Pediatric emergency department readiness among US trauma hospitals.

BACKGROUND: Pediatric readiness among US emergency departments is not universal. Trauma hospitals adhere to standards that may support day-to-day readiness for children. METHODS: In 2013 4,146 emergency departments participated in the NPRP to assess compliance with the 2009 Guidelines to Care for Children in the Emergency Department. Probabilistic linkage (90%) to the 2009 American Hospital Association survey found 1,247 self-identified trauma hospitals (levels 1, 2, 3, 4). Relationship between trauma hospital level and weighted pediatric readiness score (WPRS) on a 100-point scale was performed; significance was assessed using a Kruskal-Wallis test and pediatric readiness elements using χ. Adjusted relative risks were calculated using modified Poisson regression, controlling for pediatric volume, hospital configuration, and geography. RESULTS: The overall WPRS among all trauma hospitals (1,247) was 71.8. Among those not self-identified as a children's hospital or emergency department approved for pediatrics (EDAP) (1088), Level 1 and 2 trauma hospitals had higher WPRS than level 3 and 4 trauma hospitals, 83.5 and 71.8, respectively versus 64.9 and 62.6. Yet, compared with EDAP trauma hospitals (median 90.5), level 1 general trauma hospitals were less likely to have critical pediatric-specific elements. Common gaps among general trauma hospitals included presence of interfacility transfer agreements for children, measurement of pediatric weights solely in kilograms, quality improvement processes with pediatric-specific metrics, and disaster plans that include pediatric-specific needs. CONCLUSION: Self-identified trauma hospital level may not translate to pediatric readiness in emergency departments. Across all levels of general non-EDAP, nonchildren's trauma hospitals, gaps in pediatric readiness exist. Nonchildren's hospital EDs (i.e., EDAPs) can be prepared to meet the emergency needs of all children and trauma hospital designation should incorporate these core elements of pediatric readiness. LEVEL OF EVIDENCE: Care management, level III.

Transitions of Care: The Presence of Written Interfacility Transfer Guidelines and Agreements for Pediatric Patients.

OBJECTIVE: Every year, emergency medical services agencies transport approximately 150,000 pediatric patients between hospitals. During these transitions of care, patient safety may be affected and contribute to adverse events when important clinical information is missing, incomplete, or inaccurate. Written interfacility transfer policies are one way to standardize procedures and facilitate communication between the hospitals leading to improved patient safety and satisfaction for children and families. METHODS: We assessed the presence and components of written interfacility transfer guidelines and agreements for pediatric patients via a survey sent to US hospital emergency department (ED) nurse managers during 2010 and 2013. RESULTS: Although there was an increase in the presence of written interfacility transfer guidelines and agreements, a third of hospitals did not have either by 2013, and only 50% had guidelines with all recommended pediatric components. Hospitals with medium and low ED pediatric patient volumes were less likely to have written guidelines or agreements compared with hospitals with high volume. Hospitals with advanced pediatric resources, such as a pediatric emergency care coordinator or EDs designated approved for pediatrics, were more likely to have guidelines or agreements than less resourced hospitals. CONCLUSIONS: Although there was improvement over time, opportunities exist for increasing the presence of written interfacility transfer guidelines as well as agreements for pediatric patients. Further studies are needed to demonstrate whether improved delivery of patient care is associated with the presence of written interfacility transfer guidelines and agreements and to identify other elements in the process to ensure optimal pediatric patient care.

Organized interfacility transfer processes: an opportunity to improve pediatric emergency care.

