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Bongiorno DM, Ravicz M, Nadeau NL, Michelson KA, Alpern ER, Myers SR, Samuels‐Kalow ME. Pediatric capacity crisis: A framework and strategies to prepare for a pediatric surge. J Am Coll Emerg Physicians Open 2024; 5:e13093. [PMID: 38230303 PMCID: PMC10790808 DOI: 10.1002/emp2.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 11/02/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024] Open
Abstract
A pediatric capacity crisis developed across the country in the Fall and Winter of 2022 due to a combination of factors, including a surge in respiratory viruses, staffing shortages, and historical closures of inpatient pediatric units. The COVID-19 pandemic and associated surge in critically ill adult patients demonstrated that health care systems and health care workers can quickly implement creative and collaborative system-wide solutions to deliver the best care possible during a capacity crisis. Similar solutions are needed to respond to future surges in pediatric volume and to maintain a high standard of care during such a surge. This paper aims to build upon insights from the COVID-19 and H1N1 pandemic responses and the 2022 pediatric capacity crisis. We provide specific recommendations addressing governmental/policy, hospital/health care system, and individual clinician strategies that can be implemented to manage future surges in pediatric patient volume.
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Affiliation(s)
- Diana M. Bongiorno
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Miranda Ravicz
- Departments of Internal Medicine and PediatricsMassachusetts General HospitalBostonMassachusettsUSA
| | - Nicole L. Nadeau
- Division of Pediatric Emergency MedicineDepartment of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | | | - Elizabeth R. Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's HospitalNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Sage R. Myers
- Division of Emergency MedicineDepartment of Pediatrics, Children's Hospital of PhiladelphiaPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Sarafian JT, Eucker SA, Gillman M, DeLaroche AM, Rodriguez RM, Rayburn D, Nadeau NL, Drago LA, Cullen D, Kugler EM, Meskill SD, Bialeck S, Baumann BM. Impact of a hypothetical COVID-19 vaccine mandate on parental likelihood to vaccinate children: Exploring school-related concerns and vaccination decision-making. Vaccine 2023; 41:7493-7497. [PMID: 37973509 DOI: 10.1016/j.vaccine.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE We assessed the impact of a hypothetical school-entry COVID-19 vaccine mandate on parental likelihood to vaccinate their child. METHODS We collected demographics, COVID-19-related school concerns, and parental likelihood to vaccinate their child from parents of patients aged 3-16 years seen across nine pediatric Emergency Departments from 06/07/2021 to 08/13/2021. Wilcoxon signed-rank test compared pre- and post-mandate vaccination likelihood. Multivariate linear and logistic regression analyses explored associations between parental concerns with baseline and change in vaccination likelihood, respectively. RESULTS Vaccination likelihood increased from 43% to 50% with a hypothetical vaccine mandate (Z = -6.69, p < 0.001), although most parents (63%) had no change, while 26% increased and 11% decreased their vaccination likelihood. Parent concerns about their child contracting COVID-19 was associated with greater baseline vaccination likelihood. No single school-related concern explained the increased vaccination likelihood with a mandate. CONCLUSION Parental school-related concerns did not drive changes in likelihood to vaccinate with a mandate.
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Affiliation(s)
- Joshua T Sarafian
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Stephanie A Eucker
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Michael Gillman
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA; Department of Pediatric Emergency Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Amy M DeLaroche
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA; College of Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | - Robert M Rodriguez
- Department of Emergency Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - David Rayburn
- Department of Pediatric Emergency Medicine, Children's Hospital of New Orleans, New Orleans, LA, USA
| | - Nicole L Nadeau
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa A Drago
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Danielle Cullen
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emmalee M Kugler
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Sarah Dennis Meskill
- Section of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Suzanne Bialeck
- Department of Emergency Medicine, Jackson Memorial Hospital/Holtz Children's Hospital, Miami, FL, USA
| | - Brigitte M Baumann
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
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Devarajan V, Nadeau NL, Creedon JK, Dribin TE, Lin M, Hirsch AW, Neal JT, Stewart A, Popovsky E, Levitt D, Hoffmann JA, Lee M, Perron C, Shah D, Eisenberg MA, Hudgins JD. Reducing Pediatric Emergency Department Prescription Errors. Pediatrics 2022; 149:e2020014696. [PMID: 35641470 PMCID: PMC10680440 DOI: 10.1542/peds.2020-014696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Prescription errors are a significant cause of iatrogenic harm in the health care system. Pediatric emergency department (ED) patients are particularly vulnerable to error. We sought to decrease prescription errors in an academic pediatric ED by 20% over a 24-month period by implementing identified national best practice guidelines. METHODS From 2017 to 2019, a multidisciplinary, fellow-driven quality improvement (QI) project was conducted using the Model for Improvement. Four key drivers were identified including simplifying the electronic order entry into prescription folders, improving knowledge of dosing by indication, increasing error feedback to prescribers, and creating awareness of common prescription pitfalls. Four interventions were subsequently implemented. Outcome measures included prescription errors per 1000 prescriptions written for all medications and top 10 error-prone antibiotics. Process measures included provider awareness and use of prescription folders; the balancing measure was provider satisfaction. Differences in outcome measures were assessed by statistical process control methodology. Process and balancing measures were analyzed using 1-way analysis of variance and χ2 testing. RESULTS Before our interventions, 8.6 errors per 1000 prescriptions written were identified, with 62% of errors from the top 10 most error-prone antibiotics. After interventions, error rate per 1000 prescriptions decreased from 8.6 to 4.5 overall and from 20.1 to 8.8 for top 10 error-prone antibiotics. Provider awareness of prescription folders was significantly increased. CONCLUSION QI efforts to implement previously defined best practices, including simplifying and standardizing computerized provider order entry (CPOE), significantly reduced prescription errors. Synergistic effect of educational and technological efforts likely contributed to the measured improvement.
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Affiliation(s)
- Veena Devarajan
- Division of Emergency Medicine, Seattle Children’s Hospital, Seattle, Washington
| | - Nicole L. Nadeau
- Division of Pediatric Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jessica K. Creedon
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Boston Children’s Hospital, Boston, Massachusetts
| | - Timothy E. Dribin
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Margaret Lin
- Department of Emergency Medicine and Pediatrics, University of California, San Francisco, California
| | - Alexander W. Hirsch
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Boston Children’s Hospital, Boston, Massachusetts
| | - Jeffrey T. Neal
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Boston Children’s Hospital, Boston, Massachusetts
| | - Amanda Stewart
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Boston Children’s Hospital, Boston, Massachusetts
| | - Erica Popovsky
- Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Danielle Levitt
- Division of Emergency and Transport, Children’s Hospital Los Angeles, Los Angeles, California
| | - Jennifer A. Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael Lee
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Boston Children’s Hospital, Boston, Massachusetts
| | - Catherine Perron
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Boston Children’s Hospital, Boston, Massachusetts
| | - Dhara Shah
- Department of Pharmacy, Boston Children’s Hospital, Boston, Massachusetts
| | - Matthew A. Eisenberg
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Boston Children’s Hospital, Boston, Massachusetts
| | - Joel D. Hudgins
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Boston Children’s Hospital, Boston, Massachusetts
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