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Evaluation of Pediatric Readiness Using Simulation in General Emergency Departments in a Medically Underserved Region
Chrystal Rutledge1, Kristen Waddell2, Stacy Gaither1
1From the Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
Insights
General emergency departments (GEDs) show lower readiness for pediatric emergencies compared to pediatric emergency departments (PEDs). Simulation reveals disparities, highlighting the need for improved resources and education in underserved areas for critical pediatric care.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Medical Simulation
Background:
- Regionalization of pediatric care aims to improve outcomes by concentrating resources, but can lead to fewer pediatric specialists in underserved areas.
- General emergency departments (GEDs) frequently encounter pediatric emergencies, which are high-risk, low-frequency events for these settings.
Purpose of the Study:
- To enhance general emergency department (GED) preparedness for pediatric emergencies through simulation in the southeastern United States.
- To assess pediatric emergency clinical care processes using simulation and evaluate factors influencing readiness, such as patient volume and location.
- To compare current findings with the 2013 National Pediatric Readiness Project.
Main Methods:
- A prospective in situ simulation study evaluated 40 emergency departments (EDs) using the Emergency Medical Services for Children Pediatric Readiness Score (PRS) and team performance.
- Simulated pediatric emergencies were used to assess care processes and calculate a Composite Quality Score (CQS) for each ED.
- Comparisons were made between general emergency departments (GEDs) and pediatric emergency departments (PEDs), and between urban and rural GEDs based on patient volume.
Main Results:
- The single pediatric emergency department (PED) had a substantially higher pediatric patient volume than the 39 general emergency departments (GEDs).
- GEDs demonstrated significantly lower Pediatric Readiness Scores (PRS) and Composite Quality Scores (CQS) compared to the PED.
- While patient volume did not significantly impact GED readiness, urban GEDs showed higher CQSs than rural GEDs.
Conclusions:
- A significant gap exists in the readiness and performance of general emergency departments (GEDs) compared to pediatric emergency departments (PEDs), particularly in underserved regions.
- There is a critical need for enhanced education and improved resource accessibility in general emergency departments to ensure adequate care for critically ill pediatric patients.
Background:
Regionalization of pediatric care in the United States was developed to improve care by directing patients to hospitals with optimal pediatric resources and experience, leading to less pediatric-trained providers in medically underserved areas. Children with emergencies, however, continue to present to local general emergency departments (GEDs), where pediatric emergencies are low-frequency, high-risk events.
Objective:
The goals of this project were to: increase exposure of GEDs in the southeast United States to pediatric emergencies through simulation, assess pediatric emergency clinical care processes with simulation, describe factors associated with readiness including volume of pediatric patients and ED location (urban/rural), and compare these findings to the 2013 National Pediatric Readiness Project.
Methods:
This prospective in situ simulation study evaluated GED readiness using the Emergency Medical Services for Children Pediatric Readiness Score (PRS) and team performance in caring for 4 simulated pediatric emergencies. Comparisons between GED and pediatric ED (PED) performance and PRS, GED performance, and PRS based on pediatric patient volume and hospital location were evaluated. A Composite Quality Score (CQS) was calculated for each ED.
Results:
Seventy-five teams from 40 EDs participated (39 GED; 1 PED). The PED had a significantly higher volume of pediatric patients (73,000 vs 4492; P = 0.003). The PRS for GEDs was significantly lower (57% [SD, 17] vs 98%; P = 0.022). The CQSs for all GEDs were significantly lower than the PED (55% vs 87%; P < 0.004). Among GEDs, there was no statistically significant difference in PRS or CQS based on pediatric patient volume, but urban GEDs had significantly higher CQSs versus rural GEDs (59.8% vs 50.6%, P = 0.001).
Conclusions:
This study shows a significant disparity in the performance and readiness of GEDs versus a PED in a medically underserved area. More education and better access to resources is needed in these areas to adequately care for critically ill pediatric patients.
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