Mittiga Matthew R, FitzGerald Michael R, Kerrey Benjamin T
From the Department of Pediatrics, University of Cincinnati College of Medicine.
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Pediatr Emerg Care. 2019 Aug;35(8):552-557. doi: 10.1097/PEC.0000000000000991.
The aim of this study was to delineate pediatric emergency medicine provider opinions regarding the importance of, and to ascertain existing processes by which practitioners maintain, the following critical procedural skills: oral endotracheal intubation, intraosseous line placement, pharmacologic and electrical cardioversion, tube thoracostomy, and defibrillation.
A customized survey was administered to all members of the Listserv for the American Academy of Pediatrics Section on Emergency Medicine. Perceived importance of maintaining critical pediatric procedural skills was measured using a 5-point Likert-type scale. Secondary outcomes included presence and type of mandatory training, availability of on-site backup, and perceived barriers to maintenance of skills.
Two hundred sixty-two members (25%) responded representing 106 different institutions, 70% of freestanding children's hospitals that received graduate medical education payments in 2014, and 68% of pediatric emergency medicine fellowship programs. More than 90% of respondents felt it was either very or extremely important to maintain competency for 5 of the 6 critical procedures, but no more than 49% of respondents felt that clinical care alone provided opportunity to maintain skills. The proportion of respondents indicating no mandatory training for each critical procedural skill was as follows: oral endotracheal intubation (23%), intraosseous line placement (30%), pharmacologic cardioversion (32%), electrical cardioversion (32%), tube thoracostomy (40%), and defibrillation (32%).
Critical procedural skills are perceived by emergency providers who care for children as extremely important to maintain. Direct care of pediatric patients likely does not provide sufficient opportunity to maintain these skills. There are widespread deficiencies relating to mandatory maintenance of critical procedural skill training.
本研究旨在阐明儿科急诊医学从业者对于以下关键操作技能的重要性的看法，并确定从业者维持这些技能的现有流程：气管内插管、骨内通路建立、药物及电复律、胸腔闭式引流术和除颤。
对美国儿科学会急诊医学分会邮件列表服务的所有成员进行了一项定制调查。使用5点李克特量表来衡量维持关键儿科操作技能的感知重要性。次要结果包括强制性培训的存在情况和类型、现场后备支持的可用性以及技能维持的感知障碍。
262名成员（25%）做出了回应，代表106个不同机构，占2014年接受研究生医学教育资助的独立儿童医院的70%，以及儿科急诊医学 fellowship 项目的68%。超过90%的受访者认为维持6项关键操作中的5项能力非常重要或极其重要，但不超过49%的受访者认为仅临床护理就能提供维持技能的机会。表示每项关键操作技能没有强制性培训的受访者比例如下：气管内插管（23%）、骨内通路建立（30%）、药物复律（32%）、电复律（32%）、胸腔闭式引流术（40%）和除颤（32%）。
照顾儿童的急诊提供者认为关键操作技能的维持极其重要。对儿科患者的直接护理可能无法提供足够的机会来维持这些技能。在关键操作技能培训的强制性维持方面存在广泛不足。
