care are limited. Our objective was to elicit pediatric emergency medicine (PEM) physicians' perspectives on challenges and opportunities for improvement of emergency care of CMC, with a focus on emergency information forms (EIFs). METHODS We conducted a web-based survey of PEM physicians participating the American Academy of Pediatrics Section on Emergency Medicine Survey listserv. The survey was designed using an expert panel, and subsequently piloted and revised to an 18-item survey. Data were analyzed with descriptive statistics. RESULTS One hundred fifty-one of 495 respondents (30%) completed the survey. Most respondents (62.9%) reported caring for >10 CMC per month. Whereas overall medical fragility and time constraints were major contributors to the challenges of caring for CMC in the ED, communication with known providers and shared care plans were identified as particularly helpful. Most respondents did not report routine use of EIFs. Anticipated emergencies/action plan was deemed the most important component of EIFs. CONCLUSIONS Most PEM physicians view the care for CMC in the ED as challenging despite practicing in high-resource environments. Further research is needed to develop and implement strategies to improve care of CMC in the ED. Understanding experiences of providers in general ED settings is also an important next step given that 80% of CMC present for emergency care outside of major children's hospitals.
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Affiliation(s)
- Christian D Pulcini
- From the Division of Emergency Medicine, Department of Surgery and Pediatrics
| | - Amy Dubuque
- Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
| | - Miles Lamberson
- Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
| | - Michelle L Macy
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph J Zorc
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Martha W Stevens
- From the Division of Emergency Medicine, Department of Surgery and Pediatrics
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Gereige RS, Gross T, Jastaniah E. Individual Medical Emergencies Occurring at School. Pediatrics 2022; 150:188345. [PMID: 35757966 DOI: 10.1542/peds.2022-057987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Children and adults may face emergency medical situations because of injuries, complications of chronic health conditions, or unexpected major illnesses that occur in schools. The American Academy of Pediatrics published a policy statement in 2001 titled "Guidelines for Emergency Medical Care in Schools," and in 2008, published its revision, "Medical Emergencies Occurring at School." Those statements focused on the preparedness of schools to address individual student emergencies. The increase in the number of children with special health care needs and chronic medical conditions attending schools, together with the added challenges faced by school districts to ensure that schools have access to on-site, licensed health care professionals on an ongoing basis, have contributed to added risks that medical and nonmedical personnel face in dealing with medical emergencies in schools. This newly revised policy statement serves as an update of the statement published in 2008 and reaffirmed in 2017, and intends to increase pediatricians' awareness of schools' roles in preparing for individual student emergencies and provide recommendations for the medical home and school physicians on how to assist and support school personnel. This statement does not address schoolwide or communitywide emergencies that might occur as a result of natural or man-made disasters.
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Affiliation(s)
- Rani S Gereige
- Director of Medical Education, Department of Medical Education, Nicklaus Children's Hospital, Miami, Florida
| | - Toni Gross
- Emergency Medicine, Children's Hospital New Orleans, New Orleans, Louisiana
| | - Ebaa Jastaniah
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Arkansas Children's Hospital/UAMS, Little Rock, Arkansas.,Department of Emergency Medicine, Section of Pediatric Emergency Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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Abstract
School-based health centers (SBHCs) are unique health care settings for our nation's school-aged children and adolescents. SBHCs represent the collaboration between the health and school communities to support the health and mental health needs and the academic achievements of children and adolescents, particularly students with health disparities or poor access to health care. SBHCs improve access to health care services for students by decreasing financial, geographic, age, and cultural barriers. This policy statement provides an overview of SBHCs, including the scope of services as well as some of the documented benefits and challenges. This policy statement also reviews the role of SBHCs in working with the pediatric medical home and provides recommendations that support the coordination of SBHCs with pediatric primary care providers and the pediatric medical home.
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Fratta KA, Fishe JN, Schenk E, Anders JF. Emergency Medical Services Clinicians' Pediatric Destination Decision-Making: A Qualitative Study. Cureus 2021; 13:e17443. [PMID: 34589349 PMCID: PMC8462747 DOI: 10.7759/cureus.17443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 11/05/2022] Open
Abstract
Objective This study sought to identify factors that influence emergency medical services (EMS) clinicians' destination decision-making for pediatric patients. We also sought EMS clinicians' opinions on potential systems improvements, such as protocol changes and the use of evidence-based transport guidelines. Methods Thirty-six in-depth phone interviews were conducted using a semi-structured format. We utilized a modified Grounded Theory approach to understand the complicated decision-making processes of EMS personnel. Memo writing was used throughout the data collection and analysis processes in order to identify emerging themes. The research team utilized hierarchical coding of interview transcripts to organize data into sub-categories for final analysis. Results EMS clinicians cited the perceived need for specialty care, the presence of a medical home, a desire for improved continuity of care, and the availability of aeromedical transport as factors that promoted transport to a pediatric specialty center. They voiced that children with emergent stabilization needs should be transported to the closest facility, however, they did not identify any specific medical conditions suitable for transport to non-specialty centers. EMS clinicians recommended improvements in pediatric-specific education, improved clarity of hospitals' pediatric capabilities, and the creation of a pediatric-specific destination decision-making tool. Conclusion This study describes specific factors that influence EMS clinicians' transport destination decision-making for pediatric patients. It also describes potential systems and educational improvements that may increase pediatric transport directly to definitive care. EMS clinicians are in support of specific designations for hospitals' pediatric capabilities and were in favor of the creation of a formal destination decision-making tool.
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Affiliation(s)
- Kyle A Fratta
- Emergency Medicine, University of Pittsburgh Medical Center, Harrisburg, USA
| | - Jennifer N Fishe
- Pediatric Emergency Medicine, University of Florida College of Medicine, Jacksonville, USA
| | - Ellen Schenk
- Epidemiology and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Jennifer F Anders
- Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Fuchs S. The Origins and Evolution of Emergency Medical Services for Children. Pediatr Ann 2021; 50:e150-e154. [PMID: 34039172 DOI: 10.3928/19382359-20210316-01] [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: 11/20/2022]
Abstract
The emergency medical services for children (EMSC) program was established in 1984 to improve the quality of emergency care for children. Since that time, all 50 states and Washington, DC, 5 US territories, and 3 freely associated states have received federal funding to achieve this goal. There have been many unique training and education programs developed, along with quality improvement and pediatric research initiatives. This article provides a history of the EMSC program and its accomplishments. [Pediatr Ann. 2021;50(4):e150-e154.].
