From the Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
Pediatric Critical Care, Children's of Alabama, Birmingham, AL.
Pediatr Emerg Care. 2024 May 1;40(5):335-340. doi: 10.1097/PEC.0000000000003056. Epub 2023 Nov 16.
Regionalization of pediatric care in the United States was developed to improve care by directing patients to hospitals with optimal pediatric resources and experience, leading to less pediatric-trained providers in medically underserved areas. Children with emergencies, however, continue to present to local general emergency departments (GEDs), where pediatric emergencies are low-frequency, high-risk events.
The goals of this project were to: increase exposure of GEDs in the southeast United States to pediatric emergencies through simulation, assess pediatric emergency clinical care processes with simulation, describe factors associated with readiness including volume of pediatric patients and ED location (urban/rural), and compare these findings to the 2013 National Pediatric Readiness Project.
This prospective in situ simulation study evaluated GED readiness using the Emergency Medical Services for Children Pediatric Readiness Score (PRS) and team performance in caring for 4 simulated pediatric emergencies. Comparisons between GED and pediatric ED (PED) performance and PRS, GED performance, and PRS based on pediatric patient volume and hospital location were evaluated. A Composite Quality Score (CQS) was calculated for each ED.
Seventy-five teams from 40 EDs participated (39 GED; 1 PED). The PED had a significantly higher volume of pediatric patients (73,000 vs 4492; P = 0.003). The PRS for GEDs was significantly lower (57% [SD, 17] vs 98%; P = 0.022). The CQSs for all GEDs were significantly lower than the PED (55% vs 87%; P < 0.004). Among GEDs, there was no statistically significant difference in PRS or CQS based on pediatric patient volume, but urban GEDs had significantly higher CQSs versus rural GEDs (59.8% vs 50.6%, P = 0.001).
This study shows a significant disparity in the performance and readiness of GEDs versus a PED in a medically underserved area. More education and better access to resources is needed in these areas to adequately care for critically ill pediatric patients.
美国儿科医疗服务的区域化发展旨在通过引导患者前往具有最佳儿科资源和经验的医院来改善医疗服务，从而导致医疗资源匮乏地区的儿科医疗服务人员减少。然而，患有急症的儿童仍继续前往当地综合急诊部（GED）就诊，而儿科急症在这些地方属于低频率、高风险事件。
本项目的目标是：通过模拟增加美国东南部 GED 对儿科急症的接触，评估模拟儿科急诊的临床护理流程，描述包括儿科患者数量和 ED 位置（城市/农村）在内的准备情况相关因素，并将这些发现与 2013 年国家儿科准备项目进行比较。
本前瞻性现场模拟研究使用儿童急诊医疗服务儿科准备评分（PRS）评估 GED 的准备情况，并评估 4 例模拟儿科急症中团队的护理表现。比较 GED 和儿科急诊部（PED）的表现和 PRS、GED 的表现和 PRS ，以及根据儿科患者数量和医院位置的 GED 表现和 PRS。为每个 ED 计算综合质量评分（CQS）。
来自 40 个 ED 的 75 个团队参与了研究（39 个 GED；1 个 PED）。PED 的儿科患者数量明显更多（73000 比 4492；P=0.003）。GED 的 PRS 明显较低（57%[SD，17]比 98%；P=0.022）。所有 GED 的 CQS 明显低于 PED（55%比 87%；P<0.004）。在 GED 中，PRS 或 CQS 与儿科患者数量之间无统计学显著差异，但城市 GED 的 CQS 明显高于农村 GED（59.8%比 50.6%，P=0.001）。
本研究表明，在医疗资源匮乏地区，GED 的表现和准备情况与 PED 之间存在显著差异。这些地区需要更多的教育和更好地获得资源，以充分照顾患有危急重症的儿科患者。
