Improving Pediatric Readiness in General Emergency Departments: A Prospective Interventional Study.

OBJECTIVE: To describe the impact of a national interventional collaborative on pediatric readiness within general emergency departments (EDs). STUDY DESIGN: A prospective, multicenter, interventional study measured pediatric readiness in general EDs before and after participation in a pediatric readiness improvement intervention. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) on a 100-point scale. The study protocol extended over 6 months and involved 3 phases: (1) a baseline on-site assessment of pediatric readiness and simulated quality of care; (2) pediatric readiness interventions; and (3) a follow-up on-site assessment of WPRS. The intervention phase included a benchmarking performance report, resources toolkits, and ongoing interactions between general EDs and academic medical centers. RESULTS: Thirty-six general EDs were enrolled, and 34 (94%) completed the study. Four EDs (11%) were located in Canada, and the rest were in the US. The mean improvement in WPRS was 16.3 (P < .001) from a baseline of 62.4 (SEM = 2.2) to 78.7 (SEM = 2.1), with significant improvement in the domains of administration/coordination of care; policies, protocol, and procedures; and quality improvement. Six EDs (17%) were fully adherent to the protocol timeline. CONCLUSIONS: Implementing a collaborative intervention model including simulation and quality improvement initiatives is associated with improvement in WPRS when disseminated to a diverse group of general EDs partnering with their regional pediatric academic medical centers. This work provides evidence that innovative collaboration facilitated by academic medical centers can serve as an effective strategy to improve pediatric readiness and processes of care.

Use of Electromagnetic Device to Insert Postpyloric Feeding Tubes in a Pediatric Intensive Care Unit.

BACKGROUND: The preferred route for providing nutrition in the pediatric intensive care unit is enteral. Placement of postpyloric feeding tubes using an electromagnetic-tipped stylet that emits a signal detected by a device held over the patient's abdomen is effective in adult intensive care units, but has not been well studied in pediatric units. OBJECTIVES: To determine the effectiveness of the electromagnetic device in reducing the numbers of radiation exposures, intrahospital transports, tubes used, and tube placement attempts in the pediatric intensive care unit. METHODS: Data from a historical control group were compared with data from a prospective intervention group of patients less than 18 years of age and weighing at least 3 kg who required a postpyloric feeding tube in a 23-bed pediatric intensive care unit. Primary outcome was number of radiation exposures. Independent-samples Student t tests were used to compare the 2 study groups for mean equality; Pearson χ2 tests were used to compare categorical data. Statistical testing was 2-sided, and P less than .05 was considered statistically significant. RESULTS: Of 73 children (30 in control group, 43 in intervention group), those in the intervention group had a higher success rate at tube placement (P = .009) and fewer radiation exposures (P = .006), intrahospital transports (P = .004), and tubes used (P < .001). CONCLUSIONS: Successful placement of postpyloric feeding tubes by nurse practitioners was safely enhanced using an electromagnetic device. Establishing users' expertise with the device before studying outcomes may improve effectiveness.

Use of Simulation to Gauge Preparedness for Ebola at a Free-Standing Children's Hospital.

STATEMENT: On October 10, 2014, a health care worker exposed to Ebola traveled to Akron, OH, where she became symptomatic. The resulting local public health agencies and health care organization response was unequalled in our region. The day this information was announced, the emergency disaster response was activated at our hospital. The simulation center had 12 hours to prepare simulations to evaluate hospital preparedness should a patient screen positive for Ebola exposure. The team developed hybrid simulation scenarios using standardized patients, mannequin simulators, and task trainers to assess hospital preparedness in the emergency department, transport team, pediatric intensive care unit, and for interdepartmental transfers. These simulations were multidisciplinary and demonstrated gaps in the system that could expose staff to Ebola. The results of these simulations were provided rapidly to the administration. Further simulation cycles were used during the next 2 weeks to identify additional gaps and to evaluate possible solutions.