Improving Pediatric Readiness in General Emergency Departments: A Prospective Interventional Study

Abulebda, Kamal; Whitfill, Travis; Montgomery, Edward; Thomas, Anita; Dudas, Robert A.; Leung, James; Scherzer, Daniel; Aebersold, Michelle; Ittersum, Wendy L. Van; Kant, Shruti; Walls, Theresa A.; Sessa, Anna; Janofsky, Stephen; Fenster, Daniel; Kessler, David; Chatfield, Jenny; Okada, Pamela J.; Arteaga, Grace M.; Berg, Marc D.; Knight, Lynda; Keilman, Ashley; Makharashvili, Ana; Good, Grace; Bingham, Ladonna K.; Mathias, Emily; Nagy, Kristine; Hamilton, Melinda Fiedor; Vora, Samreen; Mathias, Karen; Auerbach, Marc; Lutfi, Riad; Abu‐Sultaneh, Samer; Berrens, Zachary; Burns, Brian; Reid, Jennifer; Fenstermacher, Sara; Lavoie, Megan; Tay, Khoon‐Yen

doi:10.1016/j.jpeds.2020.10.040

Cited by 22 publications

(23 citation statements)

References 28 publications

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“…Furthermore, collaborative networks that connect regional academic pediatric medical centers (ie, hubs) with general EDs (ie, spokes) should be established and sustainably funded. These networks facilitate knowledge sharing and a collective responsibility to enhance pediatric readiness, with exemplar models resulting in improved wPRS . Finally, continued financial support and growth of national initiatives, such as the National Pediatric Readiness Project, is critical to fill existing gaps in ED pediatric readiness through the dissemination of pediatric-specific resources, tools, and training across the country.…”

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confidence: 99%

Saving Children’s Lives by Improving Pediatric Readiness for Emergency Care

Foster

Hoffmann

2023

JAMA Netw Open

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Most children in the US seek emergency care in general emergency departments (EDs) that evaluate both children and adults. Some EDs are well prepared to care for children, whereas others have variable access to pediatric-specific resources, resulting in barriers to optimal pediatric emergency care delivery. 1 Over the past 2 decades, major efforts have been made to measure and improve pediatric readiness across EDs. 1 The weighted Pediatric Readiness Score (wPRS) serves as a measure of adherence to 6 domains of pediatric emergency care: coordination of care, physician and nurse staffing, quality improvement, patient safety, policies and procedures, and equipment and supplies. 1 Prior literature has demonstrated that a high wPRS is associated with improved mortality among 2 distinct groups of children: critically ill children 2 and children with injuries presenting to trauma centers. 3 However, it is unknown whether the mortality benefits of high ED pediatric readiness extend to all children or whether these mortality benefits for all children are sustained beyond the immediate care period.Newgard et al 4 found that high ED pediatric readiness is associated with both short-term and longterm mortality benefits for children. This retrospective cohort study was conducted over 6 years and included 796 937 children across 983 EDs in 11 states. 4 Pediatric readiness was measured using the wPRS, derived from a national assessment of EDs performed in 2013. 1 The primary outcome was inhospital mortality. Six states had longitudinal data available, allowing for evaluation of mortality at 1-year from the index ED visit. Children presenting for injuries and medical conditions were analyzed as separate cohorts using patient-level mixed effects logistic regression models. Prespecified subgroup analyses were performed by clinical condition, severity of illness, age group, and transfer status.The findings of the study are striking: provision of care in EDs with the highest quartile wPRS (quartile 4, wPRS Ն88) compared with the lowest quartile wPRS (quartile 1, wPRS Յ58) was associated with a 60% reduction in mortality for the injury cohort and a 76% reduction in mortality for the medical cohort. 4 Remarkably, an estimated 1442 pediatric deaths could have been prevented if all lower readiness EDs (quartiles 1-3) had performed similarly to high readiness EDs (quartile 4). 4 These findings remained consistent after adjusting for hospital-level variables, including annual pediatric ED volume, annual pediatric admission volume, presence of a separate pediatric ED, hospital type, and trauma center designation level. When examining 1-year outcomes, the injury and medical cohorts had a 41% (adjusted hazard ratio, 0.59) and 66% (adjusted hazard ratio, 0.34) reduction in risk of death, respectively, in high readiness EDs (quartile 4 vs quartile 1). 4 Results from this groundbreaking study 4 invoke a call to action to improve pediatric readiness among all EDs that provide emergency care to children. Additionally, the study establishes a spe...

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confidence: 99%

Saving Children’s Lives by Improving Pediatric Readiness for Emergency Care

Foster

Hoffmann

2023

JAMA Netw Open

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“…The scope of the Simulathon also assured the national relevance of the information gathered, allowing for a comprehensive approach to the large-scale implications of the pandemic. We also note that the Simulathon process aligns with other efforts to improve clinical practice and systems integration, 51,52 and the categories that emerged during the debriefing align with principles of human factors (ie, SEIPS 2.0) 53 and human-centered design (ie, SEIPS 3.0). 54 Our successful incorporation of SEIPS concepts within the Simulathon lends further credibility to the SEIPS model.…”

Section: Discussionmentioning

confidence: 63%

Simulathon 2020

Thyagarajan¹,

Ramachandra²,

Jamalpuri³

et al. 2021

Sim Healthcare

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Summary StatementThe disaster management cycle is an accepted model that encompasses preparation for and recovery from large-scale disasters. Over the past decade, India's Pediatric Simulation Training and Research Society has developed a national-scale simulation delivery platform, termed the Simulathon, with a period prevalence methodology that integrates with core aspects of this model. As an exemplar of the effectiveness of this approach, we describe the development, implementation, and outcomes of the 2020 Simulathon, conducted from April 20 to May 20 in response to the nascent COVID-19 pandemic disaster. We conclude by discussing how aspects of the COVID-19 Simulathon enabled us to address key aspects of the disaster management cycle, as well as challenges that we encountered. We present a roadmap by which other simulation programs in low- and middle-income countries could enact a similar process.

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“…Within the US, this infrastructure has been supported by federal funds and legislation for over 30 years (https:// emsci mprov ement. center/ about/) and has shown that general EDs can improve how ready they are to manage a sick or injured child when high-quality resources and best practices are shared [5,6]. Investment in a pan-Canadian strategy for pediatric emergency knowledge mobilization is needed, whereby health systems can work together to focus on common problems while maintaining independence to address issues relevant to local contexts.…”

Section: Sustaining Pediatric Emergency Knowledge Mobilizationmentioning

confidence: 99%

“…Moreover, they have expressed concerns in maintaining pediatric expertise and competencies particularly if they do not often treat children or certain pediatric conditions [2,4]. These concerns are well-founded; the gap in pediatric care between pediatric and general EDs has been associated with a disparity in health outcomes [5]. Efforts are needed to improve ED pediatric readiness, and ensuring children have access to timely, well-resourced, and effective emergency care [6].…”

Section: Introductionmentioning

confidence: 99%