Pediatric emergency care
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Pediatric emergency care · Feb 2022
Optimizing Critical Care Documentation in a Pediatric Emergency Department.
Emergency department (ED) physicians frequently provide critical care (CC) but document inconsistently. Variability in documentation can result in underbilling and is inconsistent with financial stewardship. We used admissions to the intensive care unit (ICU) as a proxy for CC provision. At baseline, CC notes were correctly documented for 20% of eligible visits, with potential missed charges of $1.8 million per year.Our objective was to increase CC note placement for eligible patients from 20% to 60% over 2 years. Additionally, we measured CC notes and the number of ICU admissions per 1000 ED visits, and change in facility fees. ⋯ This project resulted in significant and sustained improvements in CC note completion. We believe providing education, simplifying the documentation process, automating reminders, and incentivizing optimal documentation were vital to success.
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Pediatric emergency care · Feb 2022
Point-of-Care Ultrasound on Management of Cellulitis Versus Local Angioedema in the Pediatric Emergency Department.
To evaluate whether ultrasound can differentiate between cellulitis and angioedema from insect bites in pediatric patients. ⋯ Point-of-care ultrasound changed physician management in 1 of 4 patients in the pediatric emergency department with soft tissue swelling secondary to insect bites. Ultrasound may guide the management in these patients and lead to improved antibiotic stewardship in conjunction with history and physical examination.
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Pediatric emergency care · Feb 2022
The Use of PECARN and CATCH Rules in Children With Minor Head Trauma Presenting to Emergency Department 24 Hours After Injury.
Major studies (PECARN [Pediatric Emergency Care Applied Research Network], CATCH [Canadian Assessment of Childhood Head Injury]) that regulate the use of computed tomography (CT) algorithms in children with minor head trauma (MHT) have been conducted among children presenting in 24 hours after injury. In this study, we aimed to compare use and results of PECARN and CATCH rules in children presenting in and after 24 hours following injury. ⋯ Patients with MHT presenting after 24 hours following injury constitute a clinically important population. Regardless of the admission time, current guidelines predict traumatic CT abnormalities.
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Pediatric emergency care · Feb 2022
Low-Resource Emergency Department Visits for Children With Complex Chronic Conditions.
Reducing emergency department (ED) use in children with complex chronic conditions (CCC) is a national health system priority. Emergency department visits with minimal clinical intervention may be the most avoidable. We assessed characteristics associated with experiencing such a low-resource ED visit among children with a CCC. ⋯ Infant age, living close to the ED, and day/evening-time visits were associated with the greatest likelihood of experiencing a low-resource ED visit in children with CCCs. Further investigation is needed to assess key drivers for ED use in these children and identify opportunities for diversion of ED care to outpatient and community settings.
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Pediatric emergency care · Feb 2022
Training Experiences of Emergency Department Providers in the Recognition of Child Trafficking.
Trafficked children face challenges to obtaining appropriate health care that may be addressed by clinician training. We evaluated emergency department (ED) staff's training experiences regarding child trafficking and attitudes toward educational efforts to provide informed recommendations for improvement in the recognition and evaluation of trafficked children in the ED setting. ⋯ We found that although most ED providers stated that they had prior training in the recognition of child trafficking, few expressed confidence in their ability to recognize and evaluate trafficked children. Barriers to education included a lack of awareness of and access to available curricula. Providers supported a variety of formats for further education. Strategies for improving educational access are discussed.