Caregiver Expectations and Satisfaction of Urgent Care in a Pediatric Emergency Department.

Health care delivery expectations that may affect patient and caregiver satisfaction are not clearly understood. This study examined caregiver expectations and satisfaction with urgent care in a pediatric emergency department. Of 201 caregivers surveyed, we found that caregivers have specific expectations regarding clinical care of their child in terms of radiographic imaging, blood testing, antibiotics, pain management, and subspecialty consultation. Caregivers were generally less dissatisfied with the actual care provided than the urgent care physicians expected.

Traditional nurse triage vs physician telepresence in a pediatric ED.

OBJECTIVES: The objective of the study is to compare traditional nurse triage (TNT) in a pediatric emergency department (PED) with physician telepresence (PTP). METHODS: This is a prospective 2 × 2 crossover study with random assignment using a sample of walk-in patients seeking care in a PED at a large, tertiary care children's hospital, from May 2012 to January 2013. Outcomes of triage times, documentation errors, triage scores, and survey responses were compared between TNT and PTP. Comparison between PTP to actual treating PED physicians regarding the accuracy of ordering blood and urine tests, throat cultures, and radiologic imaging was also studied. RESULTS: Paired samples t tests showed a statistically significant difference in triage time between TNT and PTP (P = .03) but no significant difference in documentation errors (P = .10). Triage scores of TNT were 71% accurate, compared with PTP, which were 95% accurate. Both parents and children had favorable scores regarding PTP, and most indicated that they would prefer PTP again at their next PED visit. Physician telepresence diagnostic ordering was comparable with the actual PED physician ordering, showing no statistical differences. CONCLUSIONS: Using PTP technology to remotely perform triage is a feasible alternative to traditional nurse triage, with no clinically significant differences in time, triage scores, errors, and patient and parent satisfaction.

An upsurge in pertussis: epidemiology and trends.

OBJECTIVE: The objective of the study was to review the 2010 pertussis upsurge occurring within California and recent experiences at a large tertiary care children's hospital within California. METHODS: A retrospective review of all specimens submitted for Bordetella pertussis polymerase chain reaction assay from the emergency department at a large tertiary care children's hospital from January 2009 to August 2010. Outcome measures were the number of specimens submitted, the number of positive specimens, and the percentage of positive specimens. RESULTS: The last peak incidence of pertussis, in the Unite States, was seen in 2005 with an annual incidence of 25,616 reported cases. Comparing 2010 with 2009 during the same period, the total number of positive cases increased from 13 to 94, a 723% increase at our institution. The median monthly number of positive specimen was 1.5 for 2009 and 6.5 for 2010 (P = 0.0169). CONCLUSIONS: Hospitals, private practitioners, and the California Department of Public Health need to emphasize prompt diagnosis and treatment of this contagious infection to limit the spread to susceptible individuals. A more widespread safe and effective vaccination program will hopefully enhance protection against pertussis infection.

Impact of an emergency department pharmacy on medication omission and delay.

OBJECTIVES: The objective of the study was to evaluate the impact of adding a clinical pharmacist within a pediatric emergency department (ED) on medication omissions and delays, as well as medication errors on patients with prolonged ED stays of 8 hours or greater. METHODS: This is a retrospective review of medication omissions and delays on all patients admitted to a large, tertiary-care children's hospital through the ED during a month before the addition of a clinical pharmacist (April 2007), during a month immediately after the addition of a clinical pharmacist (April 2009), and 6 months after the addition of a clinical pharmacist (October 2009). The medication omissions and delays were separated for urgent and nonurgent medications. A subgroup was further analyzed to evaluate the rate of medication omissions and delays for admitted patients boarded within the ED for 8 hours or greater. RESULTS: Medication omissions and delays decreased immediately after the addition of a clinical pharmacist for urgent medications (P = 0.007) and nonurgent medications (P < 0.0001). This decrease persisted 6 months after the addition of a clinical pharmacist approaching significance for urgent medications (P = 0.06) and statistically significant for nonurgent medications (P < 0.0001). For the patients who were boarded within the ED for 8 hours or greater, 52.8% experienced a medication omission or delay before the addition of a clinical pharmacist, compared with 28.6% and 36.2% experiencing an omission or delay in medications administration immediately after or 6 months after the addition of a clinical pharmacist, respectively. CONCLUSIONS: Medication omissions and delays are common within the ED. Admitted patients boarded within the ED for 8 hours or greater are at an increased risk for medications omissions and delays. The addition of a clinical pharmacist within an ED may reduce the number of medication omissions and delays occurring.

Teaching residents established guidelines and standards of care to strengthen their cost-containment practices.

PURPOSE: This small-scale, preliminary study was intended to evaluate the effectiveness of a structured educational intervention designed to enhance cost-awareness in medicine residents. DESIGN: The study took place at a large tertiary care children's hospital between March 2007 and December 2008. Participants randomly participated in the intervention group and were enrolled during resident noon conference time slots; the control group participated one by one as schedules allowed. METHODOLOGY: The educational intervention, a one-hour PowerPoint tutorial based on current published practice guidelines from the American Academy of Pediatrics (AAP), was given only to the intervention group. Both control and intervention groups were evaluated pre- and post-intervention using a self-administered questionnaire that utilized clinical case vignettes to assess their understanding of practice guidelines as a proxy for cost awareness. PRINCIPAL FINDINGS: Eighty pediatric residents participated in the study, 40 in each group. The average number of correct answers on pre- and post-intervention questionnaires increased from 8.32 to 13.62 of 19 questions for the intervention group, compared to an increase from 8.35 to 9.85 for the control group. The increase in the intervention group was significantly higher than the increase in the control group (P<.001). CONCLUSIONS: Following structured teaching that outlined the concepts of evidence-based medicine, an increase was seen in residents' knowledge of strategies for containing costs.