P109: Education innovation: pediatric emergencies curriculum for emergency physicians

Introduction: Tertiary care emergency departments (EDs) in large urban environments may have a low volume of high acuity pediatric presentations due to their proximity to dedicated childrens hospitals or large community centres. This may lead to discomfort among emergency physicians (EPs) and registered nurses (RNs) in managing these patients and a waning of knowledge and skills for this unique population. Among the EP group at our institution, 68% indicated they managed pediatric patients in less than 25% of their shifts, 68% also indicated they were uncomfortable managing an undifferentiated critically unwell neonate and only 32% indicated they would be comfortable teaching pediatric topics to emergency medicine residents. At our institution, our innovation was to create a useful curriculum for certified EPs and RNs to improve the interdisciplinary teams comfort level, knowledge and skill set when managing pediatric emergencies. Methods: A needs assessment was undertaken of the EPs and RNs working in our centre. This information was used to develop intended learning outcomes in a collaborative manner with the clinical nursing educator and physician curriculum leads. The team further collaborated with the local simulation centre and a pediatric emergency physician from the local childrens hospital. Results: A one-year, three-module curriculum was developed to cover the areas felt to be highest yield by the EP group: febrile illness, respiratory disease and critically ill neonates and infants. Each module contains three components: an in person interactive lecture delivered by an EP who routinely manages pediatric patients, either at a childrens hospital or large community centre; an online component with e-mail blasts of high yield pediatric content; and, culminating in an interdisciplinary interdepartmental simulation held in situ. This latter is particularly important so that all members of the interdisciplinary team can practice finding and using equipment based on its actual location within the ED. Each component of each module is then evaluated by the participants to ensure improvement for subsequent delivery. Conclusion: Well delivered continuing professional development (CPD) will become increasingly important as competence by design becomes the model for maintenance of certification. Maintaining skills for pediatric patients is an important component of CPD for physicians working in general emergency departments that see a low volume of high acuity pediatric presentations. Our curriculum seeks to address this identified need in an innovative manner using a modular and interdisciplinary approach with a diversity of teaching methods to appeal to the learning styles among our health care team.

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Development of a porcine model of emergency resternotomy at a low-volume cardiac surgery centre

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa191 ◽

2020 ◽

Vol 31 (6) ◽

pp. 803-805

Author(s):

Timothy M Guenther ◽

Sarah A Chen ◽

Joshua D Gustafson ◽

Curtis J Wozniak ◽

Bob Kiaii

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Porcine Model ◽

Comfort Level ◽

Large Animal Model ◽

Large Animal ◽

Training Environment ◽

Life Saving ◽

Simulation Scenario ◽

Low Volume

Abstract Emergency resternotomy in the intensive care unit (ICU) is a rarely performed, yet potentially life-saving intervention. Success relies on recognition of a deteriorating clinical condition, timely deployment of equipment/personnel and rapid execution. Given how infrequently it is performed, we sought to develop a large animal model of resternotomy to prepare ICU nurses and technicians at our low-volume cardiac surgery military centre. A porcine model of resternotomy was developed at the end of an already-scheduled trauma lab. Participants worked their way through a pre-planned simulation scenario, culminating in the need for resternotomy. Pre-simulation surveys assessing knowledge and comfort level with aspects of resternotomy were compared to post-simulation surveys. Participants improved their knowledge of resternotomy by 20.4% (P < 0.0001; 14.7% for nurses and 26.9% for technicians). Improvements were seen in all aspects assessed relating to subjective comfort/preparedness of resternotomy. The model was an effective and realistic method to augment training of ICU staff about resternotomy. Costs associated with this model can be reduced when used in conjunction with large animal labs. This model should be used together with mannequin-based methods of resternotomy training to provide a realistic training environment and assessment of skills at capable institutions.

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How do outcomes compare for people attended by general practitioners (GPs) or emergency physicians in hospital emergency departments?

