2018 Academic Emergency Medicine Consensus Conference: Advancing Pediatric Emergency Medicine Education Through Research and Scholarship
Jean E. KligAndrea FangSean M. FoxJeffrey HomAshley M. StrobelSonny TatJessica J. WallRahul BhatEric WeinbergKurt R. DeninghoffPaul IshimineMaybelle Kou
11
Citation
26
Reference
10
Related Paper
Citation Trend
Abstract:
To achieve high-quality emergency care for pediatric patients nationwide, it is necessary to define the key elements for pediatric emergency medicine (PEM) education and scholarship that would: 1) close the gaps in fundamental PEM education and 2) promote systems and standards that assure an ongoing communication of best practices between tertiary pediatric institutions, general (nonchildren's) hospital emergency departments, and urgent care centers. A working group of medical educators was formed to review the literature, develop a framework for consensus discussion at the breakout session, and then translate their findings into recommendations for future research and scholarship. The breakout session consensus discussion yielded many recommendations. The group concluded that future progress depends on multicenter collaborations as a PEM education research network and a unified vision for PEM education that bridges organizations, providers, and institutions to assure the best possible outcomes for acutely ill or injured children.Keywords:
Pediatric emergency medicine
Breakout
Best practice
Consensus conference
Introduction Tele-emergency provides audio/visual communication between a central emergency care centre (tele-emergency hub) and a distant emergency department (remote ED) for real-time emergency care consultation. The purpose of this mixed methods study is to examine how often tele-emergency is activated in usual practice and in what circumstances it is used. Methods Tele-emergency log data and merged electronic medical record data from Avera Health (Sioux Falls, SD) were analysed for 60,193 emergency department (ED) encounters presenting over a two-and-a-half year period at 21 critical access hospitals using the tele-emergency service. Of these, tele-emergency was activated for 1512 ED encounters. Results Analyses indicated that patients presenting at rural EDs with circulatory, injury, mental and symptoms diagnoses were significantly more likely to have tele-emergency department services activated as were patients who were transferred to another hospital. Interviews conducted with 85 clinicians and administrators at 26 rural hospitals that used this service indicated that this pattern of utilization facilitated rapid transfers and followed recommended clinical protocols for patients needing serious and/or urgent attention (e.g. stroke symptoms, chest pain). Discussion Although only used in 3.5% of ED encounters on average, our findings provide evidence that tele-emergency activation is well reasoned and related to those situations when extra expert assistance is particularly beneficial.
Cite
Citations (32)
Best practice
Cite
Citations (38)
To achieve high-quality emergency care for pediatric patients nationwide, it is necessary to define the key elements for pediatric emergency medicine (PEM) education and scholarship that would: 1) close the gaps in fundamental PEM education and 2) promote systems and standards that assure an ongoing communication of best practices between tertiary pediatric institutions, general (nonchildren's) hospital emergency departments, and urgent care centers. A working group of medical educators was formed to review the literature, develop a framework for consensus discussion at the breakout session, and then translate their findings into recommendations for future research and scholarship. The breakout session consensus discussion yielded many recommendations. The group concluded that future progress depends on multicenter collaborations as a PEM education research network and a unified vision for PEM education that bridges organizations, providers, and institutions to assure the best possible outcomes for acutely ill or injured children.
Pediatric emergency medicine
Breakout
Best practice
Consensus conference
Cite
Citations (11)
Triage
Cite
Citations (54)
Disposition
Guideline
Trauma Center
Cite
Citations (0)
Cite
Citations (0)
Triage
Cite
Citations (26)
Objectives: Although life-threatening emergencies for cancer patients are relatively rare, cancer patients often seek care in the emergency department. The use of emergency medical service (EMS) by these patients is not well studied. The aim of this study was to investigate the characteristics of cancer patients who present to the emergency department (ED) for care and compare characteristics of patients transported by EMS vs. those transported by private vehicle. Methods: Our retrospective cohort study was conducted in an EMS system with 21,070 annual transports and an academic ED with 129,263 annual visits. Our study consisted of patients with a new diagnosis of cancer between January 1 and July 1, 2015 who subsequently presented to the ED between January 1, 2015 and July 1, 2017. Study variables included patient demographics, mode of ED arrival, cancer type and treatment, patient clinical characteristics, and disposition. To describe differences in patient characteristics of EMS vs. private vehicle transport, we report variable frequencies and stratified them by mode of transport. Results: Of the 2,727 patients with a new diagnosis of cancer, 1,303 (47.8%) presented to the ED with a total of 3,590 visits in 30 months. EMS transported 22% of cancer patients to the ED vs. 78% transported by private vehicle. Thus, cancer patients would make up approximately 1.5% (781/52,675) of all EMS transports during the study period. For those transported by EMS, the most common chief complaints were respiratory distress (16.0%), pain (15.4%), and neurological symptoms (12.6%). Patients with cancer of the lung/respiratory tract (21.5%), upper GI (12.4%), and central nervous system (CNS) (11.0%) were most frequently transported by EMS. Older age, presence of CNS cancer, presentation with neurological or cardiovascular complaints, and higher acuity were significantly associated with EMS transport to ED, while gender and pain severity were not. Patients transported by EMS were more likely to be hospitalized and for greater than 2 days (p < 0.0001). Conclusions: Cancer patients frequently seek emergency care after initial diagnosis, most commonly present for symptom relief, and are often admitted. Patients transported by EMS are more likely to be admitted and for longer periods of time.
