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Meeting children's needs: a mixed-methods approach to a regionalized pediatric surge plan-the Los Angeles County
Bridget M Berg1, Valerie M Muller1, Millicent Wilson2
1Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
Insights
Los Angeles County enhanced pediatric surge capacity by creating a plan to double bed availability and address resource gaps for children during emergencies. This initiative improves preparedness for mass casualty incidents impacting vulnerable youth.
Area of Science:
- Emergency Medicine
- Public Health Preparedness
- Pediatric Critical Care
Background:
- Children possess unique vulnerabilities during mass casualty incidents due to physiological, developmental, and psychological factors.
- Enhancing pediatric surge capabilities is crucial for effective emergency response in large urban areas.
- Los Angeles County (LAC) aimed to improve its capacity to manage a sudden influx of pediatric patients.
Purpose of the Study:
- Identify gaps in pediatric surge capacity and capabilities within LAC.
- Double the existing pediatric inpatient bed capacity.
- Develop a comprehensive plan to address identified gaps and meet pediatric surge demands.
Main Methods:
- A mixed-methods approach was employed, including surveys of 38 questions on hospital capacity and capabilities.
- Analysis of publicly available inpatient bed data and US Census 2010 population data.
- Conducting three focus groups to gather stakeholder input on training, supplies, and plan functionality.
Main Results:
- Significant variability in pediatric capacity and capability was observed among hospitals.
- Identified gaps included limited pediatric bed capacity, ICU resources, specialty physician availability, and pediatric critical care supplies.
- Stakeholders emphasized the need for advance and just-in-time training and reference guides.
Conclusions:
- LAC successfully developed a pediatric surge plan that doubles acute and intensive care bed capacity through participating Hospital Preparedness Program (HPP) hospitals.
- A tiered system was established, providing surge targets and patient care guidance based on hospital capacity and capabilities.
- The plan aims to facilitate efficient distribution of pediatric patients by the LAC Emergency Medical Services Agency during surge events.
Introduction:
Children are one of the most vulnerable populations during mass casualty incidents because of their unique physiological, developmental, and psychological attributes. The objective of this project was to enhance Los Angeles County's (LAC) pediatric surge capabilities. The purpose of this study was threefold: (1) determine gaps in pediatric surge capacity and capabilities; (2) double pediatric inpatient capacity; and (3) document a plan to address gaps and meet pediatric inpatient surge. We hypothesized that LAC would be able to meet the identified pediatric surge target by leveraging resources of hospitals within the region. Deliverables included a pediatric surge plan for LAC, pediatric surge training resources, and pediatric supplies for hospitals participating in LAC's Hospital Preparedness Program (HPP).
Methods:
After Institutional Review Board approval, the authors used a mixed-methods approach to explore gaps in hospital capacity and capabilities in a large urban county. Hospitals were surveyed via Qualtrics® on 38 questions regarding capacity, staffing, availability of pediatric supplies, and existing pediatric surge plans. Publicly available inpatient bed data were collected from the Office of Statewide Health Planning and Development for the year ending June 2010 and supplemented by hospital survey responses. Population data was used from US Census 2010. This combined dataset was analyzed for capacity, pediatric designations, and capabilities. To supplement this data, three focus groups were conducted between April 2011 and May 2012. Focus group topics included: supplies and training needed for pediatric surge, surge targets, and plan development and functionality.
Results:
Hospitals varied in pediatric capacity and capability. Forty-six percent of facilities provide inpatient pediatric services. Forty-one hospitals are designated as an Emergency Department Approved for Pediatrics. Identified gaps included: limited pediatric bed capacity, geographic variability, limited pediatric intensive care unit capacity, limited pediatric specialty physician resources, varying availability of pediatric trained staff, less availability of pediatric critical care supplies, and limited ability to accept and receive children. Focus group stakeholders requested advance and just-in-time training and reference guides to supplement the plan.
Conclusion:
LAC was able to create a pediatric surge plan that doubles pediatric acute and pediatric intensive care bed capacity by using participating HPP hospitals. A tiered system was created based on capacity and capability with varying surge targets and guidance on types of patients that could be cared for at each tier. This plan will assist the LAC Emergency Medical Services Agency distribute pediatric patients during a surge event that disproportionately impacts children.