Access to High Pediatric-Readiness Emergency Care in the United States

Ray, Kristin N.; Olson, Lenora M.; Edgerton, Elizabeth A.; Ely, Michael; Gausche‐Hill, Marianne; Schmuhl, Patricia; Wallace, David J.; Kahn, Jeremy M.

doi:10.1016/j.jpeds.2017.10.074

Cited by 76 publications

(70 citation statements)

References 25 publications

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“…For most rural and remote communities, the closest ED is part of a Critical Access Hospital (CAH) that treats a low volume of pediatric patients and as a result may be challenged to have all of the resources needed to care for children. In fact, nearly two‐thirds of children cannot readily access an ED that is highly compliant with pediatric emergency care guidelines . There were 1,326 certified CAHs in 45 states in 2015, treating over 7 million people in the ED, of which approximately one‐fifth (1.46 million) were pediatric patients .…”

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confidence: 99%

“…In fact, nearly two-thirds of children cannot readily access an ED that is highly compliant with pediatric emergency care guidelines. 7 There were 1,326 certified CAHs in 45 states in 2015, treating over 7 million people in the ED, of which approximately one-fifth (1.46 million) were pediatric patients. [8][9][10][11] Improving the infrastructure of CAHs to have equipment, medications, policies, and trained personnel to provide safe, quality pediatric emergency care including responding to children in disasters or in mental health crises, or to be able to transfer children when needed, is essential to promoting the health and well-being of children and their families in rural communities.…”

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confidence: 99%

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Pediatric Readiness in Critical Access Hospital Emergency Departments

Pilkey

Edwards

Richards

et al. 2018

The Journal of Rural Health

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confidence: 99%

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confidence: 99%

Pediatric Readiness in Critical Access Hospital Emergency Departments

Pilkey

Edwards

Richards

et al. 2018

The Journal of Rural Health

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“…These lower‐pediatric‐volume EDs have been noted to be less “pediatric ready” when measured by a national survey . A recent report noted that 30% of U.S. children do not live within a 30‐minute drive time to an ED with high pediatric readiness …”

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confidence: 99%

Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty Emergency Departments: A Prospective, In Situ, Simulation‐based Study

Auerbach

Brown

Whitfill

et al. 2018

Academic Emergency Medicine

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This study demonstrated variable adherence to pediatric cardiac arrest guidelines across a spectrum of EDs. Overall adherence was not associated with ED pediatric volume. Medium-high-volume EDs demonstrated the highest levels of adherence for BLS and PEA. Lower-volume EDs were noted to have lower adherence to BLS guidelines. Improved adherence was not directly associated with higher PRS score provider experience, simulation teamwork performance, or more providers with PALS training. This study demonstrates that current approaches optimizing the care of children in cardiac arrest in the ED (provider training, teamwork training, environmental preparation) are insufficient.

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“…Additionally, the Emergency Medical Services for Children (EMSC) has been active in enhancing GED readiness to care for children through changes in policy and procedure. Despite advances in national pediatric readiness, two‐thirds of children cannot readily access an ED that is highly compliant with pediatric emergency care, defined as an ED that has a perfect Pediatric Readiness Score (100) . As such, studies have shown uneven care by demonstrating 1) variation in the care of common pediatric illnesses, such as asthma, croup, dehydration, diabetic ketoacidosis (DKA); 2) more aggressive lab testing and increased hospitalization rates; and 3) lower quality of resuscitations in the GED compared to the PED.…”

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Minding the Gap: A Qualitative Study of Provider Experience to Optimize Care for Critically Ill Children in General Emergency Departments

Query

Olson

Meyer

et al. 2018

Academic Emergency Medicine

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Background: Pediatric emergency care provision in the United States is uneven. Institutional barriers to readiness in the general emergency department (GED) are known, but little is understood about the frontline providers. Our objective was to explore the lived experiences of emergency medicine (EM) providers caring for acutely ill children in the GED and identify opportunities to optimize their pediatric practice.Methods: This grounded theory study used theoretical sampling with snowball recruitment to enroll EM physicians and advanced practice providers from 25 Wisconsin GEDs. Participants completed one-on-one, semistructured interviews. Audio recordings were transcribed and coded by a multi-investigator team drawing on theory produced from comparative analysis. Results:We reached theoretical saturation with 18 participants. The data suggested that providers felt competent managing routine pediatric care, but critically ill children outstripped their resources and expertise. They recognized environmental constraints on the care they could safely provide, which were intensified by unanticipated knowledge gaps and lack of awareness regarding pediatric practice guidelines. A fragmented medical network to support their pediatric practice was identified as a challenge to their care provision at critical junctures. Due to lack of guidance and feedback, providers internalized their experience with critically ill children with uncertainty, which limited learning and practice change. They benefited from meaningful relationships with pediatricians and pediatric subspecialists, targeted education, timely consults, and looped feedback about care provided and patient outcomes.Conclusions: General ED providers struggled with critically ill children because they could not anticipate their pediatric-specific knowledge gaps and only realized them at critical junctures. EM providers were isolated and frustrated when seeking help; without guidance and feedback they internalized their experience with uncertainty and were left underprepared for subsequent encounters. The data suggested the need for provider-focused interventions to address gaps in pediatric-specific continuing medical education, just-in-time assistance, and knowledge transfer.E ach year in the United States, approximately 35 million children are evaluated in an emergency department (ED). Secondary to hospital distribution and geographic limitations, 1 the large majority (95%) of these children are seen in a general emergency department (GED), 2 as opposed to a dedicated

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Access to High Pediatric-Readiness Emergency Care in the United States

Abstract: A significant proportion of US children do not have timely access to EDs with high pediatric readiness.

Cited by 76 publications

References 25 publications

Pediatric Readiness in Critical Access Hospital Emergency Departments

Pediatric Readiness in Critical Access Hospital Emergency Departments

Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty Emergency Departments: A Prospective, In Situ, Simulation‐based Study

Minding the Gap: A Qualitative Study of Provider Experience to Optimize Care for Critically Ill Children in General Emergency Departments

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