Where Are the Sick Kids?

McGovern, Terrance; D’Amore, Katrina

doi:10.1016/j.annemergmed.2016.08.432

Cited by 9 publications

(8 citation statements)

References 33 publications

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“…Most (80%–90%) children, including the majority of medically complex children, presenting for emergency care in the United States are evaluated in general and community emergency departments (ED) 1–5 . When a pediatric patient and their family present for care, they expect that their emergency medicine (EM) physician has the necessary knowledge and experience.…”

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confidence: 99%

“…M ost (80%-90%) children, including the majority of medically complex children, presenting for emergency care in the United States are evaluated in general and community emergency departments (ED). [1][2][3][4][5] When a pediatric patient and their family present for care, they expect that their emergency medicine (EM) physician has the necessary knowledge and experience. Langhan et al 6 found that EM physicians felt less prepared to handle pediatric patients, compared to adult patients with similar presentations, and reported particular stress managing pediatric resuscitation.…”

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confidence: 99%

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A Descriptive Analysis of the Cumulative Experiences of Emergency Medicine Residents in the Pediatric Emergency Department

Loftus

Schumacher

Mittiga

et al. 2020

AEM Education and Training

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Objectives: Most children seeking emergency care are evaluated in general emergency departments (EDs). The cumulative pediatric clinical experiences of emergency medicine (EM) residents are largely unknown. This study examined EM resident pediatric clinical experience through the lens of the Accreditation Council for Graduate Medical Education requirements and the Model of the Clinical Practice of Emergency Medicine. Methods: Retrospective, observational study of the cumulative clinical experience of two classes of EM residents from a 4-year training program at two pediatric EDs of a quaternary care pediatric center. A database of resident patient encounters was generated from the electronic medical record. Experiences classified included: diagnosis categories per the Model of the Clinical Practice of Emergency Medicine, procedures, and resuscitations. Results were stratified by age, acuity, and disposition.Results: Twenty-five EM residents evaluated 17,642 patients (median = 723). Most patients (73.5%) were emergent acuity (Emergency Severity Index triage level 2 or 3 or non-intensive care admission); 2% were critical. Residents participated in 598 (median = 22) medical resuscitations and 483 (median = 19) trauma resuscitations. Minor procedures (e.g., laceration repair) were commonly performed; critical procedures (e.g., intubation) were rare. Exposure to neonates was infrequent and pediatric deaths were rare. Abdominal pain (5.7%), asthma exacerbation (4.6%), and fever (3.8%) were the most common diagnoses.Conclusions: Emergency medicine residents encountered a wide array of pediatric diagnoses throughout training and performed a substantial number of common pediatric procedures. Exposure to critical acuity and procedures, neonatal pathology, and certain pediatric-specific diagnoses, such as congenital heart disease, was limited despite training in a large, quaternary care children's hospital. Curriculum development and collaboration should focus on these areas.

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confidence: 99%

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confidence: 99%

A Descriptive Analysis of the Cumulative Experiences of Emergency Medicine Residents in the Pediatric Emergency Department

Loftus

Schumacher

Mittiga

et al. 2020

AEM Education and Training

View full text Add to dashboard Cite

show abstract

“…Lack of provider experience with paediatric resuscitations is a well-known issue in emergency medicine. 20 Practitioners completing a general emergency medicine residency participate in only a fraction of paediatric medical and trauma resuscitations when compared to adult cases. 21 Nursing literature reports a similar lack of exposure to paediatric cases.…”

Section: Discussionmentioning

confidence: 99%

“…24 Data has shown that simulation training can improve competence and familiarity in paediatric resuscitation cases. 20…”

Section: Discussionmentioning

confidence: 99%

Multiprofessional perspectives on the identification of latent safety threats via in situ simulation: a prospective cohort pilot study

