Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
Department of Pediatrics and the Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut.
Respir Care. 2019 Sep;64(9):1073-1081. doi: 10.4187/respcare.06750. Epub 2019 Apr 23.
Pediatric airway management is a challenging process at community emergency departments (CEDs) due to lower pediatric volume, a lack of pediatric expertise among staff, and a lack of pediatric-specific equipment and resources. This has contributed to increased mortality in pediatric patients presenting to CEDs in comparison to pediatric academic medical centers (AMCs). We hypothesized that a collaborative program between CEDs and the state AMC would improve the quality of pediatric airway management provided by CEDs in simulated settings and the CEDs' pediatric emergency readiness scores.
This prospective, pre- and post-intervention study utilized in situ simulation and was conducted in 10 CEDs in the state of Indiana. A team from the pediatric AMC led a multi-faceted improvement program, which included post-simulation debriefing, addressing pediatric airway management issues, targeted assessment reports, access to pediatric resources, and ongoing communication with the AMC. The primary outcome of the study was improvement of simulated pediatric airway management in the CEDs. The secondary outcome was improvement of the CEDs' pediatric emergency readiness scores score.
A total of 35 multidisciplinary teams participated in pre-intervention sessions, and 40 teams participated in post-intervention sessions. Overall adherence to a critical action checklist improved from 52% at the pre-intervention visits to 71% post-intervention ( = .003). There were significant improvements in the use of appropriate endotracheal tube (ETT) size (from 67% to 100%, = .02), cuffed ETT (from 8% to 71%, < .001), appropriate blade size (from 58% to 100%, = .03), and availability of suction catheter (from 10% to 42%, = .049). The CEDs' total pediatric emergency readiness scores score improved from 58.8 ± 15.6 pre-intervention to 75.8 ± 9.3 post-intervention ( = .01).
A collaborative improvement program between a pediatric AMC and CEDs improved the CEDs' simulated pediatric emergency airway management. This model can be utilized to improve management of other pediatric critical conditions in these CEDs.
由于儿科患者数量较少，医护人员缺乏儿科专业知识，以及缺乏儿科专用设备和资源，社区急诊部门（CEDs）的儿科气道管理是一个具有挑战性的过程。这导致与儿科学术医疗中心（AMC）相比，CEDs 就诊的儿科患者死亡率更高。我们假设 CEDs 与州 AMC 之间的合作计划将提高 CEDs 在模拟环境中提供的儿科气道管理质量，并提高 CEDs 的儿科急诊准备评分。
这是一项前瞻性、干预前后研究，采用现场模拟，并在印第安纳州的 10 个 CED 中进行。来自儿科 AMC 的一个团队领导了一个多方面的改进计划，其中包括模拟后讨论、解决儿科气道管理问题、有针对性的评估报告、获得儿科资源以及与 AMC 的持续沟通。该研究的主要结果是提高 CEDs 中模拟儿科气道管理的质量。次要结果是提高 CEDs 的儿科急诊准备评分。
共有 35 个多学科团队参加了干预前的会议，40 个团队参加了干预后的会议。总体而言，关键操作检查表的遵守率从干预前的 52%提高到干预后的 71%（ =.003）。在使用合适的气管内导管（ETT）尺寸（从 67%提高到 100%， =.02）、带囊 ETT（从 8%提高到 71%， <.001）、合适的刀片尺寸（从 58%提高到 100%， =.03）和吸引导管的可用性（从 10%提高到 42%， =.049）方面均有显著改善。CEDs 的儿科急诊准备总评分从干预前的 58.8 ± 15.6 提高到干预后的 75.8 ± 9.3（ =.01）。
儿科 AMC 和 CEDs 之间的合作改进计划提高了 CEDs 的模拟儿科紧急气道管理水平。这种模式可以用于提高这些 CEDs 中其他儿科危急情况的管理水平。
