Emergency Department Arrival Modes: Time for Mandatory Pediatric Readiness.

INTRODUCTION: Because small children can be transported by private vehicles, many children seek emergency care outside of Emergency Medical Services (EMS). Such transports may access the closest emergency departments (EDs) without knowledge of their pediatric competence. This study quantifies this practice and the concept of mandatory pediatric readiness. METHODS: The electronic health records of 3 general EDs and 2 pediatric EDs were queried for all pediatric and young adult visits for the year 2022. Data collected included patient age, ED type, arrival mode (EMS/police or private mode), and disposition (admission/transfer or discharge). Study patients were categorized as "small children" if aged younger than 10 years, "large children" if 10 to 18 years, and "young adult" if 19 to 40 years. Associations between mode of arrival, ED type, and disposition were analyzed through χ 2 and analysis of variance. RESULTS: The study population included 37,866 small children, 19,108 large children, and 68,293 young adults. When compared with EMS/police transports, a private arrival mode was selected by 96.1% of small children, 90.0% of large children, and 85.4% of young adults ( P < 0.0001). For the admission/transfer patients, private transportation was selected by 87.4% of small children, 73.8% of large children, and 78.8% of young adults ( P < 0.0001). For admitted/transferred children, the private mode was used by 80.4% of those in the general ED and 81.9% in the pediatric ED ( P > 0.41). CONCLUSIONS: Pediatric patients seeking ED care overwhelmingly arrive through a private mode regardless of the severity of their problem or type of ED in which treated. Emergency Medical Services programs and state hospital regulatory agencies need to recognize this practice and assure the pediatric competence of every ED within their system.

Ease of oral administration and owner-perceived acceptability of triglyceride oil, dissolving thin film strip, and gelatin capsule formulations to healthy cats.

OBJECTIVE: To compare owner-assessed ease of administration and overall acceptability of 3 chemically inactive formulations administered PO to cats. ANIMALS: 90 healthy client-owned cats. PROCEDURES: Cats were randomly assigned to receive 1 of 3 formulations PO once daily for 14 days: medium chain triglyceride (MCT) oil, dissolving thin film strips (proprietary ingredients), or gelatin capsules filled with microcrystalline cellulose. Owners administered the formulations and rated ease of administration daily on a 10-cm visual analogue scale (VAS). At the end of the study, owners rated overall acceptability of formulations from their own perspective and their overall perception of acceptability to their cat. RESULTS: Mean VAS scores for daily ease of administration of MCT oil and film strips were significantly higher than scores for gelatin capsules at all time points, except on days 2, 4, and 7. There was no difference between MCT oil and film strip formulation scores. Mean VAS scores were 8.8 (MCT oil), 8.9 (film strips), and 7.4 (gelatin capsules) for overall acceptability to owners and 8.0 (MCT oil), 8.3 (film strips), and 6.7 (gelatin capsules) for overall owner-perceived acceptability to cats. CONCLUSIONS AND CLINICAL RELEVANCE: Daily ease of administration on 11 of 14 days and overall owner-perceived acceptability to cats were scored significantly higher for film strips and MCT oil, compared with scores for gelatin capsules. Overall acceptability to owners followed a similar pattern; however, the differences were not significant. Dissolving thin film strip or MCT oil vehicles may allow for easier PO administration of medication to cats than does administration of gelatin capsules.