A considerable proportion of inner-city pediatric patients discharged from the hospital from the ED after standard treatment for acute asthma had poor short-term outcomes. Conventional markers of successful ED treatment, such as avoiding hospital admission or relapse, do not adequately describe outcomes of acute care. The patient-oriented measures described here may provide more useful indicators of outcome in the evaluation of acute asthma care.

There is much potential for computer-based programmes to be used for injury-prevention behaviour change. The reviewed studies provide evidence that computer-based communication is effective in conveying information and influencing how participants think about an injury topic and adopt safety behaviours.

Regularly scheduled pediatric simulations in the CAH emergency department setting improved team performance over time on expected resuscitation tasks. The program was accepted by providers. Implementation of simulation-based training programs can help address concerns regarding pediatric preparedness in the CAH setting. A future project will look at the impact of the program on patient care and safety.

Successful discharge from the ED for children with acute asthma can be predicted accurately using a simple clinical model, potentially improving disposition decisions. However, predicting correct placement of patients requiring extended care is problematic.

OBJECTIVE-No study has evaluated the association between state endorsement of American Academy of Pediatrics (AAP) and American Public Health Association (APHA) national guidelines and unnecessary exclusion decisions. We sought to determine the rate of unnecessary exclusion decisions by child care directors in a state that endorses AAP/APHA guidelines and to identify factors that are associated with higher unnecessary exclusion decisions.METHODS-A telephone survey was administered to directors in metropolitan Milwaukee, Wisconsin. Directors were randomly sampled from a list of 971 registered centers. Director, center, and neighborhood characteristics were obtained. Directors reported whether immediate exclusion was indicated for 5 vignettes that featured children with mild illness that do not require exclusion by AAP/APHA guidelines. Weighted data were summarized by using descriptive statistics. Regression analysis was used to identify factors that were associated with directors' exclusion decisions.RESULTS-A total of 305 directors completed the survey. Overall, directors would unnecessarily exclude 57% of children. More than 62% had never heard of the AAP/APHA guidelines. Regression analysis showed fewer exclusions among more experienced compared with less experienced directors, among larger centers compared with smaller centers, and among centers that were located in areas with a higher percentage of female heads of household. Centers with ≤10% children on state-assisted tuition excluded more. CONCLUSIONS-High METHODS Study Design, Setting, and PopulationThe study was a cross-sectional telephone survey of licensed child care centers in the southeastern Wisconsin, 6-county Milwaukee metropolitan area (Kenosha, Milwaukee, Ozaukee, Racine, Washington, and Waukesha). Racial demographics in this 6-county area closely approximate national demographics. 22 Child care centers were eligible when they met Wisconsin's definition as a licensed group child care center (≥9 children who are supervised and cared for <24 h/day).23 Centers were excluded when they cared for only sick children or children who had special needs or chronic illness; they did not care for children who were younger than 5 years; they were closed during the study; they operated <3 h/day; they were unreachable by telephone; or the directors were non-English-speaking, had previously participated in the study, or were not responsible for the daily administrative operation of the child care centers. Our study was approved by the hospital's institutional review board. Given our estimation that child care center directors in Wisconsin would exclude less, we estimated that a sample size of ~300 directors would be needed to give us a 95% confidence level at ±5% (confidence width) around a predicted exclusion rate of 25%. Survey InstrumentWe adapted 5 vignettes used by the Copeland et al 13 for telephone use (Table 1). Vignettes were simplified to make them more clearly "nonexcludable," and none of the children in the 1. director characteristics: educa...