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The Effect of a Collaborative Pediatric Emergency Readiness Improvement Intervention on Patients' Hospital Outcomes
Mohannad Abu-Sultanah1, Riad Lutfi1, Samer Abu-Sultaneh1
1The Department of Pediatrics (M Abu-Sultanah, R Lutfi, S Abu-Sultaneh, and K Abulebda), Division of Pediatric Critical Care Medicine, Riley Hospital for Children at Indiana University Indianapolis.
Insights
Improving pediatric readiness scores in general emergency departments (GEDs) through collaborative intervention was associated with shorter pediatric intensive care unit (PICU) and hospital stays. This highlights the importance of enhancing pediatric readiness for better patient outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Systems Improvement
- Critical Care
Background:
- Pediatric readiness in general emergency departments (GEDs) is crucial for the optimal care of critically ill children.
- Existing disparities in pediatric readiness can lead to suboptimal outcomes.
- Collaborative interventions aim to standardize and improve pediatric emergency care capabilities.
Purpose of the Study:
- To evaluate the association between a collaborative intervention to improve the weighted pediatric readiness score (WPRS) and patient outcomes.
- To determine if enhanced pediatric readiness impacts pediatric intensive care unit (PICU) mortality, PICU length of stay (LOS), and hospital LOS.
Main Methods:
- A pre- and post-intervention study analyzing transfers from GEDs to a pediatric critical care setting.
- Intervention included customized reports, best practice sharing, nurse pediatric emergency care coordinator (PECC) designation, and follow-up interactions.
- Clinical outcomes (PICU LOS, hospital LOS, PICU mortality) were assessed using descriptive statistics, bivariate analyses, and multivariable models.
Main Results:
- The study included 278 patients pre-intervention and 314 post-intervention.
- Multivariable analyses showed a significant association between improved WPRS and decreased PICU LOS (P=.02) and hospital LOS (P=.04).
- No significant association was found between the intervention and PICU mortality or other patient outcomes.
Conclusions:
- Improving pediatric readiness scores in GEDs is linked to reduced lengths of stay in PICU and hospitals for critically ill children.
- These findings support the widespread implementation of pediatric readiness initiatives.
- Further efforts are needed to disseminate pediatric readiness strategies to improve national outcomes for critically ill children.
Objective:
We hypothesized that collaborative intervention to improve weighted pediatric readiness score (WPRS) will be associated with decreased pediatric intensive care (PICU) mortality, PICU and hospital length of stay.
Methods:
This study analyzes the transfer of acutely ill and injured patients from general emergency departments (GEDs) to our institution. The intervention involved customized assessment reports focusing on team performance and systems improvement for pediatric readiness, sharing best practices and clinical resources, designation of a nurse pediatric emergency care coordinator (PECC) at each GED and ongoing interactions at 2 and 4 months. Data was collected from charts before and after the intervention, focusing on patients transferred to our pediatric emergency department (ED) or directly admitted to our PICU from the GEDs. Clinical outcomes such as PICU length of stay (LOS), hospital LOS, and PICU mortality were assessed. Descriptive statistics were used for demographics, and various statistical tests were employed to analyze the data. Bivariate analyses and multivariable models were utilized to examine patient outcomes and the association between the intervention and outcomes.
Results:
There were 278 patients in the pre-intervention period and 314 patients in the post-intervention period. Multivariable analyses revealed a significant association between the change in WPRS and decreased PICU LOS (β = -0.05 [95% CI: -0.09, -0.01), P = .02), and hospital LOS (β = -0.12 [95% CI: -0.21, -0.04], P = .04), but showed no association between the intervention and other patient outcomes.
Conclusions:
In this cohort, improving pediatric readiness scores in GEDs was associated with significant improvements in PICU and hospital length of stay. Future initiatives should focus on disseminating pediatric readiness efforts to improve outcomes of critically ill children nationally.
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