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Study finds low quality of pediatric resuscitative care in general EDs

July 7, 2023

A study of 175 general emergency departments (GEDs) showed a low quality of pediatric resuscitative care.

The Improving Pediatric Acute Care Through Simulation research group found several steps these EDs could take to improve care, which they detailed in “Factors Associated with Improved Pediatric Resuscitative Care in General Emergency Departments,” (Auerbach MA, et al. Pediatrics. July 7, 2023).

The group noted 30 million children receive care in an ED annually, and more than 90% initially present to general, not pediatric, EDs.

To assess the quality of resuscitative care, it conducted simulations with 287 teams in 175 EDs in the U.S. and Canada. Each team participated in three standardized simulated scenarios — infant sepsis, infant seizure and child cardiac arrest — using real equipment and simulated medications.

Teams were scored on a scale of 0 to 100 based on adherence to checklists for care. The median overall score was 62.8. Median scores for individual simulations were 50 for sepsis, 61.5 for cardiac arrest and 57.1 for seizure.

The adjusted analysis showed higher scores were linked to being affiliated with a pediatric academic medical center (PAMC) as well as designation of both a nurse and physician pediatric emergency care coordinator (PECC).

Affiliations with regional PAMCs are becoming more common, they said, and the study “supports the potential positive impact of these affiliations on the quality of pediatric care.”

Combining PAMC affiliation and PECC staff “can be powerful tools to improve pediatric readiness,” authors wrote. “We recommend collaboration between PAMCs and PECCs to create sustainable collaborative local interventions.”

The study also found EDs that saw more pediatric patients tended to have higher scores, as did facilities in the Northeast and Midwest.

“These data suggest prioritizing the implementation of improvement interventions in low pediatric-volume GEDs, especially among those in the Southeastern region,” authors said.

Researchers said they were surprised to see EDs with high scores on National Pediatric Readiness Project assessments had lower scores on the simulation exercises. However, they noted the correlation was weak, and the two assessments have different methodologies and participants.

The current study was limited due to its reliance on simulations and underrepresentation of rural EDs. Authors also noted the findings could have been impacted by the types of EDs that agreed to join the study.

“Future work is needed to examine the specific elements of affiliation that lead to improved quality and to develop and test pediatric emergency care improvement initiatives targeting lower pediatric volume EDs,” they wrote.



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