Bordley W Clayton, Travers Debbie, Scanlon Patricia, Frush Karen, Hohenhaus Sue
Department of Pediatrics, Duke University School of Medicine, Chapel Hill, North Carolina, USA.
Pediatrics. 2003 Aug;112(2):291-5. doi: 10.1542/peds.112.2.291.
Many children enter the emergency medical system through primary care offices, yet these offices may not be adequately prepared to stabilize severely ill children. We conducted this study to evaluate the effectiveness of an office-based educational program designed to improve the preparation of primary care practices for pediatric emergencies.
A prospective, randomized, controlled trial was conducted of primary care practices (pediatric, family practice, and health departments) that were recruited from an existing database of North Carolina practices. Practices that agreed to participate were randomly assigned to either the intervention or the control group. Unannounced mock codes were conducted in the intervention practices by 2 emergency medicine clinicians (medical doctor and/or registered nurse). Practices were expected to respond to the mock code using their own staff, equipment, and local emergency medical system. After the exercise, the emergency medicine clinicians and the local emergency medical system team led a structured debriefing session providing constructive feedback to the staff on their performance, a review of the office's equipment, and a resource manual designed for the project. The primary outcome measures were obtained by survey 3 to 6 months postintervention and included 1) purchase of new pediatric emergency equipment and medications, 2) receipt or updating of basic life support/pediatric advanced life support/advanced life support training by staff members, and 3) development of written emergency pediatric protocols. The control practices received no interventions during the trial and completed a similar outcome survey.
Thirty-nine practices (20 intervention, 19 control) completed the trial. There were no significant differences in practice characteristics between the 2 groups. Intervention practices were more likely to develop written office protocols (60% vs 21%); more staff in the intervention practices received additional basic life support/pediatric advanced life support/advanced life support training 3 to 6 months after the intervention (118 vs 54). There were no significant differences in the purchase of new equipment or medications. Ninety percent of the intervention practices rated the intervention as useful for their practice, and 95% believed that the program should be continued.
The findings suggest that the intervention was well received and motivated practices to take concrete actions to prepare for pediatric emergencies.
许多儿童通过初级保健机构进入急诊医疗系统，但这些机构可能未做好充分准备来稳定重症儿童的病情。我们开展这项研究以评估一项基于机构的教育项目的效果，该项目旨在改善初级保健机构应对儿科急症的准备情况。
对从北卡罗来纳州现有机构数据库中招募的初级保健机构（儿科、家庭医学和卫生部门）进行了一项前瞻性、随机对照试验。同意参与的机构被随机分配到干预组或对照组。由2名急诊医学临床医生（医生和/或注册护士）在干预机构中进行不预先通知的模拟急救演练。各机构应使用自身的工作人员、设备和当地急诊医疗系统对模拟急救做出反应。演练结束后，急诊医学临床医生和当地急诊医疗系统团队主持了一次结构化的汇报会，就工作人员的表现提供建设性反馈，检查机构的设备，并提供为该项目设计的资源手册。主要结局指标在干预后3至6个月通过调查获得，包括：1）购买新的儿科急救设备和药物；2）工作人员接受或更新基础生命支持/儿科高级生命支持/高级生命支持培训；3）制定书面的儿科急诊预案。对照组在试验期间未接受任何干预，并完成了类似的结局调查。
39个机构（20个干预组，19个对照组）完成了试验。两组的机构特征无显著差异。干预组机构更有可能制定书面的机构预案（60%对21%）；干预组更多工作人员在干预后3至6个月接受了额外的基础生命支持/儿科高级生命支持/高级生命支持培训（118人对54人）。在购买新设备或药物方面无显著差异。90%的干预组机构认为该干预对其机构有用，95%的机构认为该项目应继续开展。
研究结果表明，该干预措施受到好评，并促使各机构采取具体行动为儿科急症做准备。
