Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
J Pediatr. 2021 Mar;230:230-237.e1. doi: 10.1016/j.jpeds.2020.10.040. Epub 2020 Oct 31.
To describe the impact of a national interventional collaborative on pediatric readiness within general emergency departments (EDs).
A prospective, multicenter, interventional study measured pediatric readiness in general EDs before and after participation in a pediatric readiness improvement intervention. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) on a 100-point scale. The study protocol extended over 6 months and involved 3 phases: (1) a baseline on-site assessment of pediatric readiness and simulated quality of care; (2) pediatric readiness interventions; and (3) a follow-up on-site assessment of WPRS. The intervention phase included a benchmarking performance report, resources toolkits, and ongoing interactions between general EDs and academic medical centers.
Thirty-six general EDs were enrolled, and 34 (94%) completed the study. Four EDs (11%) were located in Canada, and the rest were in the US. The mean improvement in WPRS was 16.3 (P < .001) from a baseline of 62.4 (SEM = 2.2) to 78.7 (SEM = 2.1), with significant improvement in the domains of administration/coordination of care; policies, protocol, and procedures; and quality improvement. Six EDs (17%) were fully adherent to the protocol timeline.
Implementing a collaborative intervention model including simulation and quality improvement initiatives is associated with improvement in WPRS when disseminated to a diverse group of general EDs partnering with their regional pediatric academic medical centers. This work provides evidence that innovative collaboration facilitated by academic medical centers can serve as an effective strategy to improve pediatric readiness and processes of care.
描述国家介入性合作对普通急诊科儿科准备情况的影响。
一项前瞻性、多中心的介入性研究，在参与儿科准备改进干预之前和之后，在普通急诊科测量儿科准备情况。儿科准备情况使用 100 分制的加权儿科准备评分（WPRS）进行评估。研究方案持续了 6 个月，包括 3 个阶段：（1）儿科准备情况和模拟护理质量的现场基线评估；（2）儿科准备干预；（3）WPRS 的后续现场评估。干预阶段包括基准绩效报告、资源工具包以及普通急诊科和学术医疗中心之间的持续互动。
共纳入 36 家普通急诊科，其中 34 家（94%）完成了研究。4 家急诊科（11%）位于加拿大，其余位于美国。WPRS 从基线的 62.4（SEM=2.2）平均提高了 16.3（P<0.001），达到 78.7（SEM=2.1），在管理/协调护理；政策、协议和程序；以及质量改进等领域有显著改善。6 家急诊科（17%）完全遵守方案时间表。
向与区域儿科学术医疗中心合作的普通急诊科推广包括模拟和质量改进计划的协作干预模型，与 WPRS 的改善相关。这项工作提供了证据，表明学术医疗中心促进的创新合作可以作为改善儿科准备情况和护理流程的有效策略。