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Wendel D, Mezoff EA, Raghu VK, Kinberg S, Soden J, Avitzur Y, Rudolph JA, Gniadek M, Cohran VC, Venick RS, Cole CR. Management of Central Venous Access in Children With Intestinal Failure: A Position Paper From the NASPGHAN Intestinal Rehabilitation Special Interest Group. J Pediatr Gastroenterol Nutr 2021; 72:474-486. [PMID: 33399327 PMCID: PMC8260029 DOI: 10.1097/mpg.0000000000003036] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT Intestinal failure requires the placement and maintenance of a long-term central venous catheter for the provision of fluids and/or nutrients. Complications associated with this access contribute to significant morbidity and mortality, while the loss of access is an increasingly common reason for intestinal transplant referral. As more emphasis has been placed on the prevention of central line-associated bloodstream infections and new technologies have developed, care for central lines has improved; however, because care has evolved independently in local centers, care of central venous access varies significantly in this vulnerable population. The present position paper from the Intestinal Failure Special Interest Group of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) reviews current evidence and provides recommendations for central line management in children with intestinal failure.
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Affiliation(s)
- Danielle Wendel
- Division of Gastroenterology and Hepatology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | - Ethan A. Mezoff
- Division of Gastroenterology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
| | - Vikram K. Raghu
- Division of Gastroenterology, Hepatology, and Nutrition, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sivan Kinberg
- Division of Gastroenterology, Hepatology, and Nutrition, New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University, New York, NY
| | - Jason Soden
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Yaron Avitzur
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jeffrey A. Rudolph
- Division of Gastroenterology, Hepatology, and Nutrition, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michelle Gniadek
- Division of Gastroenterology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
| | - Valeria C. Cohran
- Division of Gastroenterology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert S. Venick
- Division of Gastroenterology, Hepatology, and Nutrition, UCLA Mattel Children’s Hospital, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Conrad R. Cole
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH
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Schneider M, Mehari K, Langhinrichsen-Rohling J. What Caregivers Want: Preferences for Behavioral Health Screening Implementation Procedures in Pediatric Primary Care. J Clin Psychol Med Settings 2020; 28:562-574. [PMID: 33048313 DOI: 10.1007/s10880-020-09745-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 01/04/2023]
Abstract
There has been a national push for universal psychosocial prevention screening in pediatric primary care. Implementation science highlights the importance of considering patients' perspectives when developing such procedures; however, minimal studies have examined this. The present study employed a mixed-methods design to examine caregivers of pediatric patients' (n = 149) preferences and comfort with psychosocial screening procedures. A subset of participants (n = 20) were interviewed to better understand reasons for responses. Results indicated that caregivers rated screening for physical health, development, emotion and behavior, caregiver adverse childhood experiences (ACEs), and child ACEs within primary care as important or very important. The majority of caregivers were not comfortable completing screenings in the waiting room and preferred the exam room. Caregivers primarily preferred the primary care provider to administer screenings and communicate results and recommendations. Parents also preferred the behavioral health provider to provide recommendations on emotion and behavior, parent ACEs, and child ACEs. Qualitative reasons for responses included relationship quality, knowledge of child, expertise, and desire for direct communication. Findings have implications for developing family-centered, trauma-informed practices within primary care, particularly among those within under-resourced rural communities.
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Affiliation(s)
- Mallory Schneider
- Department of Psychology, University of South Alabama, 307 N University Blvd, UCOM 1000, Mobile, AL, 36606, USA.
| | - Krista Mehari
- Department of Psychology, University of South Alabama, 307 N University Blvd, UCOM 1000, Mobile, AL, 36606, USA
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Kamzan A, Jun-Ihn E, Kulkarni D. On the Front Lines of Pediatric Complex Care: Are We Preparing Emergency Medicine Residents? Hosp Pediatr 2020; 10:712-714. [PMID: 32680917 DOI: 10.1542/hpeds.2020-0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Audrey Kamzan
- Department of Pediatrics, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Esther Jun-Ihn
- Department of Pediatrics, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Deepa Kulkarni
- Department of Pediatrics, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California
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Fano C, Lorenzoni G, Azzolina D, Giuliani A, French M, Campagna S, Berchialla P, Gregori D. Perception of Choking Injury Risk Among Healthcare Students. J Community Health 2020; 44:974-981. [PMID: 30993473 DOI: 10.1007/s10900-019-00662-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Choking injuries in children represent a severe public health burden. Although most choking injuries are due to food, parents have often been found to be unaware of the choking hazards presented by food. In this context, healthcare professionals may play an important role in choking prevention by educating families. We investigate the perception of choking injury risk among healthcare profession students by comparing their awareness and knowledge of choking hazards with those of people without a specific health education. A survey was conducted among a sample of final year healthcare profession students from two universities in northern Italy and a sample of adults from the general population without any health education. Respondents were asked to look at ten pictures and identify the items that pose the greatest choking hazard to children of different age groups. Seventy-one students and 742 adults without any health education responded to the survey. A higher percentage of the adults without a health education identified a food item as posing the greatest choking hazard in comparison to the percentage of healthcare profession students. The results of this study suggest that there is a need to include specific educational modules on choking prevention in healthcare-related degree programs.
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Affiliation(s)
- Carolina Fano
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padova, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padova, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padova, Italy
| | | | | | - Sara Campagna
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padova, Italy.
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15
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Copper TC, Jeffe DB, Ahmad FA, Abraham G, Yu F, Hickey B, Schnadower D. Emergency Information Forms for Children With Medical Complexity: A Qualitative Study. Pediatr Emerg Care 2020; 36:e318-e323. [PMID: 29489603 PMCID: PMC6113122 DOI: 10.1097/pec.0000000000001443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Children with medical complexity (CMC) are at risk for poor outcomes during medical emergencies. Emergency information forms (EIFs) provide essential medical information for CMC during emergencies; however, they are not widely used. We sought to identify factors related to optimal care for CMC to inform development of EIFs for CMC. METHODS We interviewed 26 stakeholders, including parents of CMC, healthcare providers, health information technology, and privacy compliance experts. We inquired about barriers and facilitators to emergency care of CMC, as well as the desired content, structure, ownership, and maintenance of an EIF. Audio recordings were transcribed and analyzed inductively for common themes using thematic analysis techniques. RESULTS Providers identified problems with documentation and poor caregiver understanding as major barriers to care. Parents reported poor provider understanding of their child's condition as a barrier. All groups reported that summary documents facilitate quality care. Recommended content included demographic/contact information, medical history, medications, allergies, advance directives, information about the patient's disease, and an action plan for anticipated emergencies. Twenty-three participants indicated a preference for electronic EIFs; 19 preferred a Web-based EIF that syncs with the medical record, with paper or portable electronic copies. Although 13 participants thought that EIFs should be patient owned to ensure availability during emergencies, 19 expected medical providers to create and update EIFs. CONCLUSIONS Stakeholders interviewed reported a preference for Web-based, sync-capable EIFs with portable copies. Emergency information forms could be maintained by providers but owned by patients to optimize emergency care and align with the concept of the medical home.