OBJECTIVE: The objective of the study was to determine the proportion of hospitals with established guidelines and agreements for the interfacility transfer of seriously ill and injured children. METHODS: Paper- and Web-based survey tools were utilized by states to survey all hospitals with an emergency department. In addition, a content analysis was done on existing state mandates and regulations addressing interfacility transfer guidelines/protocols and agreements. RESULTS: Thirty-six states/territories participated in the Web survey. Two-thousand fifty-one or 62% of hospitals returned the surveys. Although 54% of responding facilities had interfacility transfer guidelines, only 42% of facilities included language regarding transfer of children. Only 13% of hospitals had interfacility guidelines containing all recommended components. No defined interfacility transfer processes or guidelines were in place in 46% of the data-set hospitals.Responding hospitals had agreements for transfer of patients requiring specialty services only 59% of the time, although only 43% of agreements included language specific to pediatrics. Interfacility transfer agreements were lacking in 41% of responding facilities.Fourteen states have legislative mandates requiring interfacility transfer guidelines and agreements. Enactment of state mandates for interfacility transfer agreements and guidelines may influence this process, although these data do not support this, and more research is needed. CONCLUSIONS: Organized processes for interfacility transfer of ill or injured children were not established for a sizable proportion of survey hospitals. Addressing this void may provide an opportunity to improve the emergency care of children.

Using system change as a method of performance/quality improvement for emergency and trauma care of severely injured children: pediatric system performance improvement.

Quality or performance improvement is paramount to trauma programs. In an effort to improve the emergency care continuum for children and in response to the Government Performance Review Act, the Federal Emergency Medical Services for Children (EMSC) Program developed EMSC performance measures. The measures provide benchmarking capabilities and a plan for state EMSC programs to reduce pediatric emergency or trauma gaps nationwide. Data collected by states in 2007 identify both gaps and opportunities for trauma nurses and managers to partner with state leaders to improve the emergency and trauma care systems for children.

Evaluation of a novel Web-based pediatric advanced life support course.

OBJECTIVE: To assess the educational efficacy of a Web-based pediatric advanced life support course (Web-PALS). DESIGN: Nonrandomized, prospective, cohort study. SETTING: University medical center. PARTICIPANTS: Health care providers (includes physicians, nurses, paramedics, and respiratory therapists) taking either the Web-PALS or a traditional PALS course (Trad-PALS). MAIN EXPOSURE: Web-PALS. MAIN OUTCOME MEASURES: Postcourse written examination scores and scored videotapes of students performing 5 PALS procedures were compared between study groups. Students completed precourse and postcourse questionnaires, rating on a 5-point Likert scale their self-confidence to perform PALS assessments and procedures. A structured, course satisfaction survey was given after students had taken the Web-PALS course. RESULTS: Eighty-six students completed the study (44 Web-PALS and 42 Trad-PALS). All students achieved a passing score on the written examination on their first attempt. Compared with students in the Trad-PALS group, students in the Web-PALS group scored slightly lower (97.1% vs 95.4%; difference, 1.7%; 95% confidence interval, 0.1-3.2). Mean overall videotape scores were similar among the Web-PALS and Trad-PALS groups (75.0% vs 73.0%; difference, 2.0%; 95% confidence interval, -2.0 to 6.0). After completing the Web-PALS course, the mean level of confidence improved from 3.77 to 4.28 (difference, 0.51; 95% confidence interval, 0.33-0.69). Ninety-six percent of respondents indicated that Web-PALS met all of the stated objectives of the PALS course. All respondents indicated that they would recommend Web-PALS to a colleague. CONCLUSIONS: Students perceive Web-PALS as a positive educational experience. Though not identical to students taking the Trad-PALS course, they performed well on postcourse cognitive and psychomotor testing. These findings support Web-PALS as an acceptable format for administering the PALS course.

When disaster strikes--care considerations for pediatric patients.

Katrina and the events of September 11th, 2001 have made the vulnerability of our country very apparent. Communities have been preparing and organizing multihazard response plans to assure the safety and care of citizens when disasters strike. These plans focus on advance preparation to assure access and augmentation of essential resources, as well as provider education, both of which are core components of good trauma centers and effective state trauma systems. Unfortunately though, the needs of children have traditionally been overlooked in these planning processes. This article will serve as a tool for trauma nurses in the identification of the needs, challenges, actions, and nursing leadership roles that may be assumed to assure that appropriate care is available for children when disaster strikes.