Rusiecki

Walker

Douglas

et al. 2020

BMJ Simul Technol Enhanc Learn

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ObjectivesTo describe the association between participant profession and the number and type of latent safety threats (LSTs) identified during in situ simulation (ISS). Secondary objectives were to describe the association between both (a) participants’ years of experience and LST identification and (b) type of scenario and number of identified LSTs.MethodsEmergency staff physicians (MDs), registered nurses (RNs) and respiratory therapists (RTs) participated in ISS sessions in the emergency department (ED) of a tertiary care teaching hospital. Adult and paediatric scenarios were designed to be high-acuity, low-occurrence resuscitation cases. Simulations were 10 min in duration. A written survey was administered to participants immediately postsimulation, collecting demographic data and perceived LSTs. Survey data was collated and LSTs were grouped using a previously described framework.ResultsThirteen simulation sessions were completed from July to November 2018, with 59 participants (12 MDs, 41 RNs, 6 RTs). Twenty-four unique LSTs were identified from survey data. RNs identified a median of 2 (IQR 1, 2.5) LSTs, significantly more than RTs (0.5 (IQR 0, 1.25), p=0.04). Within respective professions, MDs and RTs most commonly identified equipment issues, and RNs most commonly identified medication issues. Participants with ≤10 years of experience identified a median of 2 (IQR 1, 3) LSTs versus 1 (IQR 1, 2) LST in those with >10 years of experience (p=0.06). Adult and paediatric patient scenarios were associated with the identification of a median of 4 (IQR 3.0, 4.0) and 5 LSTs (IQR 3.5, 6.5), respectively (p=0.15).ConclusionsInclusion of a multidisciplinary team is important during ISS in order to gain a breadth of perspectives for the identification of LSTs. In our study, participants with ≤10 years of experience and simulations with paediatric scenarios were associated with a higher number of identified LSTs; however, the difference was not statistically significant.

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“…However, we found no recent data for central Europe or Switzerland since the introduction of PEM. With regard to curriculum development, previous publications addressed the problem of higher proportions of low-acuity presentations in children in comparison with adults and resulting issues with critical care skill retention (12,13). Our goal was to gain insight into the characteristics and epidemiology of children with critical illness and injuries presenting to a tertiary, non-academic PED in Switzerland, and whether the spectrum differs from other highincome countries.…”

Section: Introductionmentioning

confidence: 99%

Critically Ill Children in a Swiss Pediatric Emergency Department With an Interdisciplinary Approach: A Prospective Cohort Study

et al. 2021

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Objective: Delivery of prompt and adequate care for critically ill and injured children presenting to the pediatric emergency department (PED) is paramount for optimal outcomes. Knowledge of the local epidemiology, patient profile, and presentation modes are key for organizational planning, staff education strategy, and optimal care in a PED. Our aim was to analyze the profile of critically ill and injured children admitted to a tertiary, non-academic Swiss PED, to investigate potential risk factors associated with admission to the pediatric intensive care unit (PICU), and the outcomes mortality and PICU admission.Methods: Prospective cohort study of critically ill and injured children presenting to the PED over a two-year period (2018–2019). Inclusion criteria were Australasian triage scale category (ATS) 1, trauma team activation (TTA), medical emergency response (MER) activation, additional critical care consult, and transfer to an outside hospital.Results: Of 42,579 visits during the two-year period, 347 presentations matched the inclusion criteria (0.81%). Leading presentations were central nervous system (CNS) disorders (26.2%), trauma (25.1%), and respiratory emergencies (24.2%). 288 out of 347 cases (83%) arrived during the day or evening with an even distribution over the days of the week. 128 out of 347 (37%) arrived unexpectedly as walk-ins. 233 (67.15%) were ATS category 1. 51% of the cohort was admitted to PICU. Australasian triage scale category 1 was significantly more common in this group (p = 0.0001). Infants with respiratory disease had an increased risk of PICU transfer compared to other age groups (OR 4.18 [95%CI 2.46, 7.09] p = 0.0001), and this age group presented mainly as walk-in (p = 0.0001). Pediatric intensive care unit admissions had a longer hospital stay (4 [2, 8] days vs. 2 [1, 4] days, p = 0.0001) compared to other patients. 0.045% of all PED patients had to be transferred out. Three deaths (0.86%) occurred in the PED, 10 patients died in the PICU (2.9%).Conclusions: High acuity presentations in the PED were rare, more likely to be young with CNS disorders, trauma and respiratory diseases. A significant proportion were unexpected walk-in presentations, mainly during day and evening shifts. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED.

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Where Are the Sick Kids?

Cited by 9 publications

References 33 publications

A Descriptive Analysis of the Cumulative Experiences of Emergency Medicine Residents in the Pediatric Emergency Department

A Descriptive Analysis of the Cumulative Experiences of Emergency Medicine Residents in the Pediatric Emergency Department

Multiprofessional perspectives on the identification of latent safety threats via in situ simulation: a prospective cohort pilot study

Critically Ill Children in a Swiss Pediatric Emergency Department With an Interdisciplinary Approach: A Prospective Cohort Study

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