Foster Ashley A, Hoffmann Jennifer A, Crady Rachel, Hewes Hilary A, Li Joyce, Cook Lawrence J, Duffy Susan, Johnson Mark, Schreiber Merritt, Saidinejad Mohsen
Department of Emergency Medicine University of California San Francisco California USA.
Division of Emergency Medicine Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA.
J Am Coll Emerg Physicians Open. 2024 Sep 2;5(5):e13266. doi: 10.1002/emp2.13266. eCollection 2024 Oct.
In the United States, pediatric emergency department (ED) visits for behavioral health (BH) are increasing. We sought to determine ED-level characteristics associated with having recommended BH-related policies.
We conducted a retrospective serial cross-sectional study of National Pediatric Readiness Project assessments administered to US EDs in 2013 and 2021. Changes in responses related to BH items over time were examined. Multivariable logistic regression models examined ED characteristics associated with the presence of specific BH-related policies in 2021.
Of 3554 EDs that completed assessments in 2021, 73.0% had BH-related policies, 66.5% had transfer guidelines for children with BH issues, and 38.6% had access to BH resources in a disaster. Of 2570 EDs that completed assessments in both 2013 and 2021, presence of specific BH-related policies increased from 48.6% to 72.0% and presence of appropriate transfer guidelines increased from 56.2% to 64.9%. The adjusted odd ratios (aORs) of having specific BH-related policies were lower in rural (aOR 0.73; 95% confidence interval [CI] 0.57, 0.92) and remote EDs (aOR 0.65; 95% CI 0.48, 0.88) compared to urban EDs; lower among EDs with versus without trauma center designation (aOR 0.80; 95% CI 0.67, 0.95); and higher among EDs with a nurse and physician pediatric emergency care coordinator (PECC) (aOR 1.89; 95% CI 1.54, 2.33) versus those without a PECC.
Although pediatric readiness for BH conditions increased from 2013 to 2021, gaps remain, particularly among rural EDs and designated trauma centers. Having nurse and physician PECCs is a modifiable strategy to increase ED pediatric readiness pertaining to BH.
在美国，因行为健康问题前往儿科急诊科就诊的人数正在增加。我们试图确定与推荐的行为健康相关政策相关的急诊科层面的特征。
我们对2013年和2021年在美国急诊科进行的国家儿科准备项目评估进行了回顾性系列横断面研究。研究了与行为健康项目相关的回答随时间的变化。多变量逻辑回归模型研究了与2021年特定行为健康相关政策的存在相关的急诊科特征。
在2021年完成评估的3554家急诊科中，73.0%有行为健康相关政策，66.5%有针对行为健康问题儿童的转诊指南，38.6%在灾难中有行为健康资源可用。在2013年和2021年都完成评估的2570家急诊科中，特定行为健康相关政策的存在率从48.6%增加到72.0%，适当转诊指南的存在率从56.2%增加到64.9%。与城市急诊科相比，农村（调整优势比[aOR]0.73；95%置信区间[CI]0.57，0.92）和偏远急诊科（aOR0.65；95%CI0.48，0.88）有特定行为健康相关政策的调整优势比更低；有创伤中心指定的急诊科与没有创伤中心指定的急诊科相比更低（aOR0.80；95%CI0.67，0.95）；有护士和医生儿科急诊护理协调员（PECC）的急诊科与没有PECC的急诊科相比更高（aOR1.89；95%CI1.54，2.33）。
尽管从2013年到2021年儿科对行为健康状况的准备有所增加，但差距仍然存在，特别是在农村急诊科和指定的创伤中心。配备护士和医生PECC是提高急诊科对行为健康的儿科准备的一种可改变的策略。
