A Regional Intervention to Appoint Pediatric Emergency Care Coordinators in New England Emergency Departments.

OBJECTIVE: The aim of this study was to describe our expansion of a Massachusetts grassroots initiative-to increase the appointment of pediatric emergency care coordinators (PECCs) in emergency departments (EDs)-to all 6 New England states. METHODS: We conducted annual surveys of all EDs in New England from 2015 to 2020 regarding 2014 to 2019, respectively. Data collection included ED characteristics. The intervention from 2018 to 2019 relied on principles of self-organization and collaboration with local stakeholders including state Emergency Medical Services for Children agencies, American College of Emergency Physician state chapters, and Emergency Nursing Association state chapters to help encourage appointment of at least 1 PECC to every ED. Most ED leadership were contacted in person at regional meetings, by e-mail and/or telephone. We reached out to each individual ED to both educate and encourage action. RESULTS: Survey response rates were greater than 85% in all years. From 2014 to 2016, less than 30% of New England EDs reported a PECC. In 2017, 51% of EDs in New England reported a PECC, whereas in 2019, 91% of New England EDs reported a PECC. All other ED characteristics remained relatively consistent from 2014 to 2019. CONCLUSIONS: We successfully expanded a Massachusetts grassroots initiative to appoint PECCs to all of New England. Through individual outreach, and using principles of self-organization and creating collaborations with local stakeholders, we were able to increase the prevalence of PECCs in New England EDs from less than 30% to greater than 90%. This framework also led to the creation of a New England-wide PECC network and has fostered ongoing collaboration and communication throughout the region.

Consensus Statement on Urgent Care Centers and Retail Clinics in Acute Care of Children.

This article provides recommendations for pediatric readiness, scope of services, competencies, staffing, emergency preparedness, and transfer of care coordination for urgent care centers (UCCs) and retail clinics that provide pediatric care. It also provides general recommendations for the use of telemedicine in these establishments. With continuing increases in wait times and overcrowding in the nation's emergency departments and the mounting challenges in obtaining timely access to primary care providers, a new trend is gaining momentum for the treatment of minor illness and injuries in the form of UCCs and retail clinics. As pediatric visits to these establishments increase, considerations should be made for the type of injury or illnesses that can be safely treated, the required level training and credentials of personnel needed, the proper equipment and resources to specifically care for children, and procedures for safe transfer to a higher level of care, when needed. When used appropriately, UCCs and retail clinics can be valuable and convenient patient care resources.

Grassroots Intervention to Increase Appointment of Pediatric Emergency Care Coordinators in Massachusetts Emergency Departments.

OBJECTIVES: Appointment of a pediatric emergency care coordinator (PECC) is considered the single best intervention to improve pediatric emergency care and has been recommended for all U.S. general emergency departments (EDs) for more than a decade. Unfortunately, many EDs do not adhere with this recommendation. In 2017, we performed a grassroots intervention to establish a PECC in every Massachusetts ED. METHODS: We conducted annual surveys of all 73 Massachusetts EDs from 2014 to 2018. Data collection included ED visit volumes, presence of a pediatric area, and PECC status. The intervention in 2017-2018 included e-mails and telephone calls to every ED director to not only assess PECC status but also encourage him/her to appoint one as needed. RESULTS: Survey response rates were > 85% in all years and 100% during 2016 to 2018. While Massachusetts EDs did not materially change over time (in terms of visit volumes or presence of a pediatric area), the 2017 intervention increased the percentage of EDs with an appointed PECC. Specifically, PECCs were present in approximately 30% of EDs during 2014 to 2016, climbed to 85% in 2017, and reached 100% in 2018. Most of the newly appointed PECCs were physicians. CONCLUSIONS: Through a relatively simple grassroots intervention, we increased the appointment of PECCs in Massachusetts EDs from 30% to 100%. In addition to providing PECCs with online educational materials, ongoing work is focused on building community, identifying best practices, and implementing interventions at the local level.

A Research Agenda to Advance Pediatric Emergency Care Through Enhanced Collaboration Across Emergency Departments.

In 2018, the Society for Academic Emergency Medicine and the journal Academic Emergency Medicine (AEM) convened a consensus conference entitled, "Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps." This article is the product of the breakout session, "Emergency Department Collaboration-Pediatric Emergency Medicine in Non-Children's Hospital"). This subcommittee consisting of emergency medicine, pediatric emergency medicine, and quality improvement (QI) experts, as well as a patient advocate, identified main outcome gaps in the care of children in the emergency departments (EDs) in the following areas: variations in pediatric care and outcomes, pediatric readiness, and gaps in knowledge translation. The goal for this session was to create a research agenda that facilitates collaboration and partnering of diverse stakeholders to develop a system of care across all ED settings with the aim of improving quality and increasing safe medical care for children. The following recommended research strategies emerged: explore the use of technology as well as collaborative networks for education, research, and advocacy to develop and implement patient care guidelines, pediatric knowledge generation and dissemination, and pediatric QI and prepare all EDs to care for the acutely ill and injured pediatric patients. In conclusion, collaboration between general EDs and academic pediatric centers on research, dissemination, and implementation of evidence into clinical practice is a solution to improving the quality of pediatric care across the continuum.

Does using heat with eutectic mixture of local anesthetic cream shorten analgesic onset time? A randomized, placebo-controlled trial.

STUDY OBJECTIVES: We determine whether the addition of heat to topical eutectic mixture of local anesthetic (EMLA) cream shortens the onset time to effective analgesia. We hypothesized that applying EMLA cream for 20 minutes with an external heat pack would be as effective as the standard 60-minute application time. METHODS: In this prospective, double-blind study using adult volunteers, research subjects were randomized into groups undergoing either 20 minutes or 60 minutes of EMLA cream application time. Each research subject underwent randomized cream application over both hands and wrists in the following manner: EMLA cream with heat, EMLA cream without heat, placebo with heat, and placebo without heat. Research subjects then underwent a single attempt at intravenous catheterization over each of the 4 sites and scored the degree of pain using a 100-mm visual analog scale. RESULTS: Seventy-six research subjects were enrolled: 39 were randomized to the 20-minute group, and 37 were randomized to the 60-minute group. EMLA cream applied for 20 minutes with heat (adjusted mean visual analog scale score of 31.9 mm) provided statistically and clinically significantly greater analgesia compared with that seen in the placebo groups with or without heat (46.6 and 46.1 mm, respectively), with estimated differences of -14.6 (95% confidence interval [CI] -21.2 to -8.1) and -14.1 (95% CI -20.8 to -7.3), respectively. However, applying EMLA cream for 60 minutes without heat (16.6 mm) provided better analgesia compared with that seen after 20 minutes of EMLA cream with heat (31.9 mm; estimated difference of -15.4 [95% CI -25.1 to -5.6]). CONCLUSION: Applying EMLA cream for 20 minutes with heat provides intermediate analgesia for intravenous catheter placement, although 60 minutes of application time remains superior.