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Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments

Marc A Auerbach1, Travis Whitfill1, Erin Montgomery2

  • 1Yale University School of Medicine, New Haven, Connecticut.

Pediatrics
|July 7, 2023
PubMed

Insights

Pediatric resuscitative care quality in general emergency departments (GEDs) is low. Affiliation with a pediatric academic medical center (PAMC), higher pediatric volume, and specific coordinator roles were linked to better care quality.

Area of Science:

  • Emergency Medicine
  • Pediatric Critical Care
  • Healthcare Quality Improvement

Background:

  • Pediatric resuscitation requires specialized skills often lacking in general emergency departments (GEDs).
  • Assessing the quality of pediatric emergency care in non-specialized settings is crucial for patient safety.
  • Existing quality metrics may not fully capture the nuances of pediatric resuscitation.

Purpose of the Study:

  • To evaluate the quality of pediatric resuscitative care delivered in GEDs.
  • To identify hospital-level factors associated with superior pediatric resuscitation quality.

Main Methods:

  • A prospective observational study using in situ simulations of critical pediatric emergencies (seizure, sepsis, cardiac arrest).
  • Interprofessional teams in GEDs participated, with care quality measured by a composite quality score (CQS).
  • Analysis explored associations between CQS and modifiable/nonmodifiable hospital factors.

Main Results:

  • The median CQS was 62.8 out of 100 across 287 teams from 175 GEDs.
  • Higher quality was associated with affiliation with a pediatric academic medical center (PAMC), higher pediatric volume, and Northeast/Midwest location.
  • Adjusted analyses confirmed these associations and added the presence of nurse and physician pediatric emergency care coordinators.

Conclusions:

  • Pediatric resuscitative care quality in GEDs is suboptimal, as indicated by simulation-based assessment.
  • Key factors for higher quality care include PAMC affiliation, dedicated pediatric emergency care coordinators, high pediatric patient volume, and geographic location.
  • Pediatric readiness scores showed only a weak correlation with resuscitation quality.
Abstract

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