Cochrane Clinical Answers ◽

10.1002/cca.2217 ◽

2018 ◽

Author(s):

Jane Burch ◽

Sera Tort

Keyword(s):

General Practitioners ◽

Emergency Departments ◽

Emergency Physicians ◽

Hospital Emergency ◽

Hospital Emergency Departments

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Ill, Itinerant, and Insured: The Top 20 Users of Emergency Departments in Baltimore City

The Scientific World JOURNAL ◽

10.1100/2012/726568 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 11

Author(s):

Barbara Y. DiPietro ◽

Dana Kindermann ◽

Stephen M. Schenkel

Keyword(s):

Emergency Departments ◽

Social Factor ◽

Homeless People ◽

Chronic Illnesses ◽

Limb Pain ◽

Baltimore City ◽

Administrative Records ◽

Immunodeficiency Virus ◽

High Acuity ◽

Alteration Of Consciousness

The purpose of this study was to document the clinical and demographic characteristics of the 20 most frequent users of emergency departments (EDs) in one urban area. We reviewed administrative records from three EDs and two agencies providing services to homeless people in Baltimore City. The top 20 users accounted for 2,079 visits at the three EDs. Their mean age was 48, and median age was 51. Nineteen patients visited at least 2 EDs, 18 were homeless, and 13 had some form of public insurance. The vast majority of visits (86%) were triaged as moderate or high acuity. The five most frequent diagnoses were limb pain (n=9), lack of housing (n=6), alteration of consciousness (n=6), infection with human immunodeficiency virus (HIV) (n=5), and nausea/vomiting (n=5). Hypertension, HIV infection, diabetes, substance abuse, and alcohol abuse were the most common chronic illnesses. The most frequent ED users were relatively young, accounted for a high number of visits, used multiple EDs, and often received high triage scores. Homelessness was the most common characteristic of this patient group, suggesting a relationship between this social factor and frequent ED use.

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Addressing the Differences by Race in Analgesia Use among Pediatric Patients Attending Emergency Departments

The Journal of Pediatrics ◽

10.1016/j.jpeds.2014.06.046 ◽

2014 ◽

Vol 165 (3) ◽

pp. 434-436 ◽

Cited By ~ 1

Author(s):

Keith Elder ◽

Shahida Rice ◽

Caress Dean ◽

Crystal Piper

Keyword(s):

Emergency Departments ◽

Pediatric Patients

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Experience with genomic sequencing in pediatric patients with congenital cardiac defects in a large community hospital

Molecular Genetics & Genomic Medicine ◽

10.1002/mgg3.357 ◽

2018 ◽

Vol 6 (2) ◽

pp. 200-212 ◽

Cited By ~ 3

Author(s):

Natalie S. Hauser ◽

Benjamin D. Solomon ◽

Thierry Vilboux ◽

Alina Khromykh ◽

Rajiv Baveja ◽

...

Keyword(s):

Pediatric Patients ◽

Community Hospital ◽

Genomic Sequencing ◽

Cardiac Defects ◽

Congenital Cardiac Defects ◽

Large Community

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Providers' Perceptions of Caring for Pediatric Patients in Community Hospital Emergency Departments: A Mixed‐methods Analysis

Academic Emergency Medicine ◽

10.1111/acem.13509 ◽

2018 ◽

Vol 25 (12) ◽

pp. 1385-1395 ◽

Cited By ~ 4

Author(s):

Michael P. Goldman ◽

Ambrose H. Wong ◽

Ambika Bhatnagar ◽

Beth L. Emerson ◽

Linda L. Brown ◽

...

Keyword(s):

Mixed Methods ◽

Emergency Departments ◽

Pediatric Patients ◽

Community Hospital ◽

Hospital Emergency ◽

Hospital Emergency Departments

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Building and strengthening relationships between academic departments/divisions of emergency medicine and rural and regional emergency departments

CJEM ◽

10.1017/cem.2019.359 ◽

2019 ◽

Vol 21 (5) ◽

pp. 595-599 ◽

Cited By ~ 1

Author(s):

Aaron Johnston ◽

Kylie Booth ◽

Jim Christenson ◽

David Fu ◽

Shirley Lee ◽

...

