Clinical Pediatric Emergency Medicine最新文献

Performance measurement is the process involving regular data collection and analysis to determine efficacy of programs and services. Whereas businesses have long measured performance success through profits, public agencies are focused on outcome-based performance given that they provide public services. In the United States, federal interest in performance measurement began in 1993 when President Clinton signed the Government Performance and Results Act. Emergency Medical Services for Children is a federally funded program with the overarching mission to improve pediatric outcomes in emergency events by reducing childhood death and disability. The program is an example of almost 2 decades of performance measure development and implementation using Donabedian's 1966 three-element quality health care measurement model: structure, process, and outcome measures. Emergency Medical Services for Children performance measures cover 3 core areas of performance: prehospital, hospital, and program sustainability. These measures represent the only national assessment of the prehospital and hospital infrastructure providing emergency care for children in the United States. In this article, we describe the process, implementation strategies, and lessons learned in the development of the performance measures.

Patient and family engagement is increasingly promoted as a central element in ensuring high-quality care in health care systems. Across the Emergency Medical Services for Children (EMSC) continuum, families experience care within individual settings and in care transitions across settings. In 1999, the federal EMSC program in partnership with the EMSC National Resource Center established the Family Advisory Network (FAN) to integrate the family perspective in all EMSC activities and initiatives. With the recent conversion of EMSC's coordination center to one embedded in improvement science, the role of FAN warrants renewed focus to ensure its success as a strategic partner. An environmental scan and a strategic plan based on representation, transparency, impact, and commitment will position FAN as a vital component in the future success of EMSC.

Transitions of care between providers occur frequently in the emergency department (ED), inviting opportunity for error. The evidence base for improving transitions within the hospital is growing, yet the vast majority of children seen in EDs are discharged home to complete outpatient evaluation and management. The transition of care to the caregiver at home, primary care physician, and specialists that will assume management of the patient offers a critical opportunity to generate value for stakeholders and ensure that their needs are addressed. When reviewing in-hospital transitions, many best practices are identified that may apply to both healthy children and those with complex conditions discharged from the ED. The barriers to performing and the enablers that facilitate strong transitions to the community suggest that there is opportunity to create tools and processes including evolving digital platforms to complete efficient, effective transitions that may reduce ED recidivism.

National organizations and national surveys have highlighted the gap in quality pediatric care and preparedness in emergency departments (EDs) over the last 20 years. The objective of this review is to provide a framework, summary, and list of common resources to guide general EDs in the use of proven quality improvement tools and resources towards meaningful improvement in pediatric care in the their institution. This review also highlights organizations, such as the Emergency Medical Services for Children Innovation and Improvement Center, that serve as leaders and repositories for collaborative work and expertise to improve pediatric emergency care anywhere in the United States.

Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in the pediatric population. It impacts all levels of care in our medical system. Despite numerous published guidelines and significant resources dedicated to acute management of pediatric TBI, most patients who are discharged have unrecognized or unmet needs at 6, 12, and 24 months after injury. Rehabilitation services have been developed to address the gap in both the inpatient and outpatient setting, though access to them is variable across the country. This article examines the importance of rehabilitation in the management and outcome of pediatric TBI, recognizing that there is substantial room for growth in rehabilitation services, as well as a need for further research that examines the benefits of rehabilitation on outcomes in all categories of TBI and at many time points along the continuum of care.

After 17 years, the Pediatric Emergency Care Applied Research Network has demonstrated its significant contribution to the care of acutely ill and injured children through the successful completion of more than 35 research studies. Despite the importance of research findings and the numerous publications in medical journals, the information is not easily accessible by parents, families, or nonresearch medical providers. Another group of investigators has developed knowledge translation and dissemination using social media through the Translating Emergency Knowledge for Kids knowledge mobilization network. This model is an example for other networks and outlines the challenges of dissemination of findings. The network’s research is widely published and has been incorporated into national guidelines, but the Pediatric Emergency Care Applied Research Network’s next challenge is translation of network findings into practice so every child who seeks emergency care in the United States in large or small emergency departments can be treated with evidence-based medicine.

Many hospitals and emergency departments lack resources to optimally care for ill and injured children, perpetuating risks of receiving fragmented and “uneven” care. In this article, we describe the present state of our pediatric emergency medicine workforce as well as the impact that different innovations could have on the future of pediatric emergency care. Many innovative initiatives, including physician and advanced practice provider education and training, pediatric readiness recognition programs, telemedicine and in-situ simulation outreach, and community paramedicine are being utilized to help bridge access gaps and augment the reach of the pediatric emergency medicine workforce. Advocacy for reimbursement for novel care delivery models, such as community paramedicine and telemedicine, and funding for outreach education is essential. Also, better understanding of our current training models for and utilization of advanced practice practitioners in pediatric emergency medicine is crucial to understanding the diversity of workforce growth and opportunity.

Emergency Medical Service (EMS) responses for pediatric patients represent 13% of total EMS responses in the United States.¹ Despite that, the average experience of the typical prehospital provider in caring for pediatric patients is highly variable, with more than 39% of EMS services seeing fewer than 13 pediatric patients a year.² The requirements for initial EMS provider certification vary, from 4 to 9 hours for emergency medical technicians and 7 to 34 hours for paramedics, often combining pediatrics into a “special populations” domain which includes geriatrics, obstetrics, and other patient types.³ The lack of operational reinforcement of skills due to low pediatric volume, as well as limited educational opportunities for prehospital providers, results in a lack of comfort when EMS providers find themselves in a situation needing to provide care to an ill or injured child. It is this knowledge and experience gap that the EMS for Children program addresses through state partnership collaborations and regional partnerships.

Injuries are the leading cause of death and disability in children 1-18 years old in the United States, and many of these injuries are preventable. The Haddon matrix is a foundational concept of injury prevention, examining different phases and factors of the injury process to develop interventions. Primary prevention, including injury prevention, is the first phase of the Emergency Medical Services for Children continuum of care. As part of this continuum, the National Highway Transportation Safety Administration and the Centers for Disease Control and Prevention are integral components of the national prevention efforts to decrease unintentional injuries due to motor vehicle crashes and home and recreational injuries as well as intentional injuries. This article describes a brief history of the Emergency Medical Services for Children, National Highway Transportation Safety Administration, and the Centers for Disease Control and Prevention, as well as injury prevention initiatives for some of the leading causes of pediatric injuries and child maltreatment.