Pediatric Resuscitative Care Varies in U.S. Emergency Depts

By Will Boggs MD

August 30, 2016

NEW YORK (Reuters Health) - The quality of simulated pediatric resuscitative care varies widely across the spectrum of emergency departments (EDs), according to a multicenter study.

"There are significant opportunities for improvement in the quality of pediatric resuscitative care in both pediatric and general EDs," Dr. Marc Auerbach from Yale University School of Medicine, New Haven, Connecticut told Reuters Health by email.

More than 4,000 EDs across the U.S. recently completed the Pediatric Readiness Survey (PRS), but there is little information about the quality of pediatric resuscitative care in the ED and whether PRS scores correlate with patient outcomes or quality of care.

Dr. Auerbach's team measured the performance of interprofessional teams caring for a series of three simulated pediatric patients - one each with sepsis, seizure, and cardiac arrest - in eight pediatric EDs (PEDs) and 22 general EDs (GEDs).

PEDs had higher pediatric patient volumes, total PRS scores, ratio of physicians per team, and percentages of team members that participated in frequent pediatric simulations, compared with GEDs, according to the August 29th JAMA Pediatrics online report.

The composite quality score (CQS), a sum of scores for adherence to sepsis guidelines, adherence to pediatric advanced life support guidelines, performance on seizure resuscitation, and mean teamwork score across the three cases, was significantly higher at PEDs than at GEDs (mean, 83 vs 66; P<0.001).

Scores for each individual component of the CQS were also higher at PEDs.

Pediatric volume and PRS scores accounted for the higher CQS at PEDs, whereas PED or GED status did not predict CQS.

PRS correlated strongly with the teamwork domain of CQS, but correlated weakly with the other three domains.

"All EDs who care for children should engage in pediatric specific quality improvement, training, and education," Dr. Auerbach said. "Resources to improve pediatric care are available through organizations such as Emergency Medical Services for Children, the American Academy of Pediatrics, the American Heart Association, and the American College of Emergency Physicians."

"These data can be used to inform the development of additional targeted interventions to improve pediatric resuscitative care across U.S. EDs," he concluded. "Additional work is needed to explore whether differences in quality are associated with variability in patient outcomes."

Dr. Elliot Long from The Royal Children's Hospital, Parkville, Victoria, Australia recently reported a successful quality improvement initiative targeting ED treatment of pediatric sepsis. He told Reuters Health by email, "The variation in 'quality' of resuscitation across sites varied, which I do not find surprising. I would not be surprised if the 'quality' of resuscitation varied within sites! I was surprised that PEDs did not perform better than mixed EDs when corrected for pediatric patient volume."

"This is a very murky area and the authors have done a commendable job trying to approach it in a scientific manner," he said. "I wonder however whether simulation lends itself more to evaluation of 'human factors' or the non-technical aspects of resuscitation, and whether we are missing part of the 'gold' from the study by not including the outcomes of debriefs or synthesizing discussion points following the simulated patient encounters."

"My overall take on the study is that it confirms heterogeneity in resuscitative practice, and highlights that we need more evidence to support current guidelines/best practice in order to support more rigid adherence to protocols/guidelines," Dr. Long concluded.

SOURCE: http://bit.ly/2bMpnEK

JAMA Pediatr 2016.

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