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Affiliation(s)
| | - Donna B Jeffe
- Division of General Medical Sciences, Department of Medicine
| | - Fahd A Ahmad
- From the Division of Emergency Medicine, Department of Pediatrics
| | - George Abraham
- From the Division of Emergency Medicine, Department of Pediatrics
| | - Feliciano Yu
- Division of Hospitalist Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Brianna Hickey
- From the Division of Emergency Medicine, Department of Pediatrics
| | - David Schnadower
- From the Division of Emergency Medicine, Department of Pediatrics
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Abstract
It is crucial that all children are provided with high-quality and safe health care. Pediatric inpatient needs are unique in regard to policies, equipment, facilities, and personnel. The intent of this clinical report is to provide recommendations for the resources necessary to provide high-quality and safe pediatric inpatient medical care.
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Affiliation(s)
- Kimberly D Ernst
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma
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Abstract
Chemical and biological events (including infectious disease outbreaks) may affect children disproportionately, and the threat of a chemical or biological attack remains in the United States and worldwide. Although federal programs and funding support a broad range of federal initiatives for public health preparedness and response, funding at the state and local levels has been flat or is decreasing, potentially leaving communities vulnerable. Consequently, pediatricians need to prepare and be ready to care for children in their communities before, during, and after a chemical or biological event, including during long-term recovery. Some medical countermeasures for particular chemical and biological agents have not been adequately studied or approved for children. The American Academy of Pediatrics provides resources and education on disaster preparedness and response, including information on the pediatrician's role in disasters, pediatric medical countermeasures, and mental health after an event as well as individual and family preparedness. This policy statement addresses the steps that clinicians and policy makers can take to protect children and mitigate the effects of a chemical or biological attack.
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Affiliation(s)
- Sarita Chung
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts;
| | - Carl R Baum
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, School of Medicine, Yale University, New Haven, Connecticut; and
| | - Ann-Christine Nyquist
- Section of Pediatric Infectious Diseases and Epidemiology, Department of Pediatrics, Children's Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
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18
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Caring for Children With Medical Complexity With the Emergency Information Form. Pediatr Emerg Care 2020; 36:57-61. [PMID: 31895202 DOI: 10.1097/pec.0000000000002021] [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: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The American Academy of Pediatrics recommends an emergency information form (EIF) for children with medical complexity (CMC) to facilitate emergency care. We sought to increase the EIF completion rate at our children's hospital's CMC clinic and to evaluate the effect on caregiver and emergency department (ED) provider opinion of preparation, comfort, and communication. METHODS We used a pre/post-quality improvement design. The main outcomes were (1) the proportion of completed EIFs and (2) caregiver and ED provider opinion of preparation, comfort, and communication, using a Likert scale survey (1, low; 5, high). RESULTS Emergency information form completion increased from 3.1% (4/133) before the intervention to 47.0% (78/166) after (P < 0.001). Twenty-three providers completed presurveys, and 8 completed postsurveys. Seventy-two caregivers completed presurveys, and 38 completed postsurveys (25 with ED visit and 13 without). There were no changes in preparation, comfort, or communication for caregivers who had an ED visit after the intervention. For those without a postintervention ED visit, caregiver median scores rose for preparation (4 [interquartile range {IQR}, 3-5] vs 5 [IQR, 4-5], P = 0.02) and comfort (4 [IQR, 2.25-5] vs 5 [IQR, 4-5], P = 0.05). After the intervention, ED providers had increased median communication scores (3 [IQR, 2.75-4.25] vs 5 [IQR, 4-5], P = 0.02), whereas scores of preparation and comfort were unchanged. CONCLUSION A quality improvement project at a CMC clinic increased EIF completion, caregiver preparation and comfort, and ED provider communication in emergencies.
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Ethics of Approaching Parents for Pediatric Donation After Circulatory Death. CURRENT PEDIATRICS REPORTS 2019. [DOI: 10.1007/s40124-019-00205-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Patient at Risk: Emergency medical service providers' opinions on improving an electronic emergency information form database for the medical care of children with special health care needs. Disabil Health J 2019; 13:100852. [PMID: 31699640 DOI: 10.1016/j.dhjo.2019.100852] [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: 06/03/2019] [Revised: 09/29/2019] [Accepted: 10/17/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patient at Risk (PAR) is an online database using an emergency information form (EIF) that parents of children with special health care needs (CSHCN) complete to store their child's medical information. Emergency medical service (EMS) providers can then access PAR during medical emergencies or for pre-planning. PAR was active for over 10 years but use by patients and EMS was limited. OBJECTIVE To determine EMS perspectives on why PAR was not used to its full potential and how to improve PAR for EMS. METHODS Seven questions regarding PAR were developed and presented in focus groups at 32 fire/ambulance houses in southeast and central Wisconsin from June to August 2017. Responses were transcribed and reviewed for themes. RESULTS 146 EMS providers participated and 11% were aware of PAR. Many did not use PAR because of a lack of follow up or barriers such as limited internet access, inconvenience, other urgent responsibilities, and not knowing when to use PAR. Solutions to these issues include developing or purchasing new technology, involving the dispatch operator in PAR, and returning to a paper-based EIF. The EIF layout and content received very positive reviews with few changes suggested. Most providers felt PAR was important because it would help them provide better care and feel more comfortable treating CSHCN. CONCLUSION Despite technological and logistical barriers, EMS providers want online EIF databases for pre-planning and utilization during ambulance runs so they can practice more informed and focused care, especially for vulnerable and medically challenging CSHCN.
