Complexity and Severity of Pediatric Patients Treated at United States Emergency Departments

Hudgins, Joel; Monuteaux, Michael C.; Bourgeois, Florence T.; Nigrovic, Lise E.; Fine, Andrew M.; Lee, Lois K.; Mannix, Rebekah; Lipsett, Susan C.; Neuman, Mark I.

doi:10.1016/j.jpeds.2017.03.035

Cited by 61 publications

(49 citation statements)

References 25 publications

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“…Prior work has shown that pediatric EDs care for a higher proportion of medically complex children, children with technology dependence, and children presenting with medical problems, whereas general EDs care for a higher proportion of children with injuries . These differences in complexity and diagnosis may be responsible, in part, for some of the differences we observed across general quality measures such as longer length of stay and higher hospitalization rates.…”

Section: Discussionmentioning

confidence: 77%

“…Emergency department visits were classified as occurring at either a pediatric or general ED. A pediatric ED was defined as having more than 75% of its visits made by patients under 18 years of age …”

Section: Methodsmentioning

confidence: 99%

“…Many of the Inventory and Toolbox measures are challenging to measure in clinical practice, particularly in general EDs. As many as 95% of pediatric patients visit general EDs, which differ significantly from pediatric EDs in patient volume, complexity, and severity . Understanding and addressing variation in pediatric emergency care quality for all children therefore requires assessing both general and pediatric EDs.…”

mentioning

confidence: 99%

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Use of a National Database to Assess Pediatric Emergency Care Across United States Emergency Departments

Michelson

Lyons

Hudgins

et al. 2018

Academic Emergency Medicine

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Section: Discussionmentioning

confidence: 77%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Use of a National Database to Assess Pediatric Emergency Care Across United States Emergency Departments

Michelson

Lyons

Hudgins

et al. 2018

Academic Emergency Medicine

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“…A pediatric ED was defined as having more than 75% ED visits by patients under 18 years of age. 14,15 Of the hospitals sampled in the NEDS, 99.9% have either <49% or >96% pediatric visits, providing a means of identifying hospitals that care exclusively for children.…”

Section: Definition Of Ed Typementioning

confidence: 99%

Cardiac Arrest Survival in Pediatric and General Emergency Departments

et al. 2018

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“…Each year in the United States, approximately 35 million children are evaluated in an emergency department (ED). Secondary to hospital distribution and geographic limitations, the large majority (95%) of these children are seen in a general emergency department (GED), as opposed to a dedicated pediatric emergency department (PED). It is estimated that one in five GED visits are by children, but 39% of GEDs see fewer than five children per day and 69% see fewer than 14 children per day .…”

mentioning

confidence: 99%

Minding the Gap: A Qualitative Study of Provider Experience to Optimize Care for Critically Ill Children in General Emergency Departments

Query

Olson

Meyer

et al. 2018

Academic Emergency Medicine

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Background: Pediatric emergency care provision in the United States is uneven. Institutional barriers to readiness in the general emergency department (GED) are known, but little is understood about the frontline providers. Our objective was to explore the lived experiences of emergency medicine (EM) providers caring for acutely ill children in the GED and identify opportunities to optimize their pediatric practice.Methods: This grounded theory study used theoretical sampling with snowball recruitment to enroll EM physicians and advanced practice providers from 25 Wisconsin GEDs. Participants completed one-on-one, semistructured interviews. Audio recordings were transcribed and coded by a multi-investigator team drawing on theory produced from comparative analysis. Results:We reached theoretical saturation with 18 participants. The data suggested that providers felt competent managing routine pediatric care, but critically ill children outstripped their resources and expertise. They recognized environmental constraints on the care they could safely provide, which were intensified by unanticipated knowledge gaps and lack of awareness regarding pediatric practice guidelines. A fragmented medical network to support their pediatric practice was identified as a challenge to their care provision at critical junctures. Due to lack of guidance and feedback, providers internalized their experience with critically ill children with uncertainty, which limited learning and practice change. They benefited from meaningful relationships with pediatricians and pediatric subspecialists, targeted education, timely consults, and looped feedback about care provided and patient outcomes.Conclusions: General ED providers struggled with critically ill children because they could not anticipate their pediatric-specific knowledge gaps and only realized them at critical junctures. EM providers were isolated and frustrated when seeking help; without guidance and feedback they internalized their experience with uncertainty and were left underprepared for subsequent encounters. The data suggested the need for provider-focused interventions to address gaps in pediatric-specific continuing medical education, just-in-time assistance, and knowledge transfer.E ach year in the United States, approximately 35 million children are evaluated in an emergency department (ED). Secondary to hospital distribution and geographic limitations, 1 the large majority (95%) of these children are seen in a general emergency department (GED), 2 as opposed to a dedicated

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Complexity and Severity of Pediatric Patients Treated at United States Emergency Departments

Cited by 61 publications

References 25 publications

Use of a National Database to Assess Pediatric Emergency Care Across United States Emergency Departments

Use of a National Database to Assess Pediatric Emergency Care Across United States Emergency Departments

Cardiac Arrest Survival in Pediatric and General Emergency Departments

Minding the Gap: A Qualitative Study of Provider Experience to Optimize Care for Critically Ill Children in General Emergency Departments

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