Clinical Pediatric Emergency Medicine最新文献

Attending physicians are the primary role models of professionalism, but little is known what their perspective is on the maintenance of their professionalism. This study characterizes the pediatric emergency medicine (PEM) attending perspective on maintaining professionalism during their career. Two qualitative methods were used: field observation and semi-structured interviews. Field observations were conducted in one pediatric emergency department (ED) based on a framework for professionalism education. Semi-structured interviews were conducted with a purposive sample of PEM attendings from across the country. Interviews were transcribed and themes analyzed using an iterative, inductive process. The two differing methods allowed for data triangulation. Forty-five hours of ED observation were completed with thematic coding of observations. Seventeen interviews were conducted with PEM physicians around the country with a wide variety of demographic characteristics. Observations and interviews revealed several themes describing the PEM attending’s perspective on professionalism. Challenges to professionalism include: patient related factors (such as high volume and acuity, difficult medical situations and dissatisfied families), staff interactions (RN, ancillary, etc), trainee education and interaction, ED environment, academic pressures, and personal factors. By understanding the PEM attending perspective on professionalism, resources and education can be better targeted for professional development and interventions to solve the challenges that PEM physicians identify. Understanding the PEM attending perspective may also be useful in developing assessment tools for attendings and may provide deeper insight into the impact of role models on trainee professionalism education.

Pediatric emergency care is conducted primarily outside of academic medical centers. This care is variable among and between pediatric based providers and general emergency medicine physicians. As studies have noted these variations, there has been focus on ways to broadly improve this care and decrease variation in the non-academic community hospital setting. Initial successes have been realized in pediatric emergency preparedness, learning collaboratives and telemedicine. Although these initiatives show promise in building improvements of care for the community pediatric population, the focus towards maintaining and increasing quality in this population requires additional attention. We review current successes and offer perspective for possible future directions.

The applications of quality improvement in health care are many, as efforts are undertaken to achieve the Institute for Healthcare Improvement's triple aim. Varying institutional infrastructure models exist based on leadership philosophies, organizational charts, and/or resource availability. Successes are dependent on tactics that yield execution, engagement, and sustainability. In the following piece, we review the strategy and tactics taken by the Lurie Children's Emergency Department leadership team to maximize our operational and quality improvement impact, offering perspective for the development of quality improvement structural components at the local department level.

Nearly 90% of pediatric emergency care is provided in a general emergency department (ED) that serve both adults and children. Many children in the United States do not live near an ED with a high level of pediatric readiness and many children are transferred to dedicated pediatric centers. Telemedicine provides an opportunity to impact care delivery systems to allow for children to be treated closer to home while maintaining high quality care. In this article, we will explore opportunities to use telemedicine in the emergency department and discuss incorporating quality improvement methodology to increase utilization of telehealth services.

The growth of community hospital based pediatric emergency departments has created an opportunity to develop locally formulated quality improvement processes. Inherent challenges, resource and solutions are explored. Building a well-defined QI infrastructure, one that promotes multidisciplinary buy-in and ownership among invested participants, is central to success.

Medical errors are a leading cause of morbidity and mortality in healthcare. Pediatric patients receiving care in the acute or emergency setting may be especially susceptible to medical error and subsequent harm. Here we review the most common types of medical errors in pediatric emergency medicine – those related to medication, laboratory evaluation, communication, and diagnosis. Diagnostic errors are perhaps the most common but least studied type of error, though there has been recent interest in further quantifying, characterizing and preventing such error. Active research focuses on the systems issues and cognitive biases that likely play a role in this process.

There has been a significant increase in the number of asylum-seekers entering the United States in recent years, including children and unaccompanied minors. Upon arrival to the country, these young patients may seek care in an emergency department for acute medical issues related to their journey or chronic conditions that were undiagnosed or inadequately treated in their country of origin. The purpose of this article is to familiarize emergency department clinicians with the common medical conditions seen in pediatric asylum-seekers and outline the ethical and legal issues that may arise when caring for this vulnerable patient population.

Pediatric patients in resource-limited settings are often at high risk of severe manifestations or complications of tropical infectious diseases. Health care providers in these settings often lack access to basic diagnostic imaging. Point-of-care ultrasound is one modality that may improve the care of these children by bringing portable imaging technology to the bedside. To use ultrasound effectively, the clinician must have both the ability to obtain and interpret images and an understanding of the context and presentation of the disease in question. We discuss the utility of point-of-care ultrasound in a variety of pediatric tropical infectious diseases with dual purposes: first, to introduce practitioners with prior ultrasound experience to ways to apply preexisting knowledge in different contexts and, second, to introduce providers in low-resource settings to a diagnostic modality that can be easily learned with discrete protocols and may improve their care of vulnerable patients.

Local efforts in global health are a rising area of focus as multigenerational immigrant communities continue to grow in the United States. Immigrant and refugee children are at risk for poor health outcomes due to environmental, social, economic, and individual factors that contribute to inequities in participation within the health care system. This case-based reflection brings to light specific manifestations of the aforementioned factors. Addressing these barriers will promote health equity and allow children, regardless of background, to reach their full potential.