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Gillen JK, Morris MC. Preparing Families of Technology-Dependent Children for Emergencies. Hosp Pediatr 2019; 9:874-879. [PMID: 31591139 DOI: 10.1542/hpeds.2019-0091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To characterize the baseline level of emergency preparedness among families of technology-dependent children admitted to our PICU and to determine if an ICU-based planning intervention can sustainably improve families' disaster preparedness. METHODS A single-arm, survey-based study used to assess participants' preparedness to handle a 72-hour home power outage on the basis of a novel 8-point checklist. Parents of patients in the study completed the survey questions when their child was admitted to the PICU, discharged, or transferred from the PICU, after at least 2 weeks at home, and after at least 6 months at home. This study included a cohort of 50 children younger than18 years old who required daily use of at least 1 piece of qualifying electronic medical equipment at home and their custodial parents. The checklist surveyed was designed with the goals of maximizing care capacity at home during a power outage and planning for evacuation. Counseling and other resources were provided on the basis of item completion at admission assessment. RESULTS Patients' families completed a median of 3 items (range: 0-8; N = 50) at admission, 4 items (range: 1-8; n = 45) at discharge, and 7 items (range: 3-8; n = 37) at the 2-week follow-up and retained 7 items (range: 5-8; n = 29) at the 6-month follow-up. Completion rates were significantly higher at each follow-up time point compared with baseline (P < .001). CONCLUSIONS Families of technology-dependent children admitted to our PICU have significant disaster-preparedness needs, which can be addressed with an inpatient intervention.
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Affiliation(s)
- Jennifer K Gillen
- Department of Pediatrics, Division of Critical Care, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Marilyn C Morris
- Department of Pediatrics, Division of Critical Care, Columbia University, New York, New York
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22
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Ambrose MJ, Walton EA, Lerner M, De Pinto C, Baum M, Beers NS, Bode S, Gibson EJ, Gorski P, Kjolhede C, O’Leary SC, Schumacher H, Weiss-Harrison A. Improving Health and Safety at Camp. Pediatrics 2019; 144:peds.2019-1355. [PMID: 31209160 DOI: 10.1542/peds.2019-1355] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics has created recommendations for health appraisal and preparation of young people before participation in day, resident, or family camps and to guide health and safety practices at camp. These recommendations are intended for parents and families, primary health care providers, and camp administration and health center staff. Although camps have diverse environments, there are general guidelines that apply to all situations and specific recommendations that are appropriate under special conditions. This policy statement has been reviewed and is supported by the American Camp Association and Association of Camp Nursing.
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Spirito A, Bromberg JR, Casper TC, Chun T, Mello MJ, Mull CC, Shenoi RP, Vance C, Ahmad F, Bajaj L, Brown KM, Chernick LS, Cohen DM, Fein J, Horeczko T, Levas MN, McAninch B, Monuteaux MC, Grupp-Phelan J, Powell EC, Rogers A, Suffoletto B, Linakis JG. Screening for Adolescent Alcohol Use in the Emergency Department: What Does It Tell Us About Cannabis, Tobacco, and Other Drug Use? Subst Use Misuse 2019; 54:1007-1016. [PMID: 30727811 PMCID: PMC6476662 DOI: 10.1080/10826084.2018.1558251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The pediatric emergency department (PED) represents an opportune time for alcohol and drug screening. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends a two-question alcohol screen for adolescents as a predictor of alcohol and drug misuse. OBJECTIVE A multi-site PED study was conducted to determine the association between the NIAAA two-question alcohol screen and adolescent cannabis use disorders (CUD), cigarette smoking, and lifetime use of other drugs. METHODS Participants included 12-17-year olds (n = 4834) treated in one of 16 participating PEDs. An assessment battery, including the NIAAA two-question screen and other measures of alcohol, tobacco and drug use, was self-administered on a tablet computer. RESULTS A diagnosis of CUD, lifetime tobacco use or lifetime drug use was predicted by any self-reported alcohol use in the past year, which indicates a classification of moderate risk for middle school ages and low risk for high school ages on the NIAAA two-question screen. Drinking was most strongly predictive of a CUD, somewhat weaker for lifetime tobacco use, and weakest for lifetime drug use. This same pattern held for high school and middle school students and was stronger for high school students over middle school students for all three categories. This association was also found across gender, ethnicity and race. The association was strongest for CUD for high school students, sensitivity 81.7% (95% CI, 77.0, 86.5) and specificity 70.4% (95% CI, 68.6, 72.1). Conclusions/Importance: A single question about past year alcohol use can provide valuable information about other substance use, particularly marijuana.
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Affiliation(s)
- Anthony Spirito
- a The Warren Alpert Medical School of Brown University, Departments of Psychiatry and Human Behavior, Pediatrics, Emergency Medicine, Providence, Rhode Island, USA
| | - Julie R Bromberg
- a The Warren Alpert Medical School of Brown University, Departments of Psychiatry and Human Behavior, Pediatrics, Emergency Medicine, Providence, Rhode Island, USA.,b Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island, USA
| | - T Charles Casper
- c University of Utah, Department of Pediatrics, Salt Lake City, Utah, USA
| | - Thomas Chun
- a The Warren Alpert Medical School of Brown University, Departments of Psychiatry and Human Behavior, Pediatrics, Emergency Medicine, Providence, Rhode Island, USA.,b Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island, USA
| | - Michael J Mello
- a The Warren Alpert Medical School of Brown University, Departments of Psychiatry and Human Behavior, Pediatrics, Emergency Medicine, Providence, Rhode Island, USA.,b Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island, USA
| | - Colette C Mull
- d Nemours/Alfred I. duPont Hospital for Children, Department of Pediatrics, Wilmington, Delaware, USA
| | - Rohit P Shenoi
- e Baylor College of Medicine/Texas Children's Hospital, Departments of Emergency Medicine and Pediatrics, Houston, Texas, USA
| | - Cheryl Vance
- f University of California , Davis, Department of Pediatrics, Davis , California, USA
| | - Fahd Ahmad
- g St. Louis Children's Hospital/Washington University, Department of Emergency Medicine, St. Louis, Washington, USA
| | - Lalit Bajaj
- h Children's Hospital - Colorado, Departments of Pediatric Emergency Medicine and Pediatrics, Aurora, Colorado, USA
| | - Kathleen M Brown
- i Children's National Medical Center, Department of Emergency Medicine and Trauma Services, Washington, DC, USA
| | - Lauren S Chernick
- j Columbia University Medical Center, Department of Pediatric Emergency Medicine, New York, New York, USA
| | - Daniel M Cohen
- k Nationwide Children's Hospital, Departments of Pediatrics and Emergency Medicine, Columbus, Ohio, USA
| | - Joel Fein
- l The Children's Hospital of Philadelphia, Departments of Pediatrics and Emergency Medicine, Philadelphia, Pennsylvania, USA
| | - Timothy Horeczko
- m Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Department of Emergency and Pediatric Emergency Medicine, Los Angeles, California, USA
