The 4 S's of Disaster Management Framework: A Case Study of the 2022 Pediatric Tripledemic Response in a Community Hospital.

Most children in the United States present to community hospitals for emergency department (ED) care. Those who are acutely ill and require critical care are stabilized and transferred to a tertiary pediatric hospital with intensive care capabilities. During the fall of 2022 "tripledemic," with a marked increase in viral burden, there was a nationwide surge in pediatric ED patient volume. This caused ED crowding and decreased availability of pediatric hospital intensive care beds across the United States. As a result, there was an inability to transfer patients who were critically ill out, and the need for prolonged management increased at the community hospital level. We describe the experience of a Massachusetts community ED during this surge, including the large influx in pediatric patients, the increase in those requiring critical care, and the total number of critical care hours as compared with the same time period (September to December) in 2021. To combat these challenges, the pediatric ED leadership applied a disaster management framework based on the 4 S's of space, staff, stuff, and structure. We worked collaboratively with general emergency medicine leadership, nursing, respiratory therapy, pharmacy, local clinicians, our regional health care coalition, and emergency medical services (EMS) to create and implement the pediatric surge strategy. Here, we present the disaster framework strategy, the interventions employed, and the barriers and facilitators for implementation in our community hospital setting, which could be applied to other community hospital facing similar challenges.

Retrospective evaluation of a computerized physician order entry adaptation to prevent prescribing errors in a pediatric emergency department.

OBJECTIVE: The goal was to determine the impact on medication prescribing errors of adding a pediatric medication list (quicklist) to a computerized physician order entry system in a pediatric emergency department. METHODS: The quicklist is a drug dosing support tool that targets the most common medications in our clinical setting. We performed a retrospective comparison of orders from 420 randomly selected visits before and after quicklist introduction. Error rates were analyzed with respect to urgency level, physician training level, and patient age. The quicklist was examined for frequency of use and error rates. RESULTS: The 840 patient visits (420 before intervention and 420 after intervention) generated 724 medication orders, which contained 156 medication prescribing errors (21%). The groups did not differ with respect to urgency level, physician training level, or patient age. There were significant decreases in the rate of errors per 100 visits, from 24 to 13 errors per 100 visits, and in the rate of errors per 100 orders, from 31 to 14 errors per 100 orders. The decrease in the error rates did not vary according to urgency score, age group, or physician training level. The quicklist was used in 30% of the orders in the postintervention group. In this group, the error rate was 1.9 errors per 100 orders when the quicklist was used, compared with 18.3 errors per 100 orders when the list was not used. Errors of wrong formulation, allergy, drug-drug interaction, and rule violations were eliminated. CONCLUSION: The introduction of the quicklist was followed by a significant reduction in medication prescribing errors. A list with dosing support for commonly used pediatric medications may help adapt computerized physician order entry systems designed for adults to serve pediatric populations more effectively.