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A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Resident exposure to critical patients in a pediatric emergency department
Esther H Chen1, Christine S Cho, Frances S Shofer
1Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA. esther.chen@uphs.upenn.edu
Insights
Pediatric and non-pediatric residents see few critically ill patients in children's emergency departments. Alternative training methods may be needed to ensure competency in managing critical pediatric cases.
Area of Science:
- Pediatric Emergency Medicine
- Medical Education
- Critical Care
Background:
- Emergency departments (EDs) in children's hospitals are crucial for training residents.
- Assessing resident exposure to critically ill patients is vital for evaluating training effectiveness.
Purpose of the Study:
- To determine the percentage of critically ill patients encountered by pediatric and non-pediatric residents in a high-volume children's hospital ED.
- To evaluate the adequacy of current clinical exposure for resident training in critical care pediatrics.
Main Methods:
- A retrospective chart review of resident-patient encounters over one year was conducted.
- Critically ill patients were identified by triage status, in-ED death, or ICU admission.
- Statistical analysis included ANOVA for continuous data and chi-squared tests for categorical data.
Main Results:
- A total of 3048 critically ill patients were evaluated, representing 4.2% of total ED volume.
- Emergency medicine residents managed 30% of cases, pediatric residents 65%, and family medicine residents 5%.
- Emergency medicine residents saw fewer critical patients per shift (5) compared to pediatric residents (9).
Conclusions:
- Residents rotating through high-volume pediatric EDs have limited exposure to critically ill children.
- Current clinical experience may be insufficient for developing critical care skills.
- Supplementary educational strategies like mock resuscitations are recommended to address this training gap.
Objectives:
We hypothesize that nonpediatric and pediatric residents are exposed to a very low percentage of critically ill patients in a high-volume children's hospital emergency department (ED).
Methods:
Retrospective chart review of resident-patient encounters during a 1-year period using a patient tracking system. Critically ill patients included those who were triaged as "critical," died in the ED, or admitted to the intensive care unit. Descriptive data are presented as means +/- SD, frequencies, and percentages. Analysis of variance was used for continuous data and the chi test for categorical data.
Results:
A total of 3048 (4.2% of the total ED volume) critically ill patients with a mean age of 6 (+/- 5.6) years were evaluated. One hundred four emergency medicine (EM) residents were involved in the care of 903 (30%), 136 pediatric residents managed 2003 (65%), and 36 family medicine residents managed 142 (5%) critically ill patients. There was no significant difference in the mean age of evaluated patients compared by type of training program. On average, EM residents evaluated 5 patients per 10 shifts compared with pediatric residents ([9 patients per 10 shifts] P < 0.0001). Unlike pediatric residents, the number of patients cared for by EM or family medicine residents did not increase with the level of resident training. Sixty-seven life-saving procedures were performed, of which 32 (48%) were cardiopulmonary resuscitations and 35 (52%) were intubations.
Conclusions:
Pediatric and nonpediatric residents who rotate through a high-volume children's hospital ED are exposed to a very low number of critically ill children. Other educational formats, such as mock resuscitations or standardized patient encounters, may be required to correct this deficit.
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