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Closing the Loop: The Value of Outcome Letters for Prehospital Pediatric Care
Candice McGahern1, Zachary Cantor2, Benjamin De Mendonca2
1From the Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Insights
Paramedics found standardized outcome letters for pediatric patients valuable for learning and closure. These letters help bridge the gap in prehospital care and improve continuous medical education.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Quality Improvement
Background:
- Prehospital care providers, such as paramedics, often lack patient outcome information after emergency transport.
- This information gap can increase stress and hinder continuous learning for paramedics treating acutely ill or injured children.
Purpose of the Study:
- To assess paramedics' perceptions of standardized outcome letters for acute pediatric patients.
- To evaluate the utility of patient outcome feedback in prehospital pediatric emergency care.
Main Methods:
- A quality improvement project distributed 888 outcome letters to paramedics who treated 370 pediatric patients.
- A survey collected feedback from 172 paramedics (37% response rate) regarding the usefulness and content of the outcome letters.
Main Results:
- 91% found letters pertinent to practice, 87% used them for reflection, and 93% confirmed clinical suspicions.
- Paramedics valued letters for linking diagnoses to outcomes, fostering learning, and providing closure for difficult cases.
- Suggestions included more information, broader distribution, faster delivery, and inclusion of recommendations.
Conclusions:
- Paramedics positively received hospital-based outcome information for pediatric patients.
- Outcome letters facilitate closure, reflection, and continuous learning in prehospital emergency care.
Objectives:
Providing emergency care to acutely ill or injured children is stressful and requires a high level of training. Paramedics who provide prehospital care are typically not involved in the circle of care and do not receive patient outcome information. The aim of this quality improvement project was to assess paramedics' perceptions of standardized outcome letters pertaining to acute pediatric patients that they had treated and transported to an emergency department.
Methods:
Between December 2019 and December 2020, 888 outcome letters were distributed to paramedics who provided care for 370 acute pediatric patients transported to the Children's Hospital of Eastern Ontario in Ottawa, Canada. All paramedics who received a letter (n = 470) were invited to participate in a survey that collected their perceptions and feedback about the letters, as well as their demographic information.
Results:
The response rate was 37% (172/470). Approximately half of the respondents were Primary Care Paramedics and half Advanced Care Paramedics. The respondents' median age was 36 years, median years of service was 12 years, and 64% identified as male. Most agreed that the outcome letters contained information pertinent to their practice (91%), allowed them to reflect on care they had provided (87%), and confirmed clinical suspicions (93%). Respondents indicated that they found the letters useful for 3 reasons: 1) increases capacity to link differential diagnoses, prehospital care, or patient outcomes; 2) contributes to a culture of continuous learning and improvement; and 3) gives closure, reduces stress, or provides answers for difficult cases. Suggestions for improvement included providing more information, provision of letters on all patients transported, faster turnaround time between call and receipt of letter and inclusion of recommendations or interventions/assessments.
Conclusions:
Paramedics appreciated receiving hospital-based patient outcome information after their provision of care and reported that the letters offered opportunities for closure, reflection, and learning.
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