| | - Michael N Levas
- n Medical College of Wisconsin, Department of Pediatric Emergency Medicine, Milwaukee, Wisconsin, USA
| | - B McAninch
- o University of Pittsburgh/Children's Hospital of Pittsburgh of UPMC, Division of Pediatric Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael C Monuteaux
- p Boston Children's Hospital, Department of Pediatrics, Boston, Massachusetts, USA
| | - Jackie Grupp-Phelan
- q University of California , San Francisco, Department of Pediatric Emergency Medicine, San Francisco , California, USA
| | - Elizabeth C Powell
- r Lurie Children's Hospital of Chicago, Department of Pediatric Emergency Medicine, Chicago, Illinois, USA
| | - Alexander Rogers
- s University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan, USA
| | - Brian Suffoletto
- o University of Pittsburgh/Children's Hospital of Pittsburgh of UPMC, Division of Pediatric Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - James G Linakis
- a The Warren Alpert Medical School of Brown University, Departments of Psychiatry and Human Behavior, Pediatrics, Emergency Medicine, Providence, Rhode Island, USA.,b Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island, USA
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Benjamin L, Frush K, Shaw K, Shook JE, Snow SK. Pediatric Medication Safety in the Emergency Department. Ann Emerg Med 2018; 71:e17-e24. [PMID: 29458814 DOI: 10.1016/j.annemergmed.2017.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Indexed: 12/21/2022]
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Benjamin LS, Carney MM. Furthering the Value of the Emergency Department Beyond Its Walls: Transitions to the Medical Home for Pediatric Emergency Patients. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
OBJECTIVES Disruption in the care of special healthcare needs children may lead to life-threatening situations or preventable secondary conditions. California averages more than 100 earthquakes per week. Subsequent power outages, damage to utility systems, and road damage after an earthquake can have grave consequences for families with parenteral nutrition (PN)-dependent children. The purpose of the study was to demonstrate that we could improve disaster preparedness of families with PN-dependent children utilizing individualized family education and distribution of personalized disaster survival toolkits. METHODS We administered a baseline survey to assess disaster preparedness of our families with PN-dependent children followed by individualized disaster survival toolkit distribution and education. We followed up with these families with phone call surveys at 2 and 4 months. A generalized estimating equation with both logistic and linear regression was used to analyze data over the follow-up period. RESULTS We found statistically significant improvements in developing a family emergency plan (P < 0.0001), having a basic emergency supply kit (P < 0.0001), having a completed emergency information form from the child's provider (P < 0.0001), and the confidence level or readiness for a disaster (P < 0.0001). All participants had extra batteries for PN infusion pumps. Having alternative power sources, such as a generator, did not significantly change over time. CONCLUSIONS Individualized disaster education helped families with PN-dependent children not only to prepare for a possible earthquake, but also to feel more confident in their ability to handle a natural disaster.
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Hipper TJ, Davis R, Massey PM, Turchi RM, Lubell KM, Pechta LE, Rose DA, Wolkin A, Briseño L, Franks JL, Chernak E. The Disaster Information Needs of Families of Children with Special Healthcare Needs: A Scoping Review. Health Secur 2018; 16:178-192. [PMID: 29883200 PMCID: PMC11015856 DOI: 10.1089/hs.2018.0007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Families with children who have access and mobility challenges, chronic illness, or intellectual or developmental disabilities require targeted messages before, during, and after disasters to ensure that they understand risks to their children's health and can take measures to avoid harm and build resilience. A scoping review was conducted to assess current evidence for optimal ways to address the disaster information needs and communication preferences of families with children and youth with special healthcare needs. The disaster information needs of such families remain understudied, with few published evidence-based practices. Much of the relevant research focuses on information content, specifically the preparedness needs of these families; disaster recovery information for them remains a major gap. The few studies that have been performed suggest that parents with children and youth with special healthcare needs require additional information, education, and training to develop an effective disaster preparedness plan for their children. They are also largely unaware of schools' disaster plans, and schools are often unable to meet parents' expectations for timely, accurate information during a disaster. Several guidance documents highlighted the importance of completing an emergency information form before an event. Several studies suggested that one-on-one education or counseling was a strategy for encouraging preparedness planning; others highlighted potential value in incorporating families directly into disaster risk reduction planning. Evidence about channel preferences and their effectiveness in this population was generally lacking. Future studies should expand the evidence basis for optimal communication during all disaster phases both with parents of children and youth with special healthcare needs and with children directly.
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Desai AD, Jacob-Files EA, Wignall J, Wang G, Pratt W, Mangione-Smith R, Britto MT. Caregiver and Health Care Provider Perspectives on Cloud-Based Shared Care Plans for Children With Medical Complexity. Hosp Pediatr 2018; 8:394-403. [PMID: 29871887 DOI: 10.1542/hpeds.2017-0242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Shared care plans play an essential role in coordinating care across health care providers and settings for children with medical complexity (CMC). However, existing care plans often lack shared ownership, are out-of-date, and lack universal accessibility. In this study, we aimed to establish requirements for shared care plans to meet the information needs of caregivers and providers and to mitigate current information barriers when caring for CMC. METHODS We followed a user-centered design methodology and conducted in-depth semistructured interviews with caregivers and providers of CMC who receive care at a tertiary care children's hospital. We applied inductive, thematic analysis to identify salient themes. Analysis occurred concurrently with data collection; therefore, the interview guide was iteratively revised as new questions and themes emerged. RESULTS Interviews were conducted with 17 caregivers and 22 providers. On the basis of participant perspectives, we identified 4 requirements for shared care plans that would help meet information needs and mitigate current information barriers when caring for CMC. These requirements included the following: (1) supporting the accessibility of care plans from multiple locations (eg, cloud-based) and from multiple devices, with alert and search features; (2) ensuring the organization is tailored to the specific user; (3) including collaborative functionality such as real-time, multiuser content management and secure messaging; and (4) storing care plans on a secure platform with caregiver-controlled permission settings. CONCLUSIONS Although further studies are needed to understand the optimal design and implementation strategies, shared care plans that meet these specified requirements could mitigate perceived information barriers and improve care for CMC.