Keyword(s):

Emergency Medicine ◽

Emergency Departments ◽

Academic Departments ◽

List Type ◽

Emergency Physicians ◽

Common Value ◽

Rural And Urban ◽

Canadian Association ◽

Rural Physicians ◽

Training Opportunities

ABSTRACTObjectivesMake recommendations on approaches to building and strengthening relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.MethodsA panel of leaders from both rural and urban/academic practice environments met over 8 months. Draft recommendations were developed from panel expertise as well as survey data and presented at the 2018 Canadian Association of Emergency Physicians (CAEP) Academic Symposium. Symposium feedback was incorporated into final recommendations.ResultsSeven recommendations emerged and are summarized below: 1)CAEP should ensure engagement with other rural stakeholder organizations such as the College of Family Physicians of Canada and the Society of Rural Physicians of Canada.2)Engagement efforts require adequate financial and manpower resources.3)Training opportunities should be promoted.4)The current operational interface between the academic department of Emergency Medicine and the emergency departments in the catchment area must be examined and gaps addressed as part of building and strengthening relationships.5)Initial engagement efforts should be around projects with common value.6)Academic Departments should partner with and support rural scholars.7)Academic departments seeking to build or strengthen relationships should consider successful examples from elsewhere in the country as well as considering local culture and challenges.ConclusionThese recommendations serve as guidance for building and strengthening mutually beneficial relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.

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The first national data of Turkish pre-hospital emergency care for children: Epidemiology, clinical characteristics, and outcomes

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919892766 ◽

2019 ◽

pp. 102490791989276

Author(s):

Caner Turan ◽

Eylem Ulas Saz ◽

Murat Anil ◽

Alkan Bal ◽

Gamze Gokalp ◽

...

Keyword(s):

Emergency Departments ◽

Clinical Characteristics ◽

Medical Service ◽

Pediatric Patients ◽

Service System ◽

Pediatric Emergency ◽

Critically Ill Children ◽

Emergency Medical Service System ◽

Life Saving ◽

Medical Service System

Background and Objectives: The emergency medical service system is designed to ensure rapid identification and transport of patients from the field to emergency departments. This study aims to examine pediatric patients’ clinical characteristics and reasons for ambulance use in Turkey. Life-saving interventions and non-life-saving interventions performed during transport and patients’ outcomes following transport were also investigated. Methods: This is a prospective-multicentric study conducted at four metropolitan cities and nine tertiary pediatric emergency departments. This survey-based study evaluated all children brought by ambulance to emergency departments. Patient demographics, clinical features, triage levels, procedures performed in the ambulance or emergency department, and final outcomes were sought. Results: A total of 2094 patients were transported during the study period. Only a minority of ambulances were physician staffed (16.5%), and 72% of the patients were delivered to pediatric emergency departments without notification calls. Although notification calls were more likely given for particularly critically ill children, for non-urgent conditions transfer calls were less common (60.8% vs 23.5%, respectively; p < 0.001). A majority of transports were performed for trauma patients (20.5%), neurological issues (20%), and toxicological emergencies (13.8%). While parents prefer using the ambulances for medical emergencies, physicians prefer it for mainly traumatic and toxicological emergencies. In total, 65% of the patients received at least one intervention, and 18 patients needed immediate life-saving interventions (intubation, cardiopulmonary resuscitation, etc.) but they did not receive it. Mortality occurred in nine patients. If the health care providers were paramedics, they were more likely avoided by performing any intervention in critically ill children ( p < 0.001). A majority of the procedures performed in children were older than 12 months ( p < 0.001). Conclusion: This study presents comprehensive epidemiological and outcome data for pediatric patients transported by the national emergency medical service system in Turkey. Non-urgent calls were more likely made by parents, physicians avoided making NCs, and paramedics also avoided performing any intervention when they were transporting children.

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