Yuknis Matthew L, Abulebda Kamal, Whitfill Travis, Pearson Kellie J, Montgomery Erin E, Auerbach Marc A
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health (ML Yuknis and K Abulebda), Indianapolis, Ind 46202-5225.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health (ML Yuknis and K Abulebda), Indianapolis, Ind 46202-5225.
Acad Pediatr. 2022 Sep-Oct;22(7):1167-1174. doi: 10.1016/j.acap.2022.03.018. Epub 2022 Mar 30.
Pediatric emergencies pose a challenge to primary care practices due to irregular frequency and complexity. Simulation-based assessment can improve skills and comfort in emergencies. Our aim was improving pediatric office emergency preparedness, as measured by adherence to the existing American Academy of Pediatrics policy statement, and quality of emergency care in a simulated setting, as measured by performance checklists.
This was a single center study nested in a multicenter, prospective study measuring emergency preparedness and quality of care in 16 pediatric primary care practices and consisted of 3 phases: baseline assessment, intervention, and follow-up assessment. Baseline emergency preparedness was measured by checklist based on AAP guidelines, and quality of care was assessed using in-situ simulation. A report-out was provided along with resources addressing potential areas for improvement after baseline assessment. A repeat preparedness and simulation assessment was performed after a 6 to 10 month intervention period to measure improvement from baseline.
Sixteen offices were recruited with 13 completing baseline and follow-up preparedness assessment. Eight of these sites also completed baseline and follow-up simulation assessment. Median baseline preparedness score was 70% and follow-up was 75.9%. Median baseline simulation performance scores were 37.4% and 35.5% for respiratory distress and seizure scenarios, respectively. Follow-up simulation assessment scores were 73% and 76.9% respectively (P = .001).
Our collaborative was able to successfully improve the quality of care in a simulated setting in a group of pediatric primary care offices over 6 to 10 months. Future work will focus on expansion and improving emergency preparedness.
儿科急症因其发生频率不规律和情况复杂，给初级保健机构带来了挑战。基于模拟的评估可以提高应对急症的技能和信心。我们的目标是提高儿科门诊的应急准备水平（以遵循美国儿科学会现有政策声明来衡量），以及在模拟环境中的急诊护理质量（以绩效清单来衡量）。
这是一项嵌套在多中心前瞻性研究中的单中心研究，该多中心研究测量了16家儿科初级保健机构的应急准备情况和护理质量，本研究包括三个阶段：基线评估、干预和随访评估。通过基于美国儿科学会指南的清单来测量基线应急准备情况，并使用现场模拟来评估护理质量。在基线评估后，会提供一份报告以及针对潜在改进领域的资源。在为期6至10个月的干预期后，进行了一次重复的应急准备和模拟评估，以衡量相对于基线的改善情况。
招募了16家机构，其中13家完成了基线和随访应急准备评估。这些机构中有8家还完成了基线和随访模拟评估。基线应急准备得分中位数为70%，随访时为75.9%。在呼吸窘迫和癫痫发作场景中，基线模拟绩效得分中位数分别为37.4%和35.5%。随访模拟评估得分分别为73%和76.9%（P = .001）。
我们的合作能够在6至10个月内成功提高一组儿科初级保健机构在模拟环境中的护理质量。未来的工作将集中在扩大规模和改善应急准备方面。
