scholarly journals P062: Characterizing pediatric emergency department discharge communication using PEDICSv2

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S86-S86
Author(s):  
K. MacCuspic ◽  
S. Breneol ◽  
J. Curran
Keyword(s):  
Emergency Department ◽  
Management Plan ◽  
Pediatric Emergency ◽  
Main Concern ◽  
Pediatric Emergency Department ◽  
Care Providers ◽  
Planning Stage ◽  
Home Management ◽  
Communication Content ◽  
Discharge Communication

Introduction: Discharge communication in the pediatric emergency department (ED) is an important aspect of successful transition home for patients and families. The content, process, and pattern of discharge communication in a pediatric ED encounter has yet to be comprehensively explored. The objective of this study was to identify and characterize elements and patterns of discharge communication occurring during pediatric ED visits between health care providers (HCPs) and families. Methods: We analyzed real time video observations (N = 53) of children (0-18) presenting to two Canadian pediatric EDs with fever or minor head injury. We used a revised version of an existing coding scheme, PEDICSv2, to code all encounters. PEDICSv2 includes 32 elements capturing discharge communication. Inter-rater reliability was established with a second coder. Descriptive statistics reflecting the rates of delivery of each communication content element was reported to assess repetition at four stages of the visit (introduction/planning, actions/interventions, diagnosis/home management plan and summary/conclusion). Communication content was analyzed to depict behaviors of individual HCPs and the total communication delivered to the patient and caregiver by the healthcare team. Results: Results show 55.6% of families were asked to repeat their main concern by multiple HCPs during their ED visit. However, only 14.8% of families had comprehension of delivered discharge information assessed by more than one HCP. When involved in care, physicians were the most likely HCP to perform a comprehension assessment. Most of the communication delivered by nursing staff were elements involved in the introduction/planning and action/intervention stages of the visit. Conclusion: Findings indicate that most repetition occurs while eliciting a main concern during the introduction and planning stage of a pediatric ED encounter. In contrast, communication elements focusing on understanding the home management plan are less likely to be repeated by multiple HCPs. Future work focusing on structuring team workflow to minimize repetition during the introduction and planning stage may allow for clearer discharge teaching and more frequent comprehension assessment.

scholarly journals Acute benign myositis of childhood: Results of a prospective study performed in a pediatric emergency department

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Vanuza Rosa ◽  
Gabriela Kuzma ◽  
Luana Hornung ◽  
Márcia Bandeira
Keyword(s):  
Emergency Department ◽  
Prospective Study ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Care Providers ◽  
Study Objective ◽  
Gait Abnormality ◽  
The Mean ◽  
A Prospective Study ◽  
Musculoskeletal Involvement

OBJECTIVE: Benign acute childhood myositis is characterized by acute musculoskeletal involvement leading to transient limitations on deambulation followed by a viral illness. Our study objective to evaluate clinical and laboratory features of patients in a pediatric emergency department. METHODOS: We conducted a prospective study in patients with symptoms and laboratory findings compatible with viral myositis in the period of August 2017 to August 2018. RESULTS: We assessed 20 patients in the period of twelve months. The mean age was 8,25 years. Of these, 83,3% had infectious symptoms in the week before the musculoskeletal involvement. By the time of the diagnosis, the symptoms were: calf pain, reluctance to walk, gait abnormality, diffuse myalgia and calf weakness. The most relevant laboratory finding was the elevation of CPK (mean 3359,556U/L) level, followed by AST (mean 131U/L) and ALT (mean 64,66U/L) elevation. The mean time for symptom relief was 3 days and in 7 days all exams were normal. CONCLUSION: Though the exact incidence of this condition remains undetermined, the lower extremity pain and the gait abnormality is of concern of both parents and health care providers. We emphasize the importance of knowing this condition to avoid unnecessary exams and the delay in the diagnosis of severe conditions.

Abstract 224: Videographic Assessment of Pediatric Endotracheal Intubation in the Covid-19 Era: A Report From the Videography in Pediatric Resuscitation Collaborative

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Tara L Neubrand ◽  
Karen O'Connell ◽  
Akira Nishisaki ◽  
Sage Myers ◽  
Benjamin Kerrey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Multivariate Analysis ◽  
Endotracheal Intubation ◽  
Univariate Analysis ◽  
Pediatric Emergency ◽  
Critically Ill Children ◽  
Pediatric Emergency Department ◽  
Training Level ◽  
Care Providers ◽  
Pediatric Resuscitation

Introduction: Endotracheal intubation (ETI) of critically ill children is a high acuity, low frequency procedure in the pediatric emergency department that presents unique challenges to both pediatric and general acute care providers. COVID-19 and the associated requirements for PPE use, limitations of in-room personnel, communication difficulties, and reorganization of equipment have created new complexities. Objective: To use video review to compare intubator training level, first-attempt ETI success and presence of hypoxia during ETI attempts in the pediatric emergency department in the pre-COVID and COVID era. Methods: This is a retrospective multi-center case series of videorecordings of endotracheal intubations at the four tertiary care pediatric emergency departments comprising the VIPER Collaborative. All children undergoing emergent ETI between 1/1/2019-6/1/2020 in whom videorecordings were available were included for analysis. Data on patient age and intubator background was collected. Outcomes were first-attempt intubation success and hypoxia, defined as SpO2 <90%. Data was compared before (PRE) and after (POST) implementation of COVID-19 airway protocols, which each PED adopted in March 2020. Univariate analysis comparing PRE and POST for both outcomes was done by c2 testing. Multivariate analysis with a generalized estimating equation to control for clustering by site was done to determine the independent association between PRE and POST and outcomes. Results: Between 1/1/2019 and 6/1/2020, a total of 272 patients underwent ETI (239 PRE, 33 POST). Overall first attempt success was 155/239 (65%) in PRE and 28/33 (85%) in POST (p=0.02). Hypoxia was noted in 15% of PRE patients and in 12% of POST patients. Analysis of the training level of the intubator was notable for a significant increase in the number of intubations performed by anesthesiologists (55% POST vs. 13% PRE, p<0.001). In multivariate analysis controlling for intubator background, the POST phase was associated with greater first attempt success (AOR 2.4, 95% CI 1.6 – 3.7). Conclusion: Pediatric ETI in the COVID-19 era is associated with increased first attempt success when compared to the pre-COVID era.

