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Improving Prehospital Protocol Adherence Using Bundled Educational Interventions
Insights
A bundled educational program significantly improved prehospital care for pediatric seizures and anaphylaxis. Paramedics demonstrated better adherence to protocols for administering midazolam and epinephrine, enhancing patient outcomes.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Medical Education
Background:
- Seizures and anaphylaxis are critical pediatric emergencies requiring prompt prehospital intervention.
- Variability exists in the current treatment of pediatric patients experiencing seizures or anaphylaxis in prehospital settings.
- Educational initiatives are needed to standardize and improve the quality of prehospital care for these conditions.
Purpose of the Study:
- To enhance the quality of prehospital care for pediatric seizures and anaphylaxis.
- To implement a comprehensive, multi-faceted educational intervention for prehospital providers.
- To reduce variations in treatment protocols for pediatric emergencies.
Main Methods:
- Developed an evidence-based curriculum for paramedics focusing on pediatric seizures and anaphylaxis.
- Implemented a bundled educational strategy including in-person training, decision support tools, and social media.
- Reviewed prehospital charts for pediatric patients with seizures or anaphylaxis before and after the educational intervention.
Main Results:
- Improved administration of midazolam via preferred intranasal (IN) or intramuscular (IM) routes for actively seizing pediatric patients, increasing from 29% to 74%.
- Increased epinephrine administration by paramedics for pediatric anaphylaxis cases, rising from 17% to 67%.
- Demonstrated a significant improvement in adherence to updated pediatric prehospital protocols post-intervention.
Conclusions:
- A bundled, multifaceted educational intervention effectively improved adherence to evidence-based pediatric prehospital protocols.
- The study highlights the success of combining various educational methods to standardize emergency care.
- This approach can decrease variation and improve outcomes for critically ill children in prehospital settings.
Background:
Seizures and anaphylaxis are life-threatening conditions that require immediate treatment in the prehospital setting. There is variation in treatment of pediatric prehospital patients for both anaphylaxis and seizures. This educational study was done to improve compliance with pediatric prehospital protocols, educate prehospital providers and decrease variation in care.
Objective:
To improve the quality of care for children with seizures and anaphylaxis in the prehospital setting using a bundled, multifaceted educational intervention.
Methods:
Evidence-based pediatric prehospital guidelines for seizures and anaphylaxis were used to create a curriculum for the paramedics in the EMS system. The curriculum included in-person training, videos, distribution of decision support tools, and a targeted social media campaign to reinforce the evidence-based guidelines. Prehospital charts were reviewed for pediatric patients with a chief complaint of anaphylaxis or seizures who were transported by paramedics to one of ten hospitals, including three children's hospitals, for 8 months prior to the intervention and eight months following the intervention. The primary outcome for seizures was whether midazolam was given via the preferred intranasal (IN) or intramuscular (IM) routes. The primary outcome for anaphylaxis was whether IM epinephrine was given.
Results:
A total of 1,402 pediatric patients were transported for seizures by paramedics to during the study period. A total of 88 patients were actively seizing pre-intervention and 93 post-intervention. Of the actively seizing patients, 52 were given midazolam pre-intervention and 62 were given midazolam post-intervention. Pre-intervention, 29% (15/52) of the seizing patients received midazolam via the preferred IM or IN routes, compared to 74% (46/62) of the seizing patients post-intervention. A total of 45 patients with anaphylaxis were transported by paramedics, 30 pre-intervention and 15 post-intervention. Paramedics administered epinephrine to 17% (5/30) patients pre-intervention and 67% (10/15) patients post-intervention.
Conclusion:
The use of a bundled, multifaceted educational intervention including in-person training, decision support tools, and social media improved adherence to updated evidence-based pediatric prehospital protocols.
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