Pediatric emergency care
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Pediatric emergency care · Aug 2023
Pediatric Septic Shock Care Pathways in General Emergency Departments: A Qualitative Study Targeting How to Really Make it Work.
Many academic pediatric emergency departments (PEDs) have successfully implemented pediatric septic shock care pathways. However, many general emergency departments (GEDs), who see the majority of pediatric ED visits, have not. This study aims to compare the workflow, resources, communication, and decision making across these 2 settings to inform the future implementation of a standardized care pathway for children with septic shock in the GED. ⋯ Pediatric septic shock workflow, decision making, and system performance differ between the PED and GEDs. Implementation of a standardized care pathway in GEDs will require a tailored approach. Specific recommendations include (1) improving shared situation awareness; (2) simulation for knowledge, skill, and team-based training; and (3) promoting a culture of continuous learning.
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The objective of this study is to evaluate the impact of the introduction of an education program familiarizing staff with the effective and appropriate use of Laceraine application to children's lacerations requiring repair at The Prince Charles Hospital Children's Emergency Department (TPCH-CED), Brisbane. ⋯ There was a significant change in practice with greater use of topical anesthetic (Laceraine) for the management of laceration repair of children, as expected, after the focused education program on its correct use. As emergency departments continue to be overwhelmed with increasing attendances and long patient wait times, a simple small intervention, such as that described, has potential to improve flow through the children's emergency department. Future research should focus on a randomized control trial to determine the contribution of the use of a topical agent, as opposed to injectable local anesthetic and/or full procedural sedation to determine the contribution to the impact of this simple change of practice on patient flow and satisfaction.
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Pediatric emergency care · Aug 2023
Referrals for Pediatric Appendicitis to a Tertiary Care Children's Hospital.
This study aimed to analyze pediatric referrals for definite or possible appendicitis, to compare clinical predictors and laboratory values between patients with and without a final diagnosis of appendicitis, and to determine the accuracy of prereferral diagnostic interpretations of computed tomography scans, ultrasound, and magnetic resonance imaging modalities. ⋯ Usage of established scoring algorithms, such as Alvarado and AIR, may decrease the unnecessary cost of diagnostic imaging and transfer to tertiary care. Virtual radiology consultations may be 1 potential solution to improve the referral process for pediatric appendicitis if initial interpretation is uncertain.
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Pediatric emergency care · Aug 2023
Pediatric Emergency Medicine Fellowship Program Directors' Viewpoint: Minimum Levels of Entrustment for Graduating Fellows and Practicing Physicians to Perform the Subspecialty's Professional Activities.
Entrustable Professional Activities (EPAs) are essential tasks physicians perform within their professions. Entrustment levels that pediatric emergency medicine (PEM) fellowship program directors (FPDs) expect graduating fellows to achieve for PEM-specific and common pediatric subspecialty EPAs remain unreported. This study aims to determine minimum entrustment levels FPDs require fellows to achieve to graduate from fellowship and to compare FPD expectations for fellows versus practicing PEM physicians. ⋯ Most PEM FPDs indicated that they would graduate fellows before their achievement of the highest entrustment level for all EPAs. Most also indicated that they do not expect practicing PEM physicians to perform all EPAs without supervision. These findings indicate need for stakeholders to evaluate current structure and outcomes of PEM fellowship programs and for institutions and organizations to ensure adequate support in time and resources for ongoing learning for practicing PEM physicians.
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Pediatric emergency care · Aug 2023
Adolescent and Caregiver Perspectives on Living With a Limb Fracture: A Qualitative Study.
Fractures occur in up to half of children by age 16 years. After initial emergency care for a fracture, function is universally impaired in children, and impacts extend to the immediate family. Knowledge of expected functional limitations is key to providing proper discharge instructions and anticipatory guidance to families. ⋯ Overall, caregivers' perspectives were congruent with the self-described experiences of adolescents. Key messages for optimized discharge instructions include pain and sleep management, allowing extra time to complete tasks independently, considering impact on siblings, preparing for changes in activities and social dynamics, and normalizing frustration. These themes highlight an opportunity to better tailor discharge instructions for adolescents with fractures.