Jain Priya Narayanan, Choi Jaeun, Katyal Chhavi
Children's Hospital at Montefiore, Bronx, New York; and
Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
Hosp Pediatr. 2019 Mar;9(3):216-219. doi: 10.1542/hpeds.2018-0133.
Most pediatric emergency visits are to nonpediatric emergency departments (EDs), and little is known about provider comfort level with pediatric patients. We aimed to assess providers' comfort level caring for pediatric patients of different age groups and perceived resources and barriers to delivering evidence-based pediatric care.
We conducted an anonymous electronic survey of providers (physicians, nurse practitioners, and physician assistants) in nonpediatric EDs in an urban area who admit to a single quaternary-care children's hospital. Questions addressed provider comfort in examining, diagnosing, and treating patients across 4 age groups; access to management guidelines; resources for education; and benefits of feedback from inpatient providers. Comfort was assessed with a 5-point Likert scale, with "comfortable" being defined as a 4 or 5. The association between patient age and provider comfort was analyzed by using logistic regression with generalized estimating equations.
We surveyed 375 providers. Our response rate was 26% 14% nurse practitioners, 34% physician assistants, and 51% physicians). Of respondents, <50% report being comfortable caring for patients <3 months of age (46% examining, 38% diagnosing, 46% treating). Thirteen percent found it mostly or very easy to keep up with pediatric management guidelines ( = 12); cited barriers were time constraints, a lack of access to journals or pediatric experts, and low institutional priority due to low pediatric volume.
This study suggests that nonpediatric ED providers' comfort in caring for pediatric patients decreases with decreasing patient age. Less than half of providers report that they are comfortable managing patients <3 months old.
大多数儿科急诊就诊是在非儿科急诊科进行的，而对于医护人员照顾儿科患者时的舒适程度了解甚少。我们旨在评估医护人员照顾不同年龄组儿科患者的舒适程度，以及他们对提供循证儿科护理的可用资源和障碍的认知。
我们对市区一家接收单一四级儿童专科医院患者的非儿科急诊科的医护人员（医生、执业护士和医师助理）进行了匿名电子调查。问题涉及医护人员在检查、诊断和治疗4个年龄组患者时的舒适度；获取管理指南的情况；教育资源；以及住院部医护人员反馈的益处。舒适度采用5级李克特量表进行评估，“舒适”被定义为4分或5分。使用广义估计方程的逻辑回归分析患者年龄与医护人员舒适度之间的关联。
我们调查了375名医护人员。回复率为26%（14%为执业护士，34%为医师助理，51%为医生）。在受访者中，不到50%的人表示照顾3个月以下的患者感到舒适（46%进行检查，38%进行诊断，46%进行治疗）。13%的人认为跟上儿科管理指南大多或非常容易（n = 12）；提及的障碍包括时间限制、无法获取期刊或儿科专家资源，以及由于儿科患者数量少而导致的机构优先级低。
本研究表明，非儿科急诊科医护人员照顾儿科患者的舒适度随患者年龄降低而下降。不到一半的医护人员表示他们对管理3个月以下的患者感到舒适。
