Development and evaluation of a program for the use of ultrasound for central venous catheter placement in a pediatric emergency department.

BACKGROUND: A growing body of literature supports the use of ultrasound (US) to assist central venous catheter (CVC) placement, and in many settings, this has become the standard of care. However, this remains a relatively new and uncommonly performed procedure for pediatric emergency medicine physicians. OBJECTIVES: This study aims to describe the change over time in percentage of CVC procedures performed with US assistance per 10,000 patient visits in a pediatric emergency department. METHODS: We describe the development of an emergency US program in a pediatric emergency department and investigate how US use for CVC placement in internal jugular and femoral veins changed from July 2007, when US became available, until December 2011. Data related to CVC procedures were obtained from a procedure database maintained for quality assurance purposes. RESULTS: The percentage of CVC procedures performed with US assistance increased significantly over time (P < 0.001). CONCLUSIONS: The development of an emergency US program was associated with significantly increased physician use of US for CVC placement.

Unscheduled return visits to the emergency department: the impact of language.

BACKGROUND: Return visits to the emergency department (ED) resulting in admission are an important marker of quality of care. Patients and families with limited English proficiency (LEP) are at risk for suboptimal care related to imprecise communication. OBJECTIVE: The objective of this study was to compare the rate of return visits resulting in admission in LEP patients to the rate in the English-speaking patients. METHODS: We assembled a retrospective cohort of patients cared for in a pediatric, tertiary ED. Eligible patients included those who were discharged on the first encounter, and those who returned and were admitted to the hospital within 72 hours of ED discharge were identified. A logistic regression was performed comparing the rate of return visits resulting in admission in the LEP and non-LEP populations adjusting for emergency severity index and time of day at ED visit. RESULTS: A total of 119,782 patients were discharged from the ED during a 32-month study period. Of these patients, 11.7% (14,053) identified a language other than English as their primary language. The rate of return visits resulting in admission was 1.2% (1279/105,729) among English speakers and 1.6% (220/14,053) in the LEP population. Patients with LEP were more likely to return to the ED for admission (odds ratio, 1.30; 95% confidence interval, 1.12-1.50; P < 0.001) The increased risk of a return visit for LEP patients remained significant after controlling for age, emergency severity index, and time of day (adjusted odds ratio, 1.43; 95% confidence interval, 1.23-1.66; P < 0.001). CONCLUSION: Patients with LEP are at higher risk of return visit for admission.

Bedside ultrasonography in the pediatric emergency department: the focused assessment with sonography in trauma examination uncovers an occult intra-abdominal tumor.

We present a case of a 3-year-old male with history of minor trauma, who was brought in by ambulance from the playground where he had an acute mental status change and was noted to be hypotensive on initial evaluation. History and examination did not indicate a clear etiology of his symptoms. Point-of-care emergency ultrasonography revealed free fluid in the abdomen and expedited the care of the child's unexpected intra-abdominal hemorrhage from an occult abdominal tumor. This case demonstrates the ability of practitioners to expedite and focus care with the use of rapid assessment with ultrasonography in the pediatric emergency department.