From the Pediatric Intensive Care Unit, Children's of Alabama, Birmingham, AL.
Division of Pediatric Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
Pediatr Emerg Care. 2023 Jun 1;39(6):413-417. doi: 10.1097/PEC.0000000000002961.
We sought to determine if general emergency departments (GEDs) were managing pediatric diabetic ketoacidosis (DKA) correctly and if management could be improved using a multilayered educational initiative. We hypothesized that a multifaceted program of in situ simulation education and formal feedback on actual patient management would improve community GED management of pediatric DKA.
This study combined a prospective simulation-based performance evaluation and a retrospective chart review. A community outreach simulation education initiative was developed followed by a formal patient feedback process.
Fifteen hospitals participated in simulation sessions and the feedback process. All hospitals were scored for readiness to provide care for critically ill pediatric patients using the Emergency Medical Services for Children (EMSC) Pediatric Readiness Assessment. Six of the 15 have had a second hospital visit that included a DKA scenario with an average performance score of 60.3%. A total of 158 pediatric patients with DKA were included in the chart review. The GEDs with higher patient volumes provided best practice DKA management more often (63%) than those with lower patient volumes (40%). Participating in a DKA simulated scenario showed a trend toward improved care, with 47.2% before participation and 68.2% after participation ( P = 0.091). Participating in the formal feedback process improved best practice management provided to 68.6%. Best practice management was further improved to 70.3% if the GED participated in both a DKA simulation and the feedback process ( P = 0.04).
A multifaceted program of in situ simulation education and formal feedback on patient management can improve community GED management of pediatric patients with DKA.
我们旨在确定普通急诊部（GED）是否正确管理儿科糖尿病酮症酸中毒（DKA），以及是否可以通过多层次教育计划来改善管理。我们假设，通过现场模拟教育和对实际患者管理的正式反馈的综合计划，可以改善社区 GED 对儿科 DKA 的管理。
本研究结合了基于模拟的前瞻性绩效评估和回顾性图表审查。制定了社区外展模拟教育计划，然后进行了正式的患者反馈流程。
共有 15 家医院参加了模拟课程和反馈过程。所有医院均使用急诊医学儿童服务（EMSC）儿科准备评估（Pediatric Readiness Assessment）对提供危重症儿科患者护理的准备情况进行了评分。15 家医院中有 6 家进行了第二次医院访问，其中包括 DKA 情景，平均绩效得分为 60.3%。共有 158 例 DKA 儿科患者被纳入图表审查。患者量较高的 GED 更频繁地提供最佳 DKA 管理（63%），而患者量较低的 GED 则较少（40%）。参与 DKA 模拟情景的治疗方案显示出改善的趋势，参与前为 47.2%，参与后为 68.2%（P=0.091）。参与正式的反馈过程可将最佳实践管理改善至 68.6%。如果 GED 既参与了 DKA 模拟又参与了反馈过程，则最佳实践管理将进一步改善至 70.3%（P=0.04）。
现场模拟教育和患者管理的正式反馈的综合计划可以改善社区 GED 对儿科 DKA 患者的管理。
