Novel Approach to Emergency Departments' Pediatric Readiness Across a Health System

Abstract

Study Objective A gap analysis of emergency departments' (EDs') pediatric readiness across a health system was performed after the appointment of a service line health system pediatric emergency medicine (PEM) quality director. Methods A 55-question survey was completed by each eligible ED to generate a weighted pediatric readiness score (WPRS). The survey included questions regarding volume, ED configuration, presence of a pediatric emergency care coordinator (PECC), quality initiatives, policies and procedures, and equipment. Surveys were completed from June 1 to November 12, 2016. Analysis of variance was used to compare the 4 groups of EDs based upon their annual pediatric volume as a continuous measure (low, <1800 visits; medium, 1800–4999 visits; medium–high, 5000–9999 visits; high, >10,000 visits). The Fisher exact test was used to compare the 4 groups for the remaining categorical variables represented as frequencies and percentages. A result was considered statistically significant at the P < 0.05 level of significance. Results There were a total of 16 hospitals (after the exclusion of the children's hospital, the hub for pediatric care in the health system, and 1 adult-only hospital) with the following pediatric capability: 7 basic (no inpatient pediatrics), 7 general (inpatient pediatrics, with/without a neonatal intensive care unit), and 2 comprehensive (inpatient pediatrics, pediatric intensive care unit, and a neonatal intensive care unit). In 12 EDs, adults and children are treated in the same space. These EDs see a total of 800,000 annual visits including 120,000 pediatric visits. Two low pediatric volume EDs had a median WPRS of 69, range of 62 to 76 (national median, 61.4); 6 medium pediatric volume EDs had a median WPRS of 51, range of 42 to 81 (national median, 69.3); 4 medium-high pediatric volume EDs had a median WPRS of 69.3, range of 45 to 98 (national medium, 74.8); 4 high pediatric volume EDs had a WPRS score of 84.5, range of 58 to 100 (national medium, 89.8). There were 4 sites with PECCs: 1 medium-high volume and 3 high volume, with a median WPRS of 98.5, range of 81 to 100 (national medium, 89.8). Two low-volume EDs have Neonatal Resuscitation Program training for nurses (P < 0.0083). One medium-high volume ED requires specific pediatric competency evaluations for advanced level practitioners staffing the ED. Pediatric-specific quality programs are present in the 2 low volume EDs, 3 of the 6 EDs in the medium group, 3 of 4 EDs in the medium-high group, and all 4 high volume hospitals. After the implementation of the health system PEM quality director, all EDs have a doctor and nurse PECC with a median WPRS of 81. In additiona, a committee was formed with the following key stakeholders: PECCs, pediatric nursing educators, pediatric quality, pharmacy, obstetrics, behavioral health, and neonatology. The committee is part of the health system quality program within both pediatrics and emergency medicine and is spearheading the standardization of code carts and medications, dissemination of pediatric clinical guidelines, and the development of a pediatric quality program across the health system. Conclusions Pediatric emergency care coordinators play an important role in ED readiness to care for pediatric patients. In a large health system, a service line PEM quality director with the support of emergency medicine and pediatrics, a committee with solid frontline ED base, and a diverse array of stakeholders can foster the engagement of all EDs and improve compliance with published guidelines.

Emergency Department Pediatric Readiness and Mortality in Critically Ill Children

“…Efforts to address these deficits might include local and state collaborations designed to provide shared resources, such as educational materials, pediatric-focused policies, collaborative quality-improvement activities, and appointment of pediatric emergency care coordinators. [27][28][29] Although these efforts are difficult and resource intensive, our findings suggest that they have the potential to improve clinical outcomes, particularly for children at high risk.…”

2018 Academic Emergency Medicine Consensus Conference: A Workforce Development Research Agenda for Pediatric Care in the Emergency Department

“…The PEM subspecialty workforce, on the other hand, tends to be clustered in children's hospitals and urban centers. While PEM subspecialists tend to the minority of pediatric emergency visits, they provide expertise and guidance through communication and outreach, are a referral resource for children needing escalating levels of care, and are a conduit by which children in general emergency centers may access pediatric specialty care . In addition, PEM subspecialists in academic centers are responsible for a large proportion of pediatric knowledge generation and research.…”

The Current State of the Pediatric Emergency Medicine Workforce and Innovations to Improve Pediatric Care

“…32 In December of 2017, the EIIC, transfer guidelines and presence of essential equipment and medications. 34,35 Underscoring efforts towards pediatric readiness recognition programs is the assumption that these resources and measures will improve pediatric care and outcomes for patients treated at these centers. Although both trauma centers and neonatal intensive care unit designation programs have been associated with improved patient outcomes, there is emerging literature specifically describing the impact of pediatric readiness recognition on pediatric outcomes.…”

“…This early work suggests that facility recognition programs play an important role in addressing gaps in our pediatric care access. 35 studies have identified telemedicine to be a reliable tool for the assessment of severity of respiratory distress in pediatric patients. 43,44 The ability to assess patients in outside hospitals via pediatric critical care telemedicine and assist in the care of patients prior to their arrival leads to high parent and provider satisfaction, high quality of care, fewer medication errors, a reduction in overall transfers, and less ill children at the time of arrival to a receiving hospital's PICU when compared to children that are not assessed via telemedicine.…”