Closing the Loop

Goldman, Marshall I.; Query, Lindsey A.; Wong, Ambrose H.; Gross, Isabel T; Emerson, Beth; Auerbach, Marc; Tiyyagura, Gunjan

doi:10.1097/pec.0000000000002108

Cited by 4 publications

(5 citation statements)

References 55 publications

(129 reference statements)

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“…24 Third, it should be acknowledged that Middlesex Health has a long-standing relationship with EMSC and an experienced pediatric care champion, both instrumental factors in this QI project’s success. 9,39 Therefore, these factors may limit the generalizability in regions where these relationships amongst colleagues at different institutions remain underdeveloped. 11 Fourth, the primary outcome of this work has crucial pediatric patient safety considerations.…”

Section: Discussionmentioning

confidence: 99%

“…[35][36][37] We hypothesize this trend may represent Middlesex's prior engagement in pediatric readiness QI work with EMSC. 9,11,39 The increased transfer rate does reflect the finding that all children who were transferred received the "evidence-based" appendicitis practice. 2 But while this practice may be "evidence-based," a transfer that ends up in a subsequent children's hospital ED discharge may not be the best way to meet the family's expectations.…”

Section: Discussionmentioning

confidence: 99%

“…This feedback was intentionally filtered through the local point person to ensure that deviations from the Middlesex Pathway were addressed between the frontline provider and a trusted colleague. 9,32,33 Additionally, quarterly progress reports were shared between the QI team and Middlesex frontline staff (annotations I and K).…”

Section: Methodsmentioning

confidence: 99%

“…We implemented a pediatric transfer follow-up and feedback program within an ongoing statewide Emergency Medical Services for Children (EMSC) partnership to improve pediatric emergency care in the community hospital general emergency department (GED) setting. 9 Colleagues from this initiative identified several opportunities for collaborative quality improvement (QI) work. Pediatric appendicitis represented a significant cohort of commonly transferred children.…”

Section: Introductionmentioning

confidence: 99%

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A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting

Goldman

Lynders

Crain

et al. 2021

Pediatric Quality &Amp; Safety

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting

Goldman

Lynders

Crain

et al. 2021

Pediatric Quality &Amp; Safety

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“…This involved the review of recent pediatric transfer cases to the AMC and discussions with CED nursing and physician leadership to identify target areas. The AMC and CED team have previously described the implementation of a transfer follow‐up and feedback program to identify gaps in care and select target areas for improvement interventions, including education 23 . Additionally, a curriculum that helps identify patterns of care gaps and allows for focused improvement interventions was thought to be crucial to helping empower the CED staff.…”

Section: Methodsmentioning

confidence: 99%

Blueprint for community emergency department pediatric simulation

Kaur,

Lynders,

Goldman

et al. 2023

AEM Education and Training

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BackgroundGaps in quality of pediatric emergency care have been noted in community emergency departments (CEDs), where >85% of children receive care. In situ simulation provides opportunities for hands‐on experiences and can help close these gaps. We aimed to develop, implement, and evaluate an innovative, replicable, and scalable pediatric in situ simulation‐based CED curriculum, under the leadership of a local colleague, through collaborative approach with a regional academic medical center (AMC).MethodsKern's model was used as follows: problem identification and general needs assessment—pediatric readiness assessment and discussions with CED physician and nursing leadership; targeted needs assessment—review of recent pediatric transfer cases; goals and objectives—enhance pediatric knowledge and skills of interprofessional teams and detect latent safety threats; educational strategies—codeveloped by CED and AMC, included prelearning using podcasts and videos, simulation and facilitated debriefing, resource sharing after simulations; implementation—3‐h simulation sessions facilitated in person by the CED team and remotely by AMC (leadership required participation and paid staff); and evaluation and feedback—retrospective pre–post survey, Simulation Effectiveness Tool–Modified (SET‐M), Net Promoter Score (NPS), and review/feedback meetings.ResultsBased on needs assessment, the selected cases included newborn resuscitation, seizure, asthma, and tetrahydrocannabinol ingestion causing altered mental sensorium in a child. Twenty‐four 3‐h simulation sessions were conducted over 1 year. A total of 168 participants completed the sessions, while 75 participants (54.7% nurses, 22.7% physicians, and others) completed feedback surveys. Seventy‐six percent of participants reported completing presimulation education material. Participants reported improved skills at appropriately evaluating a critically ill newborn and critically ill infant/toddler and improved teamwork during the care of a pediatric patient. The majority agreed that simulation was effective in teaching pediatric resuscitation. The NPS was 84% (excellent).ConclusionsA locally facilitated CED in situ simulation curriculum was successfully developed and implemented under local leadership, with remote collaboration by AMC. The curriculum was well received and effective.

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