scholarly journals Point-of-care testing in a high-income country paediatric emergency department: a qualitative study in Sweden

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e054234
Author(s):  
Reza Rasti ◽  
Johanna Brännström ◽  
Andreas Mårtensson ◽  
Ingela Zenk ◽  
Jesper Gantelius ◽  
...  
Keyword(s):  
Emergency Department ◽  
Point Of Care ◽  
Healthcare Providers ◽  
High Income ◽  
Paediatric Hospital ◽  
Clinical Patient ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Resource Limited ◽  
Local Setting

ObjectivesIn many resource-limited health systems, point-of-care tests (POCTs) are the only means for clinical patient sample analyses. However, the speed and simplicity of POCTs also makes their use appealing to clinicians in high-income countries (HICs), despite greater laboratory accessibility. Although also part of the clinical routine in HICs, clinician perceptions of the utility of POCTs are relatively unknown in such settings as compared with others. In a Swedish paediatric emergency department (PED) where POCT use is routine, we aimed to characterise healthcare providers’ perspectives on the clinical utility of POCTs and explore their implementation in the local setting; to discuss and compare such perspectives, to those reported in other settings; and finally, to gather requests for ideal novel POCTs.DesignQualitative focus group discussions study. A data-driven content analysis approach was used for analysis.SettingThe PED of a secondary paediatric hospital in Stockholm, Sweden.ParticipantsTwenty-four healthcare providers clinically active at the PED were enrolled in six focus groups.ResultsA range of POCTs was routinely used. The emerging theme Utility of our POCT use is double-edged illustrated the perceived utility of POCTs. While POCT services were considered to have clinical and social value, the local routine for their use was named to distract clinicians from the care for patients. Requests were made for ideal POCTs and their implementation.ConclusionDespite their clinical integration, deficient implementation routines limit the benefits of POCT services to this well-resourced paediatric clinic. As such deficiencies are shared with other settings, it is suggested that some characteristics of POCTs and of their utility are less related to resource level and more to policy deficiency. To address this, we propose the appointment of skilled laboratory personnel as ambassadors to hospital clinics offering POCT services, to ensure higher utility of such services.

scholarly journals Point-of-care testing in a high-income country paediatric emergency department: a qualitative study in Sweden

2021 ◽  
Author(s):  
Reza Rasti ◽  
Johanna Brannstrom ◽  
Andreas Martensson ◽  
Ingela Zenk ◽  
Jesper Gantelius ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Qualitative Study ◽  
Health Care Providers ◽  
Point Of Care ◽  
High Income ◽  
Care Providers ◽  
Clinical Patient ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency

ABSTRACT Objectives In many resource-limited health systems, point-of-care tests (POCTs) are the only means for clinical patient sample analyses. However, the speed and simplicity of POCTs also makes their use appealing to clinicians in high-income countries (HICs), despite their having greater laboratory accessibility. Although also part of the clinical routine in HICs, the utility of POCTs is relatively unknown in such settings as compared to others. In a Swedish paediatric emergency department (PED) where POCT use is routine, we aimed to characterize health care providers perspectives on the clinical utility of POCTs and explore their implementation in the local setting; to compare such experiences to those reported in other settings; and finally, to gather requests for ideal novel POCTs. Design Qualitative study using focus group discussions. A data-driven content analysis approach was used for analysis. Setting The PED of a secondary paediatric hospital in Stockholm, Sweden. Participants Twenty-four health care providers clinically active at the PED were enrolled in six focus groups. Results A range of POCTs was routinely used. The emerging theme "Utility of POCTs is double-edged" illustrated the perceived utility of POCTs. While POCT services were considered to have clinical and social value, the local testing practice was named to distract from the care for patients. Requests were made for novel POCTs and their implementation. Conclusion Despite their clinical integration, deficient implementation routines limit the benefits of POCT services to this well-resourced paediatric clinic. As such deficiencies are shared with other settings, it is suggested that some characteristics of POCTs and of their utility are less related to resource level and more to policy deficiency. To address this, we propose the appointment of skilled laboratory personnel as ambassadors to hospital clinics offering POCT services, to ensure higher utility of such services.

scholarly journals To GP or not to GP: a natural experiment in children triaged to see a GP in a tertiary paediatric emergency department (ED)