Cite
Citations (8)
Handoff communication between Emergency Medical Services (EMS) and Emergency Department (ED) staff is critical to ensure quality patient care. In January 2016, the Southwest Texas Regional Advisory Council (STRAC) implemented MIST (Mechanism, Injuries, vital Signs, Treatments), a standardized EMS to ED handoff tool. The En route Care Research Center conducted a Pre-MIST implementation survey of ED staff in December 2015 and a Post-MIST follow-up survey in July 2017 to determine the impact of the MIST handoff tool on the perceived quality of transmission of pertinent patient information and in the overall handoff experience.We administered a nine-item Likert scale questionnaire to Brooke Army Military Medical Center (BAMC) ED providers and nurses before and after implementation of MIST. The questionnaire captured perceived competence and satisfaction with handoff communication (Cronbach's alpha 0.73). We analyzed responses for the total sample and by occupation (providers and nurses), and we calculated odds ratios to determine items that may be most predictive of a positive handoff experience from the perspective of the ED staff. We performed chi-square tests and reported data as percentages.Total respondents Pre- and Post-MIST were 128 (62%) nurses and 80 (38%) providers (MDs, DOs, and PAs). Following the implementation of MIST, more respondents reported that they were "informed of prehospital treatments" (p < 0.001), that "Red/Blue Trauma Alert Criteria were conveyed" (p < 0.001), and that the "time to give the report was sufficient to convey pertinent information" (p < 0.001). Nurses more frequently reported that "Red/Blue Trauma Alert Criteria were conveyed" post-MIST (p < 0.01). Providers more frequently reported that "Assessment findings were conveyed" (p < 0.05), that they 'interrupted the report for clarification" (p < 0.04), that "time to give the report was sufficient to convey pertinent information" (p < 0.001) and that they "felt positive about the overall handoff experience" (p < 0.03) Post-MIST. Overall satisfaction with the handoff was associated with frequently being informed of prehospital treatments (OR 5.5; 2.1-14.4) and frequently receiving a copy of the prehospital record (OR 2.9; 1.1-7.2).These data demonstrate that providers and nurses reported an improvement in the handoff experience Post-MIST. This study supports the use of a standardized handoff tool at this critical step in patient care.
Cite
Citations (16)
Background/aims Despite epistaxis being a common presentation to emergency departments there is a lack of guidelines, both nationally and internationally, for its management. The authors reviewed the current management of epistaxis and then introduced a new pathway for management to see if care could be improved. The aims were to evaluate the impact of the pathway on reduction of emergency department breaches, emergency ambulance transfers and hospital admissions. Methods The study was an interrupted time series analysis over 29 months and included 903 participants. A pathway for the management of adults with non-traumatic epistaxis was designed and implemented in a university teaching hospital with an emergency department annual attendance rate of 105 495 in 2019–20. Results The pathway led to a 14-minute longer stay in the emergency department, a 5% increase in emergency department breaches, an 8.2% reduction in admissions, a 3.6% reduction in emergency ambulance transfers, a 14.1% increase in nasal cautery and a 3.2% reduction in nasal packing. Conclusions The authors calculate that these results equate to roughly 56 hospital bed days saved, providing better care closer to home for patients, in addition to beneficial knock-on effects for other emergency department and admitted patients.
Attendance
Presentation (obstetrics)
Cite
Citations (1)