Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments

Marc A. Auerbach, Yale University School of Medicine, New Haven, Connecticut.
Travis Whitfill, Yale University School of Medicine, New Haven, Connecticut.
Erin Montgomery, Indiana University School of Medicine, Indianapolis, Indiana.
James Leung, McMaster University, Hamilton, Ontario, Canada.
David Kessler, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Isabel T. Gross, Yale University School of Medicine, New Haven, Connecticut.
Barbara M. Walsh, Boston University School of Medicine, Boston, Massachusetts.
Melinda Fiedor Hamilton, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Marcie Gawel, Yale University School of Medicine, New Haven, Connecticut.
Shruti Kant, University of California San Francisco, San Francisco, California.
Stephen Janofsky, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Linda L. Brown, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Theresa A. Walls, Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Michelle Alletag, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Anna Sessa, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Grace M. Arteaga, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Ashley Keilman, University of Washington and Seattle Children's Hospital, Seattle, Washington.
Wendy Van Ittersum, Akron Children's Hospital, Akron, Ohio.
Maia S. Rutman, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Pavan Zaveri, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Grace Good, Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Jessica C. Schoen, Mayo Clinic Health System, Albert Lea and Austin, Minnesota.
Meghan Lavoie, Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Mark Mannenbach, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Ladonna Bigham, Johns Hopkins School of Medicine, Baltimore, Maryland.
Robert A. Dudas, Johns Hopkins School of Medicine, Baltimore, Maryland.
Chrystal Rutledge, The University of Alabama at Birmingham, Birmingham, Alabama.
Pamela J. Okada, University of Texas, Southwestern Medical Center, Dallas, Texas.
Michelle Moegling, Case Western Reserve University and UH Rainbow Babies and Children's Hospital, Cleveland, Ohio.
Ingrid Anderson, Case Western Reserve University and UH Rainbow Babies and Children's Hospital, Cleveland, Ohio.
Khoon-Yen Tay, Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Daniel J. Scherzer, Nationwide Children's Hospital, Columbus, Ohio.

Document Type

Journal Article

Publication Date

8-1-2023

Journal

Pediatrics

Volume

152

Issue

2

DOI

10.1542/peds.2022-060790

Abstract

OBJECTIVES: To describe the quality of pediatric resuscitative care in general emergency departments (GEDs) and to determine hospital-level factors associated with higher quality. METHODS: Prospective observational study of resuscitative care provided to 3 in situ simulated patients (infant seizure, infant sepsis, and child cardiac arrest) by interprofessional GED teams. A composite quality score (CQS) was measured and the association of this score with modifiable and nonmodifiable hospital-level factors was explored. RESULTS: A median CQS of 62.8 of 100 (interquartile range 50.5-71.1) was noted for 287 resuscitation teams from 175 emergency departments. In the unadjusted analyses, a higher score was associated with the modifiable factor of an affiliation with a pediatric academic medical center (PAMC) and the nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. In the adjusted analyses, a higher CQS was associated with modifiable factors of an affiliation with a PAMC and the designation of both a nurse and physician pediatric emergency care coordinator, and nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. A weak correlation was noted between quality and pediatric readiness scores. CONCLUSIONS: A low quality of pediatric resuscitative care, measured using simulation, was noted across a cohort of GEDs. Hospital factors associated with higher quality included: an affiliation with a PAMC, designation of a pediatric emergency care coordinator, higher pediatric volume, and geographic location. A weak correlation was noted between quality and pediatric readiness scores.

Department

Pediatrics

Link to Full Text

Share

COinS