2017 ◽  
Vol 27 (7) ◽  
pp. 521-528 ◽  
Author(s):  
Laurie Smith ◽  
Yajur Narang ◽  
Ana Belen Ibarz Pavon ◽  
Karl Edwardson ◽  
Simon Bowers ◽  
...  
Keyword(s):  
Emergency Department ◽  
Natural Experiment ◽  
Care Pathway ◽  
Waiting Times ◽  
Sensitivity Analyses ◽  
Antibiotic Prescribing ◽  
Paediatric Hospital ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
The Impact

ObjectiveTo evaluate the impact of integrating a general practitioner (GP) into a tertiary paediatric emergency department (ED) on admissions, waiting times and antibiotic prescriptions.DesignRetrospective cohort study.SettingAlder Hey Children’s NHS Foundation Trust, a tertiary paediatric hospital in Liverpool, UK.ParticipantsFrom October 2014, a GP was colocated within the ED, from 14:00 to 22:00 hours, 7 days a week. Children triaged green on the Manchester Triage System without any comorbidities were classed as ‘GP appropriate’. The natural experiment compared patients triaged as ‘GP appropriate’ and able to be seen by a GP between 14:00 and 22:00 hours (GP group) to patients triaged as ‘GP appropriate’ seen outside of the hours when a GP was available (ED group). Intention-to-treat (ITT) analysis was used to assess the main outcomes.Results5223 patients were designated as ‘GP appropriate’—18.2% of the total attendances to the ED over the study period. There were 2821 (54%) in the GP group and 2402 (46%) in the ED group. The median duration of stay in the ED was 94 min (IQR 63–141) for the GP group compared with 113 min (IQR 70–167) for the ED group (p<0.0005). Using the ITT analysis equivalent, we demonstrated that the GP group were less likely to: be admitted to hospital (2.2% vs 6.5%, OR 0.32, 95% CI 0.24 to 0.44), wait longer than 4 hours (2.3% vs 5.1%, OR 0.45, 95% CI 0.33 to 0.61) or leave before being seen (3.1% vs 5.7%, OR 0.53, 95% CI 0.41 to 0.70), but more likely to receive antibiotics (26.1% vs 20.5%, OR 1.37, 95% CI 1.10 to 1.56). Sensitivity analyses yielded similar results.ConclusionsIntroducing a GP to a paediatric ED service can significantly reduce waiting times and admissions, but may lead to more antibiotic prescribing. This study demonstrates a novel, potentially more efficient ED care pathway in the current context of rising demand for children’s emergency services.

scholarly journals Parents’ and carers’ impression of “quality” within a Paediatric Emergency Department

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Brendan Lacey ◽  
Adam West ◽  
Simon Craig
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Delphi Study ◽  
Quality Measures ◽  
Quality Measure ◽  
Free Text ◽  
Paediatric Hospital ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency

Abstract Background Quality improvement systems are needed to overcome the ‘Quality Gap’ – difference between evidence-based guidelines and the care delivered. While there are a large array of potential quality assurance measures exists in the Paediatric Emergency Department, parent’s/carer’s perception of these is unknown. This study aimed to identify what ‘quality of care’ means to parents/carers of Paediatric Emergency Department (PED) patients, further determine which aspects of these are most important to them. Also, to identify which of the existing PED quality measures are most important to parents/carers, and their preferred method of providing feedback. Methods A Modified Rand-Delphi study was performed with parents/carers as the expert group and consensus was obtained from them via three web-based surveys. All parents/carers of children attending a tertiary paediatric hospital during six-week in winter were eligible– no exclusions. Quality measures scoring at least 7 on a 9-point Likert scale during the final survey were considered “very important”, while those scoring at least an 8 were considered “extremely important”. Results One hundred four parents/carers responded from a total of 1095 participants. Parents/carers generated 527 free text entries, to the initial survey on what ‘quality of care’ means. These were mapped to 48 quality measure which they ranked on subsequent surveys. Eighteen quality measures were considered very important by at least 90% of respondents. Of these, six were considered extremely important by at least 70% of respondents: ‘Thorough medical assessment’ (84%); ‘A triage system’ (84%); ‘Experienced and knowledgeable staff that are skilled in paediatrics’ (77%); ‘Resources and equipment available to provide care’ (72%); and ‘Clear follow up plans and reviews that are communicated and scheduled’ (72%). Parents/carers considered existing quality measures as important with ‘timely treatment of a critical condition’ as the most important. Most participants preferred to provide anonymous feedback (N = 69, 66%), online (N = 77, 72%) after discharge (N = 82, 70%). Conclusion We have elicited what ‘quality of care’ means to parents/carers, and which aspects are most important to them. Parents/carers consider commonly used PED quality measure as very important