Pediatric emergency care
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Pediatric emergency care · Nov 2024
Video-Based Study of the Progression of Pediatric Emergency Medicine Fellows' Tracheal Intubation Performance During Training.
The lower clinical exposure of Pediatric Emergency Medicine (PEM) fellows to critical procedures may impede skill acquisition. We sought to determine the tracheal intubation learning curve of PEM fellows during training and compared PEM fellow success against standards for tracheal intubation success. ⋯ Despite performing the majority of attempts, PEM fellows often failed to reach the standard thresholds for performance of tracheal intubation. Clinical exposure alone is too low to ensure acquisition of airway skills.
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Pediatric emergency care · Nov 2024
Impact of Surgical Team Involvement at the Time of Trauma Activation for Pediatric Patients With Motorized Cycle or All-Terrain Vehicle Injury Mechanism.
At our institution, level 2 trauma (L2T) activations are primarily managed by pediatric emergency medicine (PEM) physicians, whereas level 1 activations are co-managed by pediatric surgery and PEM. Starting in September 2019, the response to L2T activations due to all-terrain vehicles or motorized cycles (ATVs/MCs) changed to include surgical assessment upon patient arrival due to increased likelihood of significant injuries and need for higher level of care. The impact of PEM/surgery co-management of ATV/MC L2T patients on time to an admission decision is unknown. ⋯ Early surgical assessment for pediatric patients with ATV/MC injuries improved time to an admission decision and trauma communication huddle compliance. Next steps include identifying process improvement opportunities to decrease ED total length of stay for patients with ATV/MC injuries.
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Pediatric emergency care · Nov 2024
Measuring Overcrowding in a Large Academic Tertiary Care Pediatric Emergency Department.
Overcrowding scores have been studied extensively in adult emergency departments (EDs), but few studies have determined utility in the pediatric setting. The objective of this study was to determine the association between a modified National Emergency Department Overcrowding Score (mNEDOCS) and established ED metrics in a large academic tertiary care pediatric ED. ⋯ Modified NEDOCS is positively associated with ED LOS, LWBS, and 72-hour return visits, consistent with adult data. Further investigation is needed to elucidate the association between mNEDOCS and HLOS. This study illustrates the utility of mNEDOCS as a measure of overcrowding in a pediatric ED.
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Pediatric emergency care · Nov 2024
Are We Imaging Gently in Indiana? A System-Wide Population-Based Study of Chest CT Use in the Pediatric Trauma Population.
Over the past decade, there has been a significant effort to decrease radiation exposure in pediatric trauma patients. The objective of this study was to determine if trauma centers (TCs) and nontrauma centers (non-TCs) are practicing in line with this effort. We hypothesized that TCs would demonstrate a significant decrease in the use of chest computed tomography (CT) during the study period, whereas non-TC would show no change in chest CT use. ⋯ In the trauma encounters studied, chest CT was performed prior to CXR more frequently at TCs compared to non-TCs. These data may reflect regional trauma triage protocols, availability of chest CT, or differences in education between institutions. Whereas TCs may see more severely injured patients more frequently, education regarding conservative CT imaging principles should be reinforced through multidisciplinary efforts.
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Pediatric emergency care · Nov 2024
Decreasing Invasive Urinary Tract Infection Screening in a Pediatric Emergency Department to Improve Quality of Care.
Obtaining urine samples in younger children undergoing urinary tract infection (UTI) screening can be challenging in busy emergency departments (EDs), and sterile techniques, like catheterization, are invasive, traumatizing, and time consuming to complete. Noninvasive techniques have been shown to reduce catheterization rates but are variably implemented. Our aim was to implement a standardized urine bag UTI screening approach in febrile children aged 6 to 24 months to decrease the number of unnecessary catheterizations by 50% without impacting ED length of stay (LOS) or return visits (RVs). ⋯ A urine bag screening pathway was successfully implemented to decrease unnecessary, invasive catheterizations for UTI screening in children with only a slight increase in ED LOS. In addition to the urine bag pathway, an ED nursing champion, strategic alignment, and broad provider engagement were all instrumental in the initiative's success.