The impact of implementing the single provider model of emergency medicine in a paediatric hospital: a retrospective cohort analysis

Crosby, Bradley J.; Mannelli, Francesco; Nisavic, Mladen; Passannante, Alberto; Cline, David; Gillespie, Charles P; Messineo, Antonio; Ban, Kevin M.

doi:10.1136/emermed-2011-200707

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…In line with findings from other studies conducted in the United States, Canada, and Italy, 16‐19 the respondents in this study suggested that the primary decision maker when treating paediatric trauma should be a paediatric emergency medicine specialist or a paediatric surgeon. In 2008, the American Surgeons Association claimed that trauma is not a surgical disease, as most injuries require conservative treatments rather than surgical interventions 18 .…”

Section: Discussionsupporting

confidence: 86%

Physician and nurses' perception of paediatric trauma care in Israeli emergency departments

Madar

Adini

Greenberg

et al. 2021

Nursing in Critical Care

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Background Treatment of paediatric trauma requires specialized infrastructure, medical equipment, medical staff and ancillary support personnel that have been specifically trained for such tasks. Aims and Objectives To examine the perceptions and attitudes of physicians and nurses in general and paediatric emergency departments (PEDs) on training, confidence, and management of paediatric trauma in order to facilitate the establishment of an optimal model for admitting and treating paediatric trauma patients. Design Drawing on published literature and a previously conducted qualitative study that explored the provision of medical care to paediatric trauma patients, we conducted an attitude survey. Methods A 26‐item paper‐based questionnaire was distributed by nurse managers to all staff working within general EDs and PEDs of 22 medical centres across Israel. Results Of 843 physicians and nurses who completed the survey, 61.1% considered PEDs the most appropriate facility for treating both minor and severe paediatric trauma, 88.5% believed that minor paediatric trauma should be treated in designated paediatric trauma centres, and 53.6% deemed that paediatric emergency medicine specialists are the most suitable primary decision makers in paediatric trauma. PED teams expressed greater professional confidence for treating paediatric trauma and multiple casualty incident patients. Greater professional confidence was positively correlated with paediatric trauma training, greater exposure to paediatric trauma cases, and working in larger medical centres. Conclusions The results of the current study suggest that PEDs are perceived to be more appropriate for dealing with paediatric trauma. Also, treatment of severe trauma may be more appropriate in centres that admit large numbers of paediatric trauma cases. Relevance to clinical practice Emergency medicine teams should undergo training for dealing with paediatric trauma. Such training would develop their skills, increase their confidence, and enhance their emotional abilities to cope with paediatric trauma.

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Section: Discussionsupporting

confidence: 86%

Physician and nurses' perception of paediatric trauma care in Israeli emergency departments

Madar

Adini

Greenberg

et al. 2021

Nursing in Critical Care

View full text Add to dashboard Cite

show abstract

“…The specialty of the clinician initially reviewing a child with abdominal pain influenced outcome, with those seen by emergency physicians being misdiagnosed less frequently than those seen initially by a paediatrician or PS. 61 Children with intussusception managed in SPCs were also found to have shorter lengths of stay, although this difference was not statistically significant. 45…”

Section: Structural Measures: Non-appendectomy Cohortmentioning

confidence: 90%

Quality metrics for emergency abdominal surgery in children: a systematic review

Sogbodjor

Singleton

Davenport

et al. 2022

British Journal of Anaesthesia

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“…Pediatric surgeons have been credited with providing more accurate diagnoses and better long-term outcomes for pediatric trauma casualties [ 20 , 21 ]. However, a larger body of research supports a leadership role for the pediatric emergency medicine specialist in the management of pediatric trauma care, using the pediatric surgeon as an ad-hoc consultant [ 22 – 25 ]. This may be further supported by the shortage of pediatric surgeons in hospitals, as mentioned by the interviewees; they are often occupied in the operating rooms and are not available for treating trauma cases.…”

Section: Discussionmentioning

confidence: 99%

Perspectives of health professionals on the best care settings for pediatric trauma casualties: a qualitative study

Madar

Adini

Greenberg

et al. 2018

Isr J Health Policy Res

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BackgroundCritically-injured children are frequently treated by providers who lack specialty pediatric training in facilities that have not been modified for the care of children. We set out to understand the attitudes and perspectives of policy makers, and senior nursing and medical managers in the Israeli healthcare system, concerning the provision of medical care to pediatric trauma casualties in emergency departments.MethodsWe conducted semi-structured interviews with 17 health professionals from medical centers across Israel and the Ministry of Health. The interviews were analyzed by qualitative methods.ResultsThere was lack of clarity and uniformity concerning the definition of a pediatric trauma casualty. All of the participants attributed extreme importance to the professional level of the care team manager, and most suggested that this should be a pediatric emergency medicine specialist. They emphasized the importance of around-the-clock availability of pediatric medical teams to care for young trauma casualties, and the crucial need for caregivers to be equipped with a wide variety of professional skills for the adequate treatment of a broad spectrum of injuries. All participants described significant variability in pediatric-care training and experience among physicians and nurses working in emergency departments. Most participants believe that pediatric trauma casualties should be treated in designated pediatric emergency departments, in a limited number of medical centers across the country.ConclusionsOur findings indicate that specialized pediatric EDs would constitute the best location for intake of children with major traumatic injuries. Pediatric emergency medicine specialists should manage trauma cases using pediatric surgeons as ad-hoc consultants. The term ‘pediatric patient’ should be defined to allow trauma patients to be referred to the most appropriate ED. Teams working at these EDs should undergo specialized pediatric emergency medicine training. Finally, to regulate the key aspects of trauma care, clear statutory guidelines should be formulated at national and local levels.

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The impact of implementing the single provider model of emergency medicine in a paediatric hospital: a retrospective cohort analysis

Abstract: The single provider model of emergency medicine where emergency physicians manage all patients presenting to the emergency department appears to be a safe and efficient model of emergency medical care.

Cited by 4 publications

References 15 publications

Physician and nurses' perception of paediatric trauma care in Israeli emergency departments

Physician and nurses' perception of paediatric trauma care in Israeli emergency departments

Quality metrics for emergency abdominal surgery in children: a systematic review

Perspectives of health professionals on the best care settings for pediatric trauma casualties: a qualitative study

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