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Critical procedure performance in pediatric patients: Results from a national emergency medicine group

Jestin N Carlson1, Mark S Zocchi2, Coburn Allen3

  • 1US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, United States of America.

The American Journal of Emergency Medicine
|July 30, 2020
PubMed

Insights

Emergency physicians rarely perform critical pediatric procedures, especially in general and freestanding emergency departments (EDs). This scarcity impacts ED readiness for pediatric emergencies.

Area of Science:

  • Emergency Medicine
  • Pediatric Critical Care
  • Healthcare Quality

Background:

  • Pediatric critical procedures are essential interventions in emergency care.
  • Understanding the frequency of these procedures is vital for assessing emergency department (ED) readiness.
  • Variations in procedure performance across different ED settings are not well-characterized.

Purpose of the Study:

  • To examine the frequency of pediatric critical procedures performed by emergency physicians nationally.
  • To compare the rates of these procedures in general EDs, pediatric EDs, and freestanding EDs/urgent care centers.
  • To identify potential disparities in procedural experience among emergency physicians.

Main Methods:

  • Retrospective analysis of an administrative billing and coding dataset (2014-2018).
  • Inclusion of pediatric patients (<18 years).
  • Focus on critical procedures: endotracheal intubation, electrical cardioversion, central venous placement, intraosseous access, and chest tube insertion.

Main Results:

  • A total of 2233 pediatric critical procedures were performed by 2290 emergency physicians across 186 EDs.
  • A significant proportion of physicians in general EDs (53.9%) and freestanding EDs/urgent cares (89%) performed zero pediatric procedures annually.
  • Physicians in pediatric EDs performed significantly more pediatric critical procedures per 1000 ED visits (0.68) and per 1000 clinical hours (1.66) compared to those in general EDs (0.12 and 0.26, respectively).

Conclusions:

  • Pediatric critical procedures are infrequently performed by emergency physicians, particularly in general and freestanding EDs.
  • The low frequency of these procedures raises concerns about emergency physician proficiency and overall ED pediatric readiness.
  • Targeted training and resource allocation may be necessary to improve pediatric critical care capabilities in non-pediatric ED settings.
Abstract

Keywords:
Emergency careEmergency departmentProceduresResuscitation

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