Critical incident stress management for care providers in the pediatric emergency department

1992 ◽  
Vol 12 (1) ◽  
pp. 78-79 ◽  
Author(s):  
KJ Back
Keyword(s):  
Emergency Department ◽  
Critical Incident ◽  
Healthcare Providers ◽  
Pediatric Emergency ◽  
Management Program ◽  
Pediatric Emergency Department ◽  
Care Providers ◽  
Critical Incident Stress Management ◽  
Critical Incident Stress ◽  
High Level

Critical Incident Stress (CIS) is any event that evokes a critically high level of stress and makes usual coping skills ineffective. Programs to manage this stress have been developed. Due to the unique stressors encountered in the pediatric emergency department, this article proposes a CIS management program for these healthcare providers.

Exploring the Effect of Mindfulness on Burnout in a Pediatric Emergency Department

2021 ◽  
pp. 216507992110044
Author(s):  
Kei U. Wong ◽  
Lauren Palladino ◽  
Melissa L. Langhan
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Large Scale ◽  
Maslach Burnout Inventory ◽  
Pediatric Emergency ◽  
Personal Accomplishment ◽  
Pediatric Emergency Department ◽  
Care Providers ◽  
Before And After

Background: Burnout is a common phenomenon among health care providers known to adversely affect their mental health and clinical acumen. As mindfulness has been shown to diminish burnout with large-scale interventions, our aim was to assess whether smaller, on-shift activities aimed at increasing mindfulness could decrease burnout among staff in a pediatric emergency department (PED). Methods: Prior to the implementation of a series of mindfulness-based activities, a diverse cohort of PED staff including nurses, physicians, nurse practitioners, technicians, and administrative personnel completed electronic preintervention surveys about their demographics, personal mindfulness engagement, and individual baseline burnout level using the Maslach Burnout Inventory (MBI). Trained nurses and physicians served as champions who coordinated on-shift mindfulness activities, and burnout levels were subsequently reassessed using a postintervention survey. Findings: Among 83 eligible staff, 75 completed the preintervention and 69 completed the postintervention survey. For the MBI, the majority of staff had moderate to high burnout levels at baseline. Few staff engaged in personal mindfulness activities outside of work. Although 82% of staff participated in the on-shift interventions, no significant differences were found in scores before and after the intervention for emotional exhaustion (20.1 vs. 20, p = .93), depersonalization (7.6 vs. 7.3, p = .97), and personal accomplishment (36.1 vs. 34.8, p = .11). Conclusion/Application to Practice: While mindfulness effectively combats burnout, few PED providers regularly practice mindfulness activities. Brief, on-shift mindfulness activities were insufficient to significantly reduce burnout levels. Hospital leadership should consider dedicating resources to more intensive mindfulness activities to combat amplified burnout levels among emergency department staff.

scholarly journals Use of an EHR-Integrated Point-of-Care Mobile Medical Photography Application in a Pediatric Emergency Department

2019 ◽  
Vol 10 (05) ◽  
pp. 888-897 ◽  
Author(s):  
Richmond M. Castillo ◽  
Grace Y. Kim ◽  
Kirk D. Wyatt ◽  
Christine M. Lohse ◽  
Thomas R. Hellmich
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Point Of Care ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Pediatric Emergency ◽  
Common Finding ◽  
Pediatric Emergency Department ◽  
Care Providers ◽  
Medical Photography

Abstract Background Mobile applications allow health care providers to capture point-of-care medical photographs and transfer them to the electronic health record (EHR). It is unclear how providers use these photographs or how they affect clinical care. Objectives We aimed to understand the content, purpose, and outcomes of point-of-care medical photography performed in the pediatric emergency department (ED) at large academic medical center. Methods A retrospective chart review was conducted of patients <21 years of age who were seen in the ED and photographed between March 29, 2015 and July 1, 2017 using a secure smartphone application integrated with the EHR. Inter-rater agreement and reliability between the two reviewers was assessed for the first 50 charts, and any discrepancies in interpretation were resolved before proceeding with the remaining data abstraction. The documented rationale for photography, content of photographs, and outcomes were recorded. Results We identified 619 clinical encounters involving photographs of 605 patients who were eligible for inclusion. Skin was photographed in 499 (81%). The most common finding was rash (N = 177; 29%). Photos were of acceptable quality, with 569 (94%) achieving a score between 4 and 5 out of 5. The primary use of photography was documentation (N = 334; 54%), though teleconsultation was noted in 38 (6%). Nearly one-third (N = 187; 30%) of patients were seen in the ED or outpatient clinic for any reason within 2 weeks, and in 25 (13%), clinical notes explicitly referenced the initial photograph(s). In 53 (9%) cases, patients were photographed at a clinical visit in the subsequent 2 weeks, suggesting that photography was used to track changes over time. Conclusion Documentation of findings using mobile point-of-care photography allows for high-fidelity documentation and facilitates continuity of care.

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