Wilkinson Robert, Olympia Robert P, Dunnick Jennifer, Brady Jodi
From the *Penn State Hershey Children's Hospital, Hershey, PA; †Department of Emergency Medicine & Pediatrics, Penn State Hershey Medical Center/Penn State Hershey Children's Hospital, Hershey, PA; ‡Penn State College of Medicine, Hershey, PA; and §Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA.
Pediatr Emerg Care. 2016 Feb;32(2):77-81. doi: 10.1097/PEC.0000000000000698.
To describe the compliance of urgent care centers in the United States with pediatric care recommendations for emergency preparedness as set forth by the American Academy of Pediatrics.
An electronic questionnaire was distributed to urgent care center administrators as identified by the American Academy of Urgent Care Medicine directory.
A total of 122 questionnaires of the 872 distributed were available for analysis (14% usable response rate). The most common diagnoses reported for pediatric patients included otitis media (72%), upper respiratory illness (69%), strep pharyngitis (61%), bronchiolitis (30%), and extremity sprain/strain (28%). Seventy-one percent of centers have contacted community emergency medical services (EMS) to transport a critically ill or injured child to their local emergency department in the past year. Sixty-two percent of centers reported having an established written protocol with community EMS and 54% with their local emergency department or hospital. Centers reported the availability of the following essential medications and equipment: oxygen source (75%), nebulized/inhaled β-agonist (95%), intravenous epinephrine (88%), oxygen masks/nasal cannula (89%), bag-valve-mask resuscitator (81%), suctioning device (60%), and automated external defibrillator (80%). Centers reported the presence of the following written emergency plans: respiratory distress (40%), seizures (67%), dehydration/shock (69%), head injury (59%), neck injury (67%), significant fracture (69%), and blunt chest or abdominal injury (81%). Forty-seven percent of centers conduct formal reviews of emergent or difficult cases in a quality improvement format.
Areas for improvement in urgent care center preparedness were identified, such as increasing the availability of essential medications and equipment, establishing transfer and transport agreements with local hospitals and community EMS, and ensuring a structured quality improvement program.
描述美国紧急护理中心对美国儿科学会制定的儿科急诊准备护理建议的遵守情况。
向美国紧急护理医学协会名录中确定的紧急护理中心管理人员发放电子调查问卷。
在分发的872份问卷中，共有122份可供分析（可用回复率为14%）。儿科患者报告的最常见诊断包括中耳炎（72%）、上呼吸道疾病（69%）、链球菌性咽炎（61%）、细支气管炎（30%）和肢体扭伤/拉伤（28%）。71%的中心在过去一年中联系过社区紧急医疗服务（EMS），以便将重症或受伤儿童转运至当地急诊科。62%的中心报告称与社区EMS有既定的书面协议，54%的中心与当地急诊科或医院有书面协议。各中心报告了以下基本药物和设备的可用性：氧气源（75%）、雾化/吸入β受体激动剂（95%）、静脉注射肾上腺素（88%）、氧气面罩/鼻导管（89%）、袋阀面罩复苏器（81%）、吸引装置（60%）和自动体外除颤器（80%）。各中心报告存在以下书面应急预案：呼吸窘迫（40%）、癫痫发作（67%）、脱水/休克（69%）、头部受伤（59%）、颈部受伤（67%）、严重骨折（69%）以及钝性胸部或腹部损伤（81%）。47%的中心以质量改进的形式对紧急或疑难病例进行正式审查。
确定了紧急护理中心准备工作中有待改进的方面，例如增加基本药物和设备的可用性、与当地医院和社区EMS建立转运协议以及确保有结构化的质量改进计划。