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Affiliation(s)
- Arti D Desai
- Department of Pediatrics, University of Washington, Seattle, Washington; .,Seattle Children's Research Institute, Seattle, Washington
| | | | - Julia Wignall
- Seattle Children's Research Institute, Seattle, Washington
| | - Grace Wang
- Undergraduate Research Program, University of Washington, Seattle, Washington; and
| | - Wanda Pratt
- Department of Biomedical and Health Informatics, The Information School, and
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
| | - Maria T Britto
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Rubenstein J, Kaplow J, Moresco B, Kang TI. Impact of Natural Disasters on Children Receiving Palliative Care Lessons Learned from Hurricane Harvey. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0170-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Benjamin L, Frush K, Shaw K, Shook JE, Snow SK, Wright J, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N, Joseph M, Alade K, Amato C, Avarello JT, Baldwin S, Barata IA, Berg K, Brown K, Bullard-Berent J, Dietrich AM, Friesen P, Gerardi M, Heins A, Holtzman DK, Homme J, Horeczko T, Ishimine P, Lam S, Long K, Mayz K, Mehta S, Mellick L, Ojo A, Paul AZ, Pauze DR, Pearson NM, Perina D, Petrack E, Rayburn D, Rose E, Russell WS, Ruttan T, Saidinejad M, Sanders B, Simpson J, Solari P, Stoner M, Valente JH, Wall J, Wallin D, Waseem M, Whiteman PJ, Woolridge D, Young T, Foresman-Capuzzi J, Johnson R, Martin H, Milici J, Brandt C, Nelson N. Pediatric Medication Safety in the Emergency Department. Pediatrics 2018; 141:peds.2017-4066. [PMID: 30352389 DOI: 10.1542/peds.2017-4066] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric patients cared for in emergency departments (EDs) are at high risk of medication errors for a variety of reasons. A multidisciplinary panel was convened by the Emergency Medical Services for Children program and the American Academy of Pediatrics Committee on Pediatric Emergency Medicine to initiate a discussion on medication safety in the ED. Top opportunities identified to improve medication safety include using kilogram-only weight-based dosing, optimizing computerized physician order entry by using clinical decision support, developing a standard formulary for pediatric patients while limiting variability of medication concentrations, using pharmacist support within EDs, enhancing training of medical professionals, systematizing the dispensing and administration of medications within the ED, and addressing challenges for home medication administration before discharge.
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Affiliation(s)
- Lee Benjamin
- Department of Emergency Medicine, St Joseph Mercy Ann Arbor, Ypsilanti, Michigan
| | - Karen Frush
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Kathy Shaw
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joan E. Shook
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and
| | - Sally K. Snow
- Retired; Former Trauma Program Director, Cook Children's Medical Center, Fort Worth, Texas
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Abstract
It can be difficult to assist children with medical complexities (CMC) in maintaining wellness outside of hospital and emergency department settings. This growing population, with high use of medical technology and specialty care, has created a challenge for community providers who may infrequently care for children with these rare disorders and needs. CMCs have increased hospitalization rates and emergency care use. It is not realistic to believe that emergency health providers will know how to manage every type of CMC when they present for emergency care. Primary care providers (PCPs) may be able to use the medical home to avoid some urgent visits, but when CMC need emergency services, an emergency information form may add great benefit and personalized care. This article assists PCPs in identifying and preparing CMCs and families to successfully interface with emergency services as well as prepare for disaster events. [Pediatr Ann. 2018;47(3):e102-e105.].
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Mello MJ, Becker SJ, Bromberg J, Baird J, Zonfrillo MR, Spirito A. Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers-a type III hybrid effectiveness-implementation trial. Implement Sci 2018; 13:35. [PMID: 29471849 PMCID: PMC5824578 DOI: 10.1186/s13012-018-0725-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The American College of Surgeons mandates universal screening for alcohol misuse and delivery of an intervention for those screening positive as a requirement for certification as a level 1 trauma center. Though this requirement has been mandated for over a decade, its implementation has been challenging. Our research team completed an implementation study supporting seven pediatric trauma centers' compliance with the requirement by developing and implementing an institutional alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) policy for adolescent trauma patients. A mixed-methods approach indicated that SBIRT adoption rates increased at all sites; however, providers' fidelity to the SBIRT intervention was variable, and providers reported a number of barriers to SBIRT implementation. The goal of this study is to conduct a fully powered type III hybrid effectiveness-implementation trial to test the effectiveness of a comprehensive implementation strategy in increasing the implementation of SBIRT for alcohol and other drug use (AOD) in pediatric trauma centers. METHODS Our implementation strategy is based on the Science to Service Laboratory (SSL), an approach developed by the SAMHSA-funded Addiction Technology Transfer Centers that consists of three core elements (i.e., didactic training + performance feedback + leadership coaching). Utilizing a stepped wedge design, a national cohort of 10 pediatric trauma centers will receive the SSL implementation strategy. At six distinct time points, each of the 10 sites will provide data from 30 electronic medical records (n = 1800 in total). A subset of adolescents will also report on fidelity of intervention delivery and linkage to care (i.e., continued AOD discussion and/or treatment with a primary care provider) 1 month after hospital discharge. In addition, nurses, social workers, and leaders will report on organizational readiness for implementation at four distinct time points. DISCUSSION This protocol proposes a unique opportunity to examine whether a comprehensive implementation strategy can improve the fidelity of SBIRT delivery across a national cohort of pediatric trauma centers. With injured adolescents, this could optimize the detection and intervention of AOD use and improve adolescent health. TRIAL REGISTRATION Clinicaltrials.gov NCT03297060 .
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Affiliation(s)
- Michael J Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA. .,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA. .,Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, Providence, RI, USA.
