Improving Pediatric Readiness in General Emergency Departments: A Prospective Interventional Study - 22/02/21

Doi : 10.1016/j.jpeds.2020.10.040

Kamal Abulebda, MD ^1,^⁎ , Travis Whitfill, MPH ^2,³, Erin E. Montgomery, RN ⁴, Anita Thomas, MD, MPH ⁵, Robert A. Dudas, MD ⁶, James S. Leung, MD, FRCPC ⁷, Daniel J. Scherzer, MD ⁸, Michelle Aebersold, PhD, RN ⁹, Wendy L. Van Ittersum, MD ¹⁰, Shruti Kant, MD ¹¹, Theresa A. Walls, MD, MPH ¹², Anna K. Sessa, EMT-P ¹³, Stephen Janofsky, MD ¹⁴, Daniel B. Fenster, MS, MD ¹⁵, David O. Kessler, MD, MSc ¹⁵, Jenny Chatfield, MN ¹⁶, Pamela Okada, MD ¹⁷, Grace M. Arteaga, MD ¹⁸, Marc D. Berg, MD ¹⁹, Lynda J. Knight, RN ¹⁹, Ashley Keilman, MD ⁵, Ana Makharashvili, MD ², Grace Good, RN ¹², Ladonna Bingham, MD ⁶, Emily J. Mathias, MD ²⁰, Kristine Nagy, RN ¹⁰, Melinda F. Hamilton, MD ²¹, Samreen Vora, MD, MHA ²², Karen Mathias, APRN, MSN ²², Marc A. Auerbach, MD, MSc ^2,³
Improving Pediatric Acute Care through Simulation (ImPACTS)^∗
List of additional Improving Pediatric Acute Care Through simulation (ImPACTS) investigators are available at www.jpeds.com (Appendix 1).
Riad Lutfi, MD, Samer Abu-Sultaneh, MD, Zachary J. Berrens, MD, Brian Burns, DNP, Jennifer Reid, MD, Sara Fenstermacher, ARNP, Megan Lavoie, MD, Khoon-Yen Tay

¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN
² Department of Pediatrics, Yale University School of Medicine, New Haven, CT
³ Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
⁴ LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
⁵ Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
⁶ Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
⁷ Division of Pediatric Emergency Medicine, Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
⁸ Division of Pediatric Emergency Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH
⁹ University of Michigan, School of Nursing, Ann Arbor, MI
¹⁰ Division of Pediatric Hospital Medicine, Department of Pediatrics, Akron Children's Hospital, Northeast Ohio Medical University, Akron, OH
¹¹ Department of Emergency Medicine and Pediatrics, University of California San Francisco, San Francisco, CA
¹² Department of Pediatrics, Division of Emergency Medicine, The Children's Hospital of Philadelphia at the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
¹³ Office of Emergency Medical Services, Dartmouth-Hitchcock Medical Center, Lebanon, NH
¹⁴ Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA
¹⁵ Department of Emergency Medicine, Morgan Stanley Children's Hospital of New York Presbyterian at Columbia University Medical Center, New York, NY
¹⁶ KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
¹⁷ Department of Pediatrics, University of Texas Southwestern School of Medicine, Dallas, TX
¹⁸ Department of Pediatrics and Adolescent Medicine, Division of Pediatric Critical Care, Mayo Clinic, Rochester, MN
¹⁹ Davison of Critical Care Medicine, Lucile Packard children's Hospital Stanford, Stanford University College of Medicine, Palo Alto, CA
²⁰ Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
²¹ Department of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
²² Children's Minnesota, Minneapolis, MN

^∗Reprint requests: Kamal Abulebda, MD, FAAP, Department of Pediatrics, Division of Pediatric Critical Care, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr, Phase 2, Room 4900, Indianapolis, IN 46202-5225Department of PediatricsDivision of Pediatric Critical CareRiley Hospital for Children at IU Health705 Riley Hospital DrPhase 2, Room 4900IndianapolisIN46202-5225

Abstract

Objective

To describe the impact of a national interventional collaborative on pediatric readiness within general emergency departments (EDs).

Study design

A prospective, multicenter, interventional study measured pediatric readiness in general EDs before and after participation in a pediatric readiness improvement intervention. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) on a 100-point scale. The study protocol extended over 6 months and involved 3 phases: (1) a baseline on-site assessment of pediatric readiness and simulated quality of care; (2) pediatric readiness interventions; and (3) a follow-up on-site assessment of WPRS. The intervention phase included a benchmarking performance report, resources toolkits, and ongoing interactions between general EDs and academic medical centers.

Results

Thirty-six general EDs were enrolled, and 34 (94%) completed the study. Four EDs (11%) were located in Canada, and the rest were in the US. The mean improvement in WPRS was 16.3 (P < .001) from a baseline of 62.4 (SEM = 2.2) to 78.7 (SEM = 2.1), with significant improvement in the domains of administration/coordination of care; policies, protocol, and procedures; and quality improvement. Six EDs (17%) were fully adherent to the protocol timeline.

Conclusions

Implementing a collaborative intervention model including simulation and quality improvement initiatives is associated with improvement in WPRS when disseminated to a diverse group of general EDs partnering with their regional pediatric academic medical centers. This work provides evidence that innovative collaboration facilitated by academic medical centers can serve as an effective strategy to improve pediatric readiness and processes of care.

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Keywords : pediatric readiness, emergency medicine, EMSC, facility recognition

Abbreviations : ED, EMSC, ImPACTS, NPRP, PECC, WPRS

Plan

Methods

Study Setting and Population

Study Protocol

Study Phases

Pediatric Readiness Interventions

Measures

Statistical Analyses

Results

General ED Characteristics and Baseline Simulation Scores

WPRS Scores

Protocol Adherence

Discussion

Supported, in part, by Indiana University Health Values (VFE-342 [to K.A.]) and the RBaby Foundation (Rbabyfoundation.org) (to M.A.). The authors declare no conflicts of interest.

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Improving Pediatric Readiness in General Emergency Departments: A Prospective Interventional Study - 22/02/21

Abstract

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