Pediatric Preparedness of US Emergency Departments: A 2003 Survey

Gausche‐Hill, Marianne; Schmitz, Charles K.; Lewis, Russell J.

doi:10.1542/peds.2006-3780

Cited by 218 publications

(176 citation statements)

References 14 publications

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“…Although 90% of children are seen in nonpediatric-focused EDs in the United States, more than half of EDs see fewer than 6 patients per day. 34 An association between higher volumes and better outcomes has been reported for certain types of pediatric health care. [35][36][37][38][39] Whereas volume per se does not lead to better outcomes in health care, it is a proxy measure for other factors including the accumulation of experience by individual providers, 39,40 and organizational and structural attributes of hospitals.…”

Section: Figurementioning

confidence: 97%

Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

2013

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WHAT'S KNOWN ON THIS SUBJECT: Variation in the emergency department (ED) use of radiographs for asthma, bronchiolitis, and croup exists. Unnecessary radiographs contribute to higher costs of care, decreased ED efficiency, and increased radiation in children.WHAT THIS STUDY ADDS: Despite no changes in guidelines to support routine use, there is a significant upward trend in the use of radiographs for children with emergency department visits for asthma. Pediatric-focused EDs use significantly fewer radiographs for asthma, bronchiolitis, and croup. abstract OBJECTIVES: The objectives were (1) to determine trends in radiograph use in emergency department (ED) care of children with asthma, bronchiolitis, and croup; and (2) to examine the association of patient and hospital factors with variation in radiograph use.METHODS: A retrospective, cross-sectional study of National Hospital Ambulatory Medical Care Survey data between 1995 and 2009 on radiograph use at ED visits in children aged 2 to 18 years with asthma, aged 3 months to 1 year with bronchiolitis, and aged 3 months to 6 years with croup. Odds ratios (ORs) were calculated and adjusted for all factors studied. RESULTS:The use of radiographs for asthma increased significantly over time (OR: 1.06; 95% confidence interval [CI]: 1.03-1.09; P , .001 for trend) but were unchanged for bronchiolitis and croup. Pediatric-focused EDs had lower use for asthma (OR: 0.44; 95% CI: 0.29-0.68), bronchiolitis (OR: 0.37; 95% CI: 0.23-0.59), and croup (OR: 0.34; 95% CI: 0.17-0.68). Compared with the Northeast region, the Midwest and South had statistically higher use of radiographs for all 3 conditions. The Western region had higher use only for asthma (OR: 1.67; 95% CI: 1.07-2.60), and bronchiolitis (OR: 2.94; 95% CI: 1. 48-5.87). No associations were seen for metropolitan statistical area or hospital ownership status. CONCLUSIONS:The ED use of radiographs for children with asthma increased significantly from 1995 to 2009. Reversing this trend could result in substantial cost savings and reduced radiation. Pediatricfocused EDs used significantly fewer radiographs for asthma, bronchiolitis, and croup. The translation of practices from pediatricfocused EDs to all EDs could improve performance. Pediatrics 2013;132:245-252 AUTHORS:

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Section: Figurementioning

confidence: 97%

Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

2013

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“…In the United States, the vast majority of children are cared for in non-pediatric hospital emergency departments, emergency departments that are located in general hospitals rather than in hospitals dedicated to the care of children (American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, 2007;Gausche-Hill, Schmitz, & Lewis, 2007).…”

Section: Demographicsmentioning

confidence: 99%

“…In 2007, a survey which assessed the degree of pediatric preparedness of emergency departments in the United States showed that 89% of pediatric visits occurred in nonchildren's hospitals, 26% of visits occurred in rural or remote facilities and 75% of emergency departments saw less than 7000 children per year (Gausche-Hill et al, 2007).…”

Section: Demographicsmentioning

confidence: 99%

An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

Cummings¹

2013

Journal of Pediatric Health Care

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Rationale for the Study: Despite the exponential growth in pharmacological and nonpharmacological methods for the treatment of pediatric procedural pain there remains a gap between available interventions and actual practice in the emergency department clinical setting. Researchers have recommended the examination of unit culture since culture is proposed to be a major factor that affects the implementation of pain management practices. Method:Ethnography was employed to gain access to the beliefs and practices of healthcare participants in a Northeastern non-pediatric emergency department. Data were collected for 5 months with over 100 hours of observation. Six key informants were interviewed and 44 pediatric procedural interactions with 27 healthcare providers during the treatment of children two to eight years of age undergoing procedures were observed.Other information gathered included documents from the institution, and pain related information from the patient's medical record. All interviews were recorded and transcribed verbatim. Data were managed using the Ethnograph 6.0 and analyzed using the procedure developed by Leininger and McFarland (2006). Results:Seven major themes with categories were discovered that included assessment, ii procedural pain, treatment of pain, communication related to comfort, fragmentation of care in the emergency department, healthcare provider attitudes, and environmental issues and policies. Conclusion:The results of this study suggest that practice environment of the emergency department and organizational culture exerted a significant degree of influence over healthcare providers' pediatric pain management practices. Nurses' did not use pain measurement tools as they were intended to be used and instead improvised measurement by observing the child's behavior. The management of children during painful procedures consisted of an array of behaviors and practices. The use of physical restraint during painful procedures was a common practice. Participants continue to hold many assumptions and misconceptions about pediatric pain assessment and management. The findings of this study provide insight to the everyday practice of emergency department healthcare providers for pediatric pain in a non-pediatric setting.iii Acknowledgments and Dedication

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“…Additionally, few general hospitals provide training in pediatric emergencies, and less than 6% possess a full complement of child-appropriate equipment, medications, and supplies. [75][76][77] Branson discussed whether sick children can be managed as adult patients, and said that the answer depends on the specific hospital, the child's age and weight, and the pathophysiology of the disease or injury.…”

Section: Disaster Planning For Pediatricsmentioning

confidence: 99%

Neonatal and Pediatric Respiratory Care: What Does the Future Hold?

DiBlasi

Cheifetz

2011

Respir Care

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Neonatal and pediatric respiratory care continues to move forward at a truly impressive pace. Recent technologic advances and an increasing number of randomized clinical trials are leading to improved outcomes for neonates, infants, children, and adolescents with respiratory illness. The goals of this 47th RESPIRATORY CARE Journal Conference were to review pertinent recent advances in neonatal and pediatric respiratory care and, more importantly, to offer thoughts and perspectives for the future of our field. It is important to note that of the prior 46 Journal Conferences, only 2 have been dedicated to neonatal and/or pediatric respiratory care topics. It is our hope that the publication of these proceedings will provide respiratory therapists, physicians, and other members of the clinical care team a foundation on which to ponder the future of neonatal and pediatric respiratory care.

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Pediatric Preparedness of US Emergency Departments: A 2003 Survey

Abstract: Pediatric preparedness of hospital emergency departments demonstrates opportunities for improvement.

Cited by 218 publications

References 14 publications

Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

Neonatal and Pediatric Respiratory Care: What Does the Future Hold?

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