Journal of paediatrics and child health
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J Paediatr Child Health · Feb 2016
ReviewQuality in paediatric emergency medicine: Measurement and reporting.
There is a clear demand for quality in the delivery of health care around the world; paediatric emergency medicine is no exception to this movement. It has been identified that gaps exist in the quality of acute care provided to children. Regulatory bodies in Australia and New Zealand are moving to mandate the implementation of quality targets and measures. ⋯ It is clear that there is much work to be performed to generalise this work to ED. We review suggestions from the current literature relating to feasible indicators within the paediatric acute care setting. We propose options to develop a quality 'scorecard' that could be used to assist Australian and New Zealand EDs with quality measurement and benchmarking for their paediatric patients.
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J Paediatr Child Health · Feb 2016
ReviewPaediatric procedural sedation within the emergency department.
Procedural sedation and analgesia in children requires the use of non-pharmacological and pharmacological approaches to facilitate the management of painful procedures. The development of skills in such techniques has mirrored the development of paediatric emergency medicine as a subspecialty. Governance, education and credentialing must facilitate safe sedation practice, using a structured approach, as sedating children in the busy environment of an emergency department is not without risk. Emergency clinicians, patients and caregivers all have a role to play in developing a safe, effective sedation plan.
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J Paediatr Child Health · Feb 2016
ReviewPaediatric emergency and acute care in resource poor settings.
Acute care of seriously ill children is a global public health issue, and there is much scope for improving quality of care in hospitals at all levels in many developing countries. We describe the current state of paediatric emergency and acute care in the least developed regions of low and middle income countries and identify gaps and requirements for improving quality. Approaches are needed which span the continuum of care: from triage and emergency treatment, the diagnostic process, identification of co-morbidities, treatment, monitoring and supportive care, discharge planning and follow-up. ⋯ While initial emergency treatment is based on common clinical syndromes, early differentiation is required for specific treatment, and this can usually be carried out clinically without expensive tests. While global strategies are important, it is what happens locally that makes a difference and is too often neglected. In rural areas in the poorest countries in the world, public doctors and nurses who provide emergency and acute care for children are revered by their communities and demonstrate daily that much can be carried out with little.
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Death of a child in an emergency department is a rare occurrence, but one with significant impact on the family and staff involved. The rarity means few emergency department clinicians feel 'expert' in the overall management process. However, most have some knowledge and experience which can be augmented by collaborating with other health professionals. By exploring some of the main management issues and challenges for the emergency department, key aspects of care are identified for emergency department clinicians to consider in reviewing local procedures and guidelines.
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Sepsis and septic shock are the final common pathway for many decompensated paediatric infections. Fluid resuscitation therapy has been the cornerstone of haemodynamic resuscitation in these children. Good evidence for equivalence between 0.9% saline and 4% albumin, with the relative expense of the latter, has meant that 0.9% saline is currently the most commonly used resuscitation fluid world-wide. ⋯ Semi-synthetic colloids have been associated with renal dysfunction and death and should be avoided. There is evidence for harm from excessive administration of any resuscitation fluid. Resuscitation fluid volumes should be treated in the same way as the dose of any other intravenously administered medication, and the potential benefits versus harms for the individual patient weighed prior to administration.