Foster Ashley A, Saidinejad Mohsen, Duffy Susan, Hoffmann Jennifer A, Goodman Robin, Monuteaux Michael C, Li Joyce
Department of Emergency Medicine (AA Foster), University of California San Francisco, Calif.
The Lundquist Institute for Biomedical Innovation at Harbor UCLA (M Saidinejad and R Goodman), Torrance, Calif; David Geffen School of Medicine at UCLA (M Saidinejad), Los Angeles, Calif; Department of Emergency Medicine (M Saidinejad), Harbor UCLA Medical Center, Torrance, Calif.
Acad Pediatr. 2023 Jul;23(5):988-992. doi: 10.1016/j.acap.2023.03.005. Epub 2023 Mar 21.
Acute agitation episodes in the emergency department (ED) can be distressing for patients, families, and staff and may lead to injuries. We aim to understand availability of ED resources to care for children with acute agitation, perceived staff confidence with agitation management, barriers to use of de-escalation techniques, and desired resources to enhance care.
We conducted a survey of pediatric emergency care coordinators (PECCs) in EDs in Massachusetts, Rhode Island, and Los Angeles County, California.
PECCs from 63 of 102 (61.8%) EDs responded. PECCs reported that ED staff feel least confident managing agitation due to developmental delay (DD) or autism spectrum disorder (ASD) (52.4%). Few EDs had a separate space to care for children with mental health conditions (22.5%), a standardized agitation scale (9.6%), an agitation management guideline (12.9%), or agitation management training (24.2%). Modification of the environment was not perceived possible for 42% of EDs. Participants reported that a barrier to the use of the de-escalation techniques distraction and verbal de-escalation was perceived lack of effectiveness (22.6% and 22.6%, respectively). Desired resources to manage agitation included guidelines for medications (82.5%) and sample care pathways (57.1%).
ED PECCs report low confidence in managing agitation due to DD or ASD and limited pediatric resources to address acute agitation. Additional pediatric-specific resources and training, especially for children with DD or ASD, are needed to increase clinician confidence in agitation management and to promote high-quality, patient-centered care. Training programs can focus on the early identification of agitation and the effective use of non-invasive de-escalation strategies.
急诊科的急性激越发作可能会给患者、家属和工作人员带来困扰，并可能导致受伤。我们旨在了解急诊科用于护理急性激越儿童的资源可用性、工作人员对激越管理的信心、使用降级技术的障碍以及改善护理所需的资源。
我们对马萨诸塞州、罗德岛州和加利福尼亚州洛杉矶县急诊科的儿科急诊护理协调员（PECC）进行了一项调查。
102个急诊科中有63个（61.8%）的PECC做出了回应。PECC报告称，急诊科工作人员对因发育迟缓（DD）或自闭症谱系障碍（ASD）导致的激越管理最缺乏信心（52.4%）。很少有急诊科设有单独的空间来护理有心理健康问题的儿童（22.5%）、标准化的激越量表（9.6%）、激越管理指南（12.9%）或激越管理培训（24.2%）。42%的急诊科认为无法对环境进行改造。参与者报告称，使用分心和言语降级等降级技术的障碍是认为缺乏有效性（分别为22.6%和22.6%）。管理激越所需的资源包括药物指南（82.5%）和示例护理路径（57.1%）。
急诊科PECC报告称，对因DD或ASD导致的激越管理信心不足，且用于应对急性激越的儿科资源有限。需要额外的儿科特定资源和培训，特别是针对患有DD或ASD的儿童，以提高临床医生对激越管理的信心，并促进高质量的以患者为中心的护理。培训项目可以侧重于激越的早期识别和非侵入性降级策略的有效使用。
