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5 Improving the Quality of Pediatric Emergency Care
Pages 187-220

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From page 187...
... And we expect care to be provided in a way that is evidence based, protocol driven, and respectful to children and their parents or guardians. This chapter begins with an overview of the threats to patient safety in the EMS and ED environments and the implications for care, with a focus on pediatric patients.
From page 188...
... ; emergency physicians, by contrast, are often responsible for the simultaneous management of 10 to 20 patients or more with a variety of problems and different levels of acuity. This is such an intrinsic part of emergency medical practice that the oral board exam administered by the American Board of Emergency Medicine (ABEM)
From page 189...
... . A study of the effect of sleep deprivation on experienced emergency physicians revealed that physicians working night shifts demonstrated a decrease in the speed of intubation and subjective alertness as compared with their day-shift work (Smith-Coggins et al., 1997)
From page 190...
... . Additional Challenges for Pediatric Emergency Care Most of the above challenges contribute to a potentially unsafe emergency care environment for all patients, not just children.
From page 191...
... Delay in recognizing and quickly treating a state of shock can lead to widespread multiple system organ failure and death in pediatric patients (Schwarz, 2006)
From page 192...
... However, parents, guardians, and primary care physicians may not recognize the need for immediate emergency care for pediatric patients, and emergency care providers may not be able to determine the severity of illness or injury quickly. In fact, at least one study has shown that the level of agreement in triage assignment for pediatric patients in the ED is not high, and varies based on the level of pediatric training (Maldonado and Avner, 2004)
From page 193...
... Evidence of Compromised Safety for Pediatric Patients Given this potentially perilous emergency care environment, how often do medical errors occur among pediatric patients? Surprisingly, the answer to that question is unknown.
From page 194...
... . Another study of medication errors among acutely ill and injured children presenting to rural EDs revealed errors in 48 percent of patient charts (Marcin et al., 2005)
From page 195...
... could lead this effort, including the FDA, the Health Resources and Services Administration (HRSA) , and the Agency for Healthcare Research and Quality (AHRQ)
From page 196...
... PREA applies only to new molecular entities or new drugs, for which the FDA can require that the manufacturer conduct pediatric studies unless exceptions are granted. There is currently no regulation providing incentives for or requiring manufacturers to perform pediatric studies for the vast majority of drugs on the market in the generic forms used for pediatric patients.
From page 197...
... To reduce the high frequency of medication errors that occur in pediatric emergency care, the committee recommends that the Department of Health and Human Services and the National Highway Traffic Safety Administration fund the development of medication dosage guidelines, formulations, labeling guidelines, and administration techniques for the emergency care setting to maximize effectiveness and safety for infants, children, and adolescents. Emergency medical services agencies and hospitals should incorporate these guidelines, formulations, and techniques into practice (5.2)
From page 198...
...  EMERGENCY CARE FOR CHILDREN classify the strategies into three groups: provider policies, provider training, and technologies. Ideally, organizations would adopt all three of these strategies.
From page 199...
...  IMPROVING THE QUALITY vealed considerable success. EDs using the ETCC experienced a 67 percent increase in error-averting behavior and a 58 percent reduction in observable errors (Risser et al., 1999; Shapiro et al., 2004)
From page 200...
... While this appears to be a rather obvious consideration, history is filled with examples of medical technologies originally developed for adults and used on children with unintended consequences. Devices are typically developed for adults because they constitute a much larger share of the market for medical services than children.
From page 201...
... Emergency providers should be able to take comfort in knowing that the equipment they are using on pediatric patients is safe and effective. Development and testing of new products are needed to give providers this assurance.
From page 202...
... However, new AEDs with pediatric cables and pads have been designed to direct some of the current away so the pediatric patient receives a lower level of energy (Brown et al., 2004)
From page 203...
... Hospitals, EMS systems, and government entities are beginning to make substantial investments in health IT systems that may improve the quality and efficiency of emergency care delivery for all patients, but there are benefits specific to pediatric patients as well. IT systems that make immunization records of children available to emergency care providers have the potential to greatly improve the efficiency and effectiveness of care.
From page 204...
... The committee recommends that emergency medical services agencies and hospitals integrate family-centered care into emergency care practice (5.5)
From page 205...
... The development and implementation of family-centered care encompass multiple components of care delivery, policies and procedures, the care environment, and personnel practices. Collaboration with Families in the EMS and ED Environments Often a parent or guardian is present when emergency medical technicians (EMTs)
From page 206...
... Potential benefits include decreased patient and family anxiety and combativeness, decreased liability issues if parents/guardians are involved in decision making, and easing of the consent process for organ donation if parents/guardians are aware of everything that has been done (National Association of Emergency Medical Technicians, 2000b)
From page 207...
... passed a resolution supporting the presence of family members at the bedside during invasive procedures and/or resuscitations. Other organizations that explicitly support family-centered care, including the Emergency Medical Services for Children (EMS-C)
From page 208...
... manual, Adanced Pediatric Life Support (APLS) : Pediatric Emergency Medicine Resource, and the AHA's guidelines for CPR (Knapp and Mulligan-Smith, 2005)
From page 209...
... . Many hospital inpatient units, particularly in pediatric centers, use child life programs and specialists to address the psychosocial aspects of hospitalization for the pediatric patient and parents or caregivers (AAP, 2000)
From page 210...
... . These studies are not specific to pediatric patients, but cultural competency is an important issue for the emergency care system in general, not just services for children, particularly because the racial/ethnic distribution of emergency care providers is not well matched to the racial/ethnic distribution of the population, and is even less well matched to the population that uses emergency services most frequently.
From page 211...
... . The National Association of Emergency Medical Technicians emphasizes the use of communication strategies to combat some of the cultural barriers to care that may arise.
From page 212...
... 5.2 The Department of Health and Human Services and the Na tional Highway Traffic Safety Administration should fund the de velopment of medication dosage guidelines, formulations, labeling guidelines, and administration techniques for the emergency care setting to maximize effectiveness and safety for infants, children, and adolescents. Emergency medical services agencies and hospitals should incorporate these guidelines, formulations, and techniques into practice.
From page 213...
... 2006. APLS: The Pediatric Emergency Medicine Resource (4th edition)
From page 214...
... 2004. Reducing errors and promoting safety in pediatric emergency care.
From page 215...
... 2006. Textbook of Pediatric Emergency Medicine.
From page 216...
... 2002. Variables associated with medication errors in pediatric emergency medicine.
From page 217...
... Pediatric Emergency Care 18(6)
From page 218...
... 2004. Preventing medical errors in pediatric emergency medicine.
From page 219...
... 1997. False-positive preliminary radiograph interpretations in a pediatric emergency department: Clinical and economic impact.


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