| | - Sara J Becker
- Department of Behavorial and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Julie Bromberg
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, Providence, RI, USA
| | - Janette Baird
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, Providence, RI, USA
| | - Mark R Zonfrillo
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Injury Prevention Center of Rhode Island Hospital-Hasbro Children's Hospital, Providence, RI, USA.,Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Albert Medical School of Brown University, Providence, RI, USA
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Profiles of Mental Health Competence and Difficulties as Predictors of Children’s Early Learning. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9252-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Children's medically complex diseases unit. A model required in all our hospitals. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Climent Alcalá FJ, García Fernández de Villalta M, Escosa García L, Rodríguez Alonso A, Albajara Velasco LA. Unidad de niños con patología crónica compleja. Un modelo necesario en nuestros hospitales. An Pediatr (Barc) 2018; 88:12-18. [DOI: 10.1016/j.anpedi.2017.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/22/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022] Open
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Simon TD, Whitlock KB, Haaland W, Wright DR, Zhou C, Neff J, Howard W, Cartin B, Mangione-Smith R. Effectiveness of a Comprehensive Case Management Service for Children With Medical Complexity. Pediatrics 2017; 140:peds.2017-1641. [PMID: 29192004 DOI: 10.1542/peds.2017-1641] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess whether children with medical complexity (CMC) exposed to a hospital-based comprehensive case management service (CCMS) experience improved health care quality, improved functional status, reduced hospital-based utilization, and/or reduced overall health care costs. METHODS Eligible CMC at Seattle Children's Hospital were enrolled in a cluster randomized controlled trial between December 1, 2010, and September 29, 2014. Participating primary care providers (PCPs) were randomly assigned, and CMC either had access to an outpatient hospital-based CCMS or usual care directed by their PCP. The CCMS included visits to a multidisciplinary clinic ≥ every 6 months for 1.5 years, an individualized shared care plan, and access to CCMS providers. Differences between control and intervention groups in change from baseline to 12 months and baseline to 18 months (difference of differences) were tested. RESULTS Two hundred PCPs caring for 331 CMC were randomly assigned. Intervention group (n = 181) parents reported more improvement in the Consumer Assessment of Healthcare Providers and Systems version 4.0 Child Health Plan Survey global health care quality ratings than control group parents (6.7 [95% confidence interval (CI): 3.5-9.8] vs 1.3 [95% CI: 1.9-4.6] at 12 months). We did not detect significant differences in child functional status and most hospital-based utilization between groups. The difference in change of overall health care costs was higher in the intervention group (+$8233 [95% CI: $1701-$16 937]) at 18 months). CCMS clinic costs averaged $3847 per child-year. CONCLUSIONS Access to a CCMS generally improved health care quality, but was not associated with changes in child functional status or hospital-based utilization, and increased overall health care costs among CMC.
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Affiliation(s)
- Tamara D Simon
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and .,Centers for Clinical and Translational Research and
| | - Kathryn B Whitlock
- Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Wren Haaland
- Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Davene R Wright
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and.,Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Chuan Zhou
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and.,Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - John Neff
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and
| | - Waylon Howard
- Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Brian Cartin
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and.,Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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37
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Disaster Preparedness: Meeting the Needs of the Pediatric Population. CURRENT PEDIATRICS REPORTS 2017. [DOI: 10.1007/s40124-017-0147-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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38
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Postpartum HLA-Matched Bone Marrow Donation from Mother to Neonate for Reticular Dysgenesis. J Clin Immunol 2016; 37:29-31. [DOI: 10.1007/s10875-016-0355-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/13/2016] [Indexed: 10/20/2022]
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Abstract
Children with medical complexity have extensive needs for health services, experience functional limitations, and are high resource utilizers. Addressing the needs of this population to achieve high-value health care requires optimizing care within the medical home and medical neighborhood. Opportunities exist for health care providers, payers, and policy makers to develop strategies to enhance care delivery and to decrease costs. Important outcomes include decreasing unplanned hospital admissions, decreasing emergency department use, ensuring access to health services, limiting out-of-pocket expenses for families, and improving patient and family experiences, quality of life, and satisfaction with care. This report describes the population of children with medical complexity and provides strategies to optimize medical and health outcomes.
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Abstract
The school nurse has a crucial role in the provision of school health services. This statement describes the school nurse as a member of the school health services team and its relation to children with special health care needs. Recommendations for the professional preparation and education of school nurses also are provided.
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41
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Pyles LA. Testing the Consensus-Based Emergency Information Form. Pediatrics 2016; 138:peds.2016-1715. [PMID: 27436505 DOI: 10.1542/peds.2016-1715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lee A Pyles
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
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42
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Abraham G, Fehr J, Ahmad F, Jeffe DB, Copper T, Yu F, White AJ, Auerbach M, Schnadower D. Emergency Information Forms for Children With Medical Complexity: A Simulation Study. Pediatrics 2016; 138:e20160847. [PMID: 27436504 PMCID: PMC5603153 DOI: 10.1542/peds.2016-0847] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Emergency information forms (EIFs) have been proposed to provide critical information for optimal care of children with medical complexity (CMC) during emergencies; however, their impact has not been studied. The objective of this study was to measure the impact and utility of EIFs in simulated scenarios of CMC during medical emergencies. METHODS Twenty-four providers (12 junior, 12 experienced) performed 4 simulations of CMC, where access to an EIF was block randomized by group. Scenario-specific critical action checklists and consequential pathways were developed by content experts in simulation and pediatric subspecialists. Scenarios ended when all critical actions were completed or after 10 minutes, whichever came first. Two reviewers independently evaluated the video-recorded performances and calculated scenario-specific critical action scores. Performance in scenarios with and without an EIF was compared with Pearson's χ(2) and Mann-Whitney U tests. Interrater reliability was assessed with intraclass correlation. Each provider rated the utility of EIFs via exit questionnaires. RESULTS The median critical action score in scenarios with EIFs was 84.2% (95% confidence interval [CI], 71.7%-94.1%) versus 12.5% (95% CI, 10.5%-35.3%) in scenarios without an EIF (P < .001); time to completion of scenarios was shorter (6.9 minutes [interquartile range 5.8-10 minutes] vs 10 minutes), and complication rates were lower (30% [95% CI, 17.4%-46.3%] vs 100% [95% CI, 92.2%-100%]) with EIFs, independent of provider experience. Interrater reliability was excellent (intraclass correlation = 0.979). All providers strongly agreed that EIFs can improve clinical outcomes for CMC. CONCLUSIONS Using simulated scenarios of CMC, providers' performance was superior with an EIF. Clinicians evaluated the utility of EIFs very highly.
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Affiliation(s)
| | | | | | - Donna B Jeffe
- General Medical Sciences, Department of Medicine, and
| | | | | | - Andrew J White
- Rheumatology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri; and
| | - Marc Auerbach
- Division of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
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43
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Desai AD, Burkhart Q, Parast L, Simon TD, Allshouse C, Britto MT, Leyenaar JK, Gidengil CA, Toomey SL, Elliott MN, Schneider EC, Mangione-Smith R. Development and Pilot Testing of Caregiver-Reported Pediatric Quality Measures for Transitions Between Sites of Care. Acad Pediatr 2016; 16:760-769. [PMID: 27495373 PMCID: PMC9534576 DOI: 10.1016/j.acap.2016.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Few measures exist to assess pediatric transition quality between care settings. The study objective was to develop and pilot test caregiver-reported quality measures for pediatric hospital and emergency department (ED) to home transitions. METHODS On the basis of an evidence review, we developed draft caregiver-reported quality measures for transitions between sites of care. Using the RAND-UCLA Modified Delphi method, a multistakeholder panel endorsed measures for further development. Measures were operationalized into 2 surveys, which were administered to caregivers of patients (n = 2839) discharged from Seattle Children's Hospital between July 1 and September 1, 2014. Caregivers were randomized to mail or telephone survey mode. Measure scores were computed as a percentage of eligible caregivers who endorsed receiving the indicated care. Differences in scores were examined according to survey mode and caregiver characteristics. RESULTS The Delphi panel endorsed 6 of 8 hospital to home transition measures and 2 of 3 ED to home transitions measures. Scores differed significantly according to mode for 1 measure. Caregivers with lower levels of educational attainment and/or Spanish-speaking caregivers reported significantly higher scores on 3 of the measures. The largest difference was reported for the measure that assessed whether caregivers received assistance with scheduling follow-up appointments; 92% score for caregivers with lower educational attainment versus 79% for caregivers with higher educational attainment (P < .001). CONCLUSIONS We developed 8 new, evidence-based quality measures to assess transition quality from the perspective of caregivers. Pilot testing of these measures in a single institution yielded valuable insights for future testing and implementation of these measures.
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Affiliation(s)
- Arti D. Desai
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle, WA
| | | | | | - Tamara D. Simon
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle, WA
| | | | - Maria T. Britto
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Courtney A. Gidengil
- RAND Corporation, Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston, Mass
| | | | | | | | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle, WA
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Troubleshooting Common Ventilator and Related Equipment Issues in the Home. Respir Med 2016. [DOI: 10.1007/978-1-4939-3749-3_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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45
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Lipkin PH, Okamoto J. The Individuals With Disabilities Education Act (IDEA) for Children With Special Educational Needs. Pediatrics 2015; 136:e1650-62. [PMID: 26620061 DOI: 10.1542/peds.2015-3409] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The pediatric health care provider has a critical role in supporting the health and well-being of children and adolescents in all settings, including early intervention (EI), preschool, and school environments. It is estimated that 15% of children in the United States have a disability. The Individuals with Disabilities Education Act entitles every affected child in the United States from infancy to young adulthood to a free appropriate public education through EI and special education services. These services bolster development and learning of children with various disabilities. This clinical report provides the pediatric health care provider with a summary of key components of the most recent version of this law. Guidance is also provided to ensure that every child in need receives the EI and special education services to which he or she is entitled.
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Abstract
Infants, children, adolescents, and young adults have unique physical, mental, behavioral, developmental, communication, therapeutic, and social needs that must be addressed and met in all aspects of disaster preparedness, response, and recovery. Pediatricians, including primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists, have key roles to play in preparing and treating families in cases of disasters. Pediatricians should attend to the continuity of practice operations to provide services in time of need and stay abreast of disaster and public health developments to be active participants in community planning efforts. Federal, state, tribal, local, and regional institutions and agencies that serve children should collaborate with pediatricians to ensure the health and well-being of children in disasters.
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47
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Goodhue CJ, Demeter NE, Burke RV, Toor KT, Upperman JS, Merritt RJ. Mixed-Methods Pilot Study: Disaster Preparedness of Families With Children Followed in an Intestinal Rehabilitation Clinic. Nutr Clin Pract 2015; 31:257-65. [PMID: 26449891 DOI: 10.1177/0884533615605828] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Children with special healthcare needs are a vulnerable population in disasters. Special-needs families tend to be less prepared for a disaster than the general public. The purpose of this pilot project was to examine the disaster preparedness levels of families in an intestinal rehabilitation (IR) clinic. MATERIALS AND METHODS We administered an anonymous survey to a convenience sample of IR clinic families and conducted 2 focus groups. Descriptive analyses were used for survey data; Atlas.ti was used to analyze focus group data. RESULTS Survey findings revealed that 69% of families lacked an emergency supply kit, and 93% did not have a clinician-completed emergency information form. On a scale of 1-10, the mean confidence in their family's disaster preparations was 4.9. The overarching theme from focus group discussions was challenges and/or barriers to disaster preparedness. CONCLUSION IR clinic families are generally unprepared for a disaster. These findings are highly relevant to our goal of developing a disaster survival toolkit for the IR families. Toolkits are being distributed in the IR clinic.
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Affiliation(s)
- Catherine J Goodhue
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Natalie E Demeter
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Rita V Burke
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California Keck School of Medicine, University of Southern California, California
| | - Khadija T Toor
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, California
| | - Jeffrey S Upperman
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California Keck School of Medicine, University of Southern California, California
| | - Russell J Merritt
- Keck School of Medicine, University of Southern California, California Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, California
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48
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Dudley N, Ackerman A, Brown KM, Snow SK. Patient- and family-centered care of children in the emergency department. Pediatrics 2015; 135:e255-72. [PMID: 25548335 DOI: 10.1542/peds.2014-3424] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families, and health care professionals. Providing patient- and family-centered care to children in the emergency department setting presents many opportunities and challenges. This revised technical report draws on previously published policy statements and reports, reviews the current literature, and describes the present state of practice and research regarding patient- and family-centered care for children in the emergency department setting as well as some of the complexities of providing such care.
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49
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Needle S. Office Readiness, Personal Preparedness, and the Role of the Medical Home in Community Resiliency. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2014. [DOI: 10.1016/j.cpem.2014.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Children as hematopoietic cell donors in research: when is it approvable? Bone Marrow Transplant 2014; 50:15-9. [PMID: 25330224 DOI: 10.1038/bmt.2014.224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/22/2014] [Accepted: 08/27/2014] [Indexed: 11/08/2022]
Abstract
With increasing frequency, allogeneic hematopoietic cell transplantation involving children is being performed in the research setting. Allogeneic hematopoietic cell transplantation, however, cannot be performed without a hematopoietic stem cell (HSC) donor. This donor is often a sibling of the recipient and may also be a child. In such circumstances, it is unclear whether or how the federal regulations for pediatric research apply to the minor donors. This introductory paper reviews the issues to be considered while evaluating studies that use HSCs obtained from minor donors and identifies areas where further research is needed. In the era of increasing applicability for donor-derived cellular therapies, we provide a suggested framework for determining when minor donors qualify as human research subjects and when their participation can be approved under the federal regulations.
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