Auerbach Marc A, Whitfill Travis, Montgomery Erin, Leung James, Kessler David, Gross Isabel T, Walsh Barbara M, Fiedor Hamilton Melinda, Gawel Marcie, Kant Shruti, Janofsky Stephen, Brown Linda L, Walls Theresa A, Alletag Michelle, Sessa Anna, Arteaga Grace M, Keilman Ashley, Van Ittersum Wendy, Rutman Maia S, Zaveri Pavan, Good Grace, Schoen Jessica C, Lavoie Meghan, Mannenbach Mark, Bigham Ladonna, Dudas Robert A, Rutledge Chrystal, Okada Pamela J, Moegling Michelle, Anderson Ingrid, Tay Khoon-Yen, Scherzer Daniel J, Vora Samreen, Gaither Stacy, Fenster Daniel, Jones Derick, Aebersold Michelle, Chatfield Jenny, Knight Lynda, Berg Marc, Makharashvili Ana, Katznelson Jessica, Mathias Emily, Lutfi Riad, Abu-Sultaneh Samer, Burns Brian, Padlipsky Patricia, Lee Jumie, Butler Lucas, Alander Sarah, Thomas Anita, Bhatnagar Ambika, Jafri Farrukh N, Crellin Jason, Abulebda Kamal
Yale University School of Medicine, New Haven, Connecticut.
Indiana University School of Medicine, Indianapolis, Indiana.
Pediatrics. 2023 Aug 1;152(2). doi: 10.1542/peds.2022-060790.
To describe the quality of pediatric resuscitative care in general emergency departments (GEDs) and to determine hospital-level factors associated with higher quality.
Prospective observational study of resuscitative care provided to 3 in situ simulated patients (infant seizure, infant sepsis, and child cardiac arrest) by interprofessional GED teams. A composite quality score (CQS) was measured and the association of this score with modifiable and nonmodifiable hospital-level factors was explored.
A median CQS of 62.8 of 100 (interquartile range 50.5-71.1) was noted for 287 resuscitation teams from 175 emergency departments. In the unadjusted analyses, a higher score was associated with the modifiable factor of an affiliation with a pediatric academic medical center (PAMC) and the nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. In the adjusted analyses, a higher CQS was associated with modifiable factors of an affiliation with a PAMC and the designation of both a nurse and physician pediatric emergency care coordinator, and nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. A weak correlation was noted between quality and pediatric readiness scores.
A low quality of pediatric resuscitative care, measured using simulation, was noted across a cohort of GEDs. Hospital factors associated with higher quality included: an affiliation with a PAMC, designation of a pediatric emergency care coordinator, higher pediatric volume, and geographic location. A weak correlation was noted between quality and pediatric readiness scores.
描述综合急诊科（GEDs）中儿科复苏护理的质量，并确定与更高质量相关的医院层面因素。
对GED跨专业团队为3名现场模拟患者（婴儿癫痫、婴儿败血症和儿童心脏骤停）提供的复苏护理进行前瞻性观察研究。测量综合质量评分（CQS），并探讨该评分与可改变和不可改变的医院层面因素之间的关联。
来自175个急诊科的287个复苏团队的CQS中位数为62.8（满分100分，四分位间距为50.5 - 71.1）。在未调整分析中，较高的评分与与儿科学术医疗中心（PAMC）附属这一可改变因素以及儿科就诊量较高、位于东北部和中西部这些不可改变因素相关。在调整分析中，较高的CQS与与PAMC附属以及指定护士和医生担任儿科急诊护理协调员这些可改变因素，以及儿科就诊量较高、位于东北部和中西部这些不可改变因素相关。质量与儿科准备度评分之间存在弱相关性。
在一组GEDs中，通过模拟测量发现儿科复苏护理质量较低。与更高质量相关的医院因素包括：与PAMC附属、指定儿科急诊护理协调员、儿科就诊量较高以及地理位置。质量与儿科准备度评分之间存在弱相关性。
