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Pediatric Readiness in Critical Access Hospital Emergency Departments
Diane Pilkey1, Christy Edwards2, Rachel Richards3
1Emergency Medical Services for Children Program, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland.
Insights
Critical Access Hospitals (CAHs) struggle with pediatric emergency care readiness. Minimal cost interventions can improve pediatric emergency care coordination, policies, and patient safety for these facilities.
Area of Science:
- Emergency Medicine
- Pediatrics
- Healthcare Management
Background:
- Critical Access Hospitals (CAHs) are vital for emergency care but face challenges in maintaining pediatric proficiency due to low patient volume.
- Ensuring adequate pediatric readiness in CAHs is crucial for providing effective emergency services to children.
Purpose of the Study:
- To analyze the pediatric readiness of Critical Access Hospitals (CAHs).
- To provide guidance for enhancing the capacity of CAH staff to deliver effective pediatric emergency care.
Main Methods:
- Linked National Pediatric Readiness Project (NPRP) data with CAH lists from the Centers for Medicare and Medicaid Services.
- Assessed pediatric readiness using the weighted pediatric readiness score (WPRS) for 1,140 CAHs.
- Compared readiness in low-volume (<5 children/day) and medium-volume (5-14 children/day) emergency departments across six core areas.
Main Results:
- The median WPRS was 59.0 for low-volume and 67.3 for medium-volume CAHs.
- Key readiness gaps identified: 63% had pediatric emergency care coordinators, 34% had patient care review processes, 62% had transfer guidelines, and 45% used only kilograms for weight.
- CAHs in facility recognition programs had significantly higher WPRS (84.3) than non-participants (59.5).
Conclusions:
- CAHs face significant challenges in pediatric emergency care coordination, policies, procedures, and patient safety.
- Low-cost interventions can effectively improve CAH readiness for pediatric patients.
- Targeted improvements in specific readiness domains are needed to enhance pediatric emergency care in CAHs.
Purpose:
Critical Access Hospitals (CAHs), often the first point of access for emergency care, see few children and are challenged to remain proficient in caring for pediatric patients. Our analysis provides guidance to facilitate increasing CAHs staffs' ability to provide effective pediatric emergency care.
Methods:
The National Pediatric Readiness Project (NPRP) assessment of 4,146 emergency departments (EDs) was linked with the CAHs list from Centers for Medicare and Medicaid Services. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS). A WPRS of 100 indicates that the ED meets essential guidelines for pediatric readiness. Using descriptive statistics, we also compared low (fewer than 5 children a day) and medium patient volume (5-14 children a day) EDs in 6 core areas of readiness.
Findings:
Eighty-six percent (1,140) of CAHs were linked to the NPRP. In the study, 80% were low and 20% medium volume. The median WPRS was 59.0 for low and 67.3 for medium volume. While some differences were found by patient volume, overall 63% of CAHs had a pediatric emergency care coordinator, 34% had a pediatric patient care review process, 62% had interfacility transfer guidelines, and 45% weighed children only in kilograms. CAHs participating in a facility recognition program had significantly higher median WPRS scores (84.3) compared to those not participating (59.5).
Conclusion:
CAHs have challenges in being ready to care for children in the areas of pediatric emergency care coordinators, policies, procedures, and patient safety. Minimal cost interventions are available to increase the readiness of CAHs to care for children.
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