Pediatric Readiness in Critical Access Hospital Emergency Departments.


Journal

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
ISSN: 1748-0361
Titre abrégé: J Rural Health
Pays: England
ID NLM: 8508122

Informations de publication

Date de publication:
09 2019
Historique:
pubmed: 1 8 2018
medline: 23 6 2020
entrez: 1 8 2018
Statut: ppublish

Résumé

Critical Access Hospitals (CAHs), often the first point of access for emergency care, see few children and are challenged to remain proficient in caring for pediatric patients. Our analysis provides guidance to facilitate increasing CAHs staffs' ability to provide effective pediatric emergency care. The National Pediatric Readiness Project (NPRP) assessment of 4,146 emergency departments (EDs) was linked with the CAHs list from Centers for Medicare and Medicaid Services. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS). A WPRS of 100 indicates that the ED meets essential guidelines for pediatric readiness. Using descriptive statistics, we also compared low (fewer than 5 children a day) and medium patient volume (5-14 children a day) EDs in 6 core areas of readiness. Eighty-six percent (1,140) of CAHs were linked to the NPRP. In the study, 80% were low and 20% medium volume. The median WPRS was 59.0 for low and 67.3 for medium volume. While some differences were found by patient volume, overall 63% of CAHs had a pediatric emergency care coordinator, 34% had a pediatric patient care review process, 62% had interfacility transfer guidelines, and 45% weighed children only in kilograms. CAHs participating in a facility recognition program had significantly higher median WPRS scores (84.3) compared to those not participating (59.5). CAHs have challenges in being ready to care for children in the areas of pediatric emergency care coordinators, policies, procedures, and patient safety. Minimal cost interventions are available to increase the readiness of CAHs to care for children.

Identifiants

pubmed: 30062684
doi: 10.1111/jrh.12317
doi:

Types de publication

Journal Article Research Support, U.S. Gov't, P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

480-489

Informations de copyright

© 2018 National Rural Health Association.

Références

Centers for Disease Control and Prevention, National Center for Health Statistics (NCHS), National Vital Statistics System. 2016. Available at: https://webappa.cdc.gov/sasweb/ncipc/leadcause.html. Accessed June 5, 2018.
Singh GK, Siahpush M. Widening rural urban disparities in all-cause mortality and mortality from major causes of death in the USA, 1969-2009. J Urban Health. 2014;2(91):272-292.
Meit M, Knudson A, Gilbert T, et al. The 2014 Update of the Rural-Urban Chartbook. Grand Forks, ND: Rural Health Reform Policy Research Center; 2014.
US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2007. Rockville, MD: US Department of Health and Human Services; 2011.
Tang N, Stein J, Hsia RY, Maselli J, Gonzales R. Trends and characteristics of US emergency department visits, 1997-2007. JAMA. 2010;304(6):664-670.
Gausche-Hill M, Ely M, Schmuhl P, et al. A national assessment of pediatric readiness of emergency departments. JAMA Pediatr. 2015;169(6):527-534.
Ray K, Olson L, Edgerton E, et al. Access to high pediatric-readiness emergency care in the United States. J Pediatr. 2018;194:225-232.
Rural Health Information Hub. Critical access hospitals (CAHs). Available at: https://www.ruralhealthinfo.org/topics/critical-access-hospitals. Accessed January 5, 2018.
FLEX Monitoring Team. Critical access hospital locations. Available at: http://www.flexmonitoring.org/data/critical-access-hospital-locations/. Accessed January 5, 2018.
American Hospital Association. In Critical Condition: The Fragile State of Critical Access Hospitals (Infographic). Chicago, IL: AHA; 2013. Available at: https://www.aha.org/infographics/2013-12-11-critical-condition-fragile-state-critical-access-hospitals. Accessed January 5, 2018.
Data from the HCUP State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) from 34 States, Healthcare Cost and Utilization Project (HCUP). 2014. Provided by the Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.hcup-us.ahrq.gov/sidoverview.jsp and www.hcup-us.ahrq.gov/seddoverview.jsp. Data provided/Accessed November, 2017.
Franca UL, McManus ML. Trends in regionalization of hospital care for common pediatric conditions. Pediatrics. 2018;141(1):1-9.
Freeman V, Thompson K, Howard H, Randolph R, Holmes M. 21st Century Rural Hospital Chart Book, March 2015. Chapel Hill, NC: North Carolina Rural Health Research Program. Available at: http://www.shepscenter.unc.edu/wp-content/uploads/2015/02/21stCenturyRuralHospitalsChartBook.pdf. Accessed February 6, 2018.
Kaufman B, Thomas S, Randolph R, et al. The rising rate of rural hospital closures. J Rural Health. 2016;32(1): 35-43.
Kaufman M, Rutledge R, Pink G, Holmes M. Geographic Variation in Risk of Financial Distress among Rural Hospitals. Policy Brief. Chapel Hill, NC: North Carolina Rural Health Research Program; 2016.
HRSA Emergency Medical Services for Children. Pediatric medical recognition fact sheet. Available at: http://www.nedarc.org/performanceMeasures/documents/pm74FactSheet_030416.pdf. Accessed January 10, 2018.
Remick KE, Kaji A, Olson L, et al. Pediatric readiness and facility verification. Ann Emerg Med. 2016;67(3):320-328.
Rice A, Dudek J, Gross T, St Mars T, Woolridge D. The impact of a pediatric emergency department facility verification system on pediatric mortality rates in Arizona. J Emerg Med. 2017;52(6):894-901.
Ball JW, Sanddal ND, Mann NC, et al. Emergency department recognition program for pediatric services: does it make a difference? Pediatr Emerg Care. 2014;30(9):608-612.
Institute of Medicine Committee on the Future of Emergency Care in the US. Emergency Care for Children: Growing Pains. Washington, DC: National Academy Press; 2007.
Emergency Medical Services for Children. Pediatric regionalization of care primer 2015. Available at: https://www.nasemso.org/Councils/PEDS/documents/RegionalizationPrimer.pdf. Accessed January 21, 2018.
Katznelson JH, Wang J, Stevens MW, Mills W. Improving pediatric preparedness in critical access hospital emergency departments: impact of a longitudinal in situ simulation program. Pediatr Emerg Care. 2018;34(1):17-20.
American Academy of Pediatrics, Committee on Pediatric Emergency Medicine; American College of Emergency Physicians, Pediatric Committee. Care of children in the emergency department: guidelines for preparedness. Pediatrics. 2001;107:777-781.
American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, American College of Emergency Physicians, Pediatric Committee, Emergency Nurses Association Pediatric Committee. Joint policy statement: guidelines for care of children in emergency departments. Pediatrics. 2009;124:1233-1243.
Sadovich J, Adirim T, Telford R, Olson L, Gausche-Hill M, Edgerton E. Pediatric readiness in Indian Health Service and Tribal Emergency Departments: results from the National Pediatric Readiness Project. J Emerg Nursing. 2017;43(1):49-56.
US Department of Agriculture. Urban influence codes 2013. Available at: http://www.ers.usda.gov/data-products/urban-influence-codes/documentation.aspx. Accessed January 5, 2018.
Kocher KE, Sklar DP, Mehrotra A, Tayal V, Gausche-Hill M, Myles R. Categorization, designation, and regionalization of emergency care: definitions, a conceptual framework, and future challenges. Acad Emerg Med. 2010;17(12):1306-1311.
Gausche-Hill M, Schmitz C, Lewis RJ. Pediatric preparedness of US emergency departments: a 2003 survey. Pediatrics. 2007;120(6):1229-1237.
Centers for Medicare and Medicaid Services. Provider of services file 2014. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Provider-of-Services/POS2014.html. Accessed June 21, 2016.
Emergency Medical Services for Children (EMSC) National Resource Center and the Pediatric Readiness Resource Development Working Group. Pediatric readiness toolkit. Available at: https://emscimprovement.center/projects/pediatricreadiness/readiness-toolkit/. Accessed January 5, 2018.
Emergency Medical Services for Children. Ensuring pediatric readiness for all emergency departments. White Paper; 2017. Available at: https://emscimprovement.center/about/nprp-white-paper/. Accessed January 5, 2018.
Genovesi A, Olson L, Telford R, et al. Transitions of care: the presence of written inter-facility transfer guidelines and agreements for pediatric patients. Pediatr Emerg Care. 2017; Jul 11. Available at: https://doi.org/10.1097/PEC.0000000000001210. [Epub ahead of print].
Emergency Medical Services for Children. Inter-facility transfer toolkit. Available at: https://emscimprovement.center/resources/publications/interfacility-transfer-tool-kit/. Accessed January 10, 2018.
American Academy of Pediatrics. Statement of endorsement: weighing all patients in kilograms. Pediatrics. 2017;140(4):pii: e20172476. Available at: https://doi.org/10.1542/peds.2017-2476. Accessed March 5, 2018.
To Err is Human: Building a Safer Health System. Washington, DC: The National Academy Press; 2000. Available at: https://www.nap.edu/catalog/9728/to-err-is-human-building-a-safer-health-system. Accessed January 9, 2018.
Gonzales K. Medication administration errors and the pediatric population: a systematic search of the literature. J Pediatr Nursing. 2010;25(6):555-565.
Hirata K, Kang A, Ramirez G, Kimata C, Yamamoto L. Pediatric weight errors and resultant medication dosing errors in the emergency department. Pediatr Emerg Care. 2017, Oct 2. Available at: https://doi.org/10.1097/PEC.0000000000001277. [Epub ahead of print].
Koumpagioti D, Varounis C, Kletsiou E, Nteli C, Matziou V. Evaluation of the medication process in pediatric patients: a meta-analysis. J Pediatr (Rio J). 2014;90(4):344-355.
Benjamin L, Frush K, Shaw K, et al. Pediatric medication safety in the emergency department. American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Emergency Medicine Committee, Emergency Nurses Association Pediatric Emergency Medicine Committee. Pediatrics. 2018;141(3): e20174066.
Larose G, Levy A, Bailey B, Cummings-McManus B, Lebel D, Gravel J. Decreasing prescribing errors during pediatric emergencies: a randomized simulation trial. Pediatrics. 2017:139(3): 1-10.
Emergency Nurses Association. Weighing All Patients in Kilograms. Des Plaines, IL: Emergency Nurses Association; 2016. 1-12. Available at: https://www.ena.org/docs/default-source/resource-library/practice-resources/position-statements/weighingallpatientsinkilograms.pdf?sfvrsn=9c0709e_6. Accessed January 21, 2018.
Emergency Medical Services for Children. State partnership regionalization of care program. Available at: https://emscimprovement.center/projects/sproc/. Accessed June 5, 2018.
University of New Mexico Virtual Pediatric Emergency Department Telehealth Network. Available at: https://emed.unm.edu/pem/programs/child-ready-program/technologies/index.html. Accessed June 5, 2018.
Gattu R, Teshome G, Lichenstein R. Telemedicine applications for the pediatric emergency medicine: a review of the current literature. Pediatr Emerg Care 2016;32:123-130.
Barata I, Brown K, Fitzmaurice L, et al. Best practices for improving flow and care of pediatric patients in the emergency department. Pediatrics. 2015;135(1):e273-e283.
Horeczko T, Enriquez B, McGrath N, Gausche-Hill M, Lewis RJ. The pediatric assessment triangle: accuracy of its application by nurses in the triage of children. J Emerg Nurs. 2013;39(2):182-189.
American College of Emergency Physicians. Pediatric mental health emergencies in the emergency medical services system. Available at: https://www.acep.org/Clinical-Practice-Management/Pediatric-Mental-Health-Emergencies-in-the-Emergency-Medical-Services-System/. Accessed January 21, 2018.
Thomas D. Implementing the IOM recommendations for improving pediatric emergency care in your emergency department: start from where you are! J Emerg Nurs. 2011;37(4):404-408.
O'Malley P, Barata I, Snow S. Death of a child in the ED. Joint statement by the American College of Emergency Physicians, American Academy of Pediatrics, and the Emergency Nurses Association. J Emerg Nurs. 2014;40(4):e83-e101.
Emergency Medical Services for Children. Pediatric disaster toolbox. Available at: https://emscimprovement.center/resources/toolboxes/pediatric-disaster-preparedness-toolbox/. Accessed January 21, 2018.
National Library of Medicine, Disaster Information Management Research Center (Children in Disasters). Available at: https://sis.nlm.nih.gov/dimrc/children.html. Accessed January 21, 2018.
US Department of Health and Human Services, Assistant Secretary of Preparedness and Response. The technical resources, assistance center, and information exchange (TRACIE). Available at: https://asprtracie.hhs.gov/technical-resources/31/pediatric/27. Accessed January 21, 2018.
US Department of Health and Human Services, Assistant Secretary of Preparedness and Response. Hospital Preparedness Program (HPP). Available at: https://www.phe.gov/Preparedness/planning/hpp/Pages/default.aspx. Accessed January 21, 2018.
Remick K, Gross T, Adelgaias K, Shah MI, Leonard JC, Gausche-Hill M. Resource document: coordination of pediatric emergency care in EMS systems. Prehosp Emerg Care. 2017;21(3):399-407.
Cichon M, Fuchs S, Lyons E. A statewide model program to improve emergency department readiness for pediatric care. Ann Emerg Med. 2009;54(2):198-204.
Emergency Medical Services for Children Improvement and Innovation Center, Pediatric Readiness Quality Collaborative. Available at: https://emscimprovement.center/collaboratives/PRQuality-collaborative/. Accessed January 21, 2018.

Auteurs

Diane Pilkey (D)

Emergency Medical Services for Children Program, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland.

Christy Edwards (C)

Federal Office of Rural Health Policy, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland.

Rachel Richards (R)

National Emergency Medical Services for Children Data Analysis Resource Center, Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah.

Lenora M Olson (LM)

National Emergency Medical Services for Children Data Analysis Resource Center, Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah.

Michael Ely (M)

National Emergency Medical Services for Children Data Analysis Resource Center, Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah.

Elizabeth A Edgerton (EA)

Division of Child and Adolescent Health, Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH