texas emergency department pediatric readiness · 2019. 12. 3. · national pediatric readiness...
TRANSCRIPT
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Texas Emergency
Department
Pediatric Readiness
Manish Shah, MD
Program Director
EMS for Children State Partnership
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National Pediatric Readiness Project (NPRP)
•Quality improvement effort for pediatric care in
Emergency Departments (EDs)
•Based on 2009 “Guidelines for the Care of
Children in the Emergency Department”
•Voluntary, confidential, and web-based
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National Pediatric Readiness Project (NPRP)
•Texas data collection Jan-Mar, 2013
•National assessment complete
•Participating hospitals received
Immediate feedback
Comparison to similar hospitals
Individual gap analysis to assist with accreditation
goals
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Information Gathered
•Assessment of EDs open 24/7
•Gathered demographics about:
Accreditation
ED configuration
Inpatient pediatric capabilities (PICU, NICU…)
Pediatric age cut-offs for medical and trauma
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Why Does This Matter?
•30 million ED visits per year for children in the US
•1 in 3 ED visits are for a child
•Most children are not seen at children’s hospitals
•Every ED needs to be prepared for children
•2 million children per year arrive to EDs via EMS
•That’s a lot of kids!
•1 in 6 children who use EMS get admitted
•Higher acuity relative to rest of ED users
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Relevance to EMS
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COORDINATION REGIONALIZATION
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Institute of Medicine. Emergency Care for Children: Growing Pains. 2007
Limited communication with receiving
hospitals
Lack of access to the patient’s medical history
Few interfacility
transfer guidelines and
agreements
Lack of common radio
frequencies and protocols
Disconnected communication
between dispatch, EMS, ED, and public health systems
Independent planning for
adult and pediatric care
COORDINATION
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Goal: To direct critically ill and injured patients to
facilities within a community with the personnel and
resources to deliver high-level emergency care
Adult successes:
• Cardiac care
• Stroke
• Trauma
Pediatric opportunities:
• Trauma
• Critical care
• Emergency care
REGIONALIZATION
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Statewide and
Regional Data
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Domains Assessed by NPRP •Administration and coordination (19)
•Health care providers (10)
•Quality/process improvement (QI/PI) (7)
•Patient safety (14)
•Policies, procedures and protocols (17)
•Equipment, supplies, and medications (33)
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Overall Response and Score
TX response = 60.5% (305/504) TX average score = 70
•As annual pediatric ED volume , hospital pediatric readiness scores
•Texas scores were similar to national scores for all hospital volume categories
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ED Demographics
Which one of the following is the best
description of your ED configuration for
the care of children? (children as defined by your hospital)
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
0 hospitals
1 hospital
2 hospitals
3 hospitals
>3 hospitals
Number of hospitals with
a Pediatric ED in either a
children’s hospital or a
general hospital
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Inpatient Demographics
Importance of this info: - Guide EMS in regional
destination plans - Avoid unnecessary
transfers - Anticipate surge
capabilities in disasters
Are any children
admitted to your
inpatient services?
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
< 25%
26-40%
41-59%
60-75%
>75%
% of hospitals that
admit children to a
Pediatric Inpatient Unit
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
<20%
20-40%
41-60%
61-80%
>80%
% of hospitals that admit
children to a Neonatal
Intensive Care Unit
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
0%
5-10%
11-20%
21-40%
>40%
% of hospitals that admit
children to a Pediatric
Intensive Care Unit
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ED Pediatric Age Cut-Off
Importance of this info: -Guide regional transport destination decisions for EMS
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
<35%
35-45%
46-55%
56-65%
>65%
Does your hospital have a
physician coordinator who is assigned the role of
overseeing various
administrative aspects of
pediatric emergency care?
Administration & Coordination
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
<45%
45-55%
56-65%
66-75%
>75%
Does your hospital have a
nurse coordinator who
is assigned the role of
overseeing various
administrative aspects of
pediatric emergency care?
Administration & Coordination
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
<40%
40-49%
50-59%
60-69%
> 70%
Does your ED have a
pediatric patient care-
review process?
Quality/Process Improvement
Coordination between EMS and hospital EDs provides an opportunity for both to engage in process improvement
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Physician Training
•<1% of each of the following:
Obstetrics/gynecologist
Anesthesiologist
Critical
care/pulmonologist
Gastroenterologist
General practitioner
Orthopedics
Pediatric critical care
84%
64%
15% 14% 13% 5%
4%
Thinking of the physicians who
currently staff your ED and care for
children, what types of training are
represented?
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
0-19%
20-39%
40-59%
60-79%
> 80%
Are all of your physicians in
the ED who care for children
board certified in Pediatric
Emergency Medicine or ABEM
or ABOEM?
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
<20%
20-29%
30-39%
40-49%
> 50%
Does your hospital
disaster plan address issues specific
to the care of children?
Policy, Procedure & Protocol
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
<30%
30-39%
40-49%
50-59%
>60%
Does your hospital
care for children with
social and mental
health issues?
Policy, Procedure & Protocol
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
<60%
60-69%
70-79%
80-89%
>90%
Does your hospital have
written inter-facility
guidelines for the
transfer of patients of all
ages including children?
Policy, Procedure & Protocol
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Equipment, Supplies, and
Medications
•Most TX EDs were
equipped with >90% of
the equipment, supplies,
and medications
•TX EDs were within 3%
of the national average
on the availability of
these items
Essential Items Missing
• Laryngoscope (straight 00:
76%)
• Continuous end-tidal CO2
monitoring (80%)
• Pediatric Magill forceps
(82%)
• Non-rebreather masks
(infant: 84%)
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
<60%
60-69%
70-79%
80-89%
>90%
Availability of 00 straight
laryngoscope for
immediate use in the ED?
Equipment, Supplies &
Medications
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
<60%
61-70%
71-80%
81-90%
>90%
Availability of end-tidal
CO2 for immediate use in
the ED?
Equipment, Supplies &
Medications
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
<80%
80-84%
85-89%
90-94%
> 95%
Availability of pediatric
Magill forceps for
immediate use in the ED?
Equipment, Supplies &
Medications
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A
B C
D E
F
G
H I
J K
L M
N O
P Q
R
S
T U
V
No data available
<80%
80-84%
85-89%
90-94%
> 95%
Availability of infant non-
rebreather masks for
immediate use in the ED?
Equipment, Supplies &
Medications
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Barriers to Readiness •Lack of educational resources (48%)
•Lack of a QI plan (47%)
•Lack of pediatric-specific policies (46%)
•Not aware of the guidelines (45%)
•Cost of training personnel (43%)
•Lack of a disaster plan (42%)
•Lack of trained nurses (40%)
•Lack of trained physicians (36%)
•Lack of administrative support (15%)
•Not interested (9%)
•Low pediatric volume (1%)
Common barriers are not due to cost, personnel, interest
or support of administration
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Next Steps •EMS for Children State Partnership
•Share this data with more stakeholders (TCEP, ENA, TPS, CHAT,
SORH, statewide webinar)
•Compile a statewide resource document for hospitals
•Pursue development of a voluntary, pediatric facility recognition
program in collaboration with stakeholders
•Pilot the program in several interested RACs prior to statewide
implementation
•Requests for the GETAC Pediatrics Committee
•Support the development and implementation of the following in the
GETAC strategic plan:
•A voluntary pediatric facility recognition program for hospitals
•A voluntary pediatric equipment recognition program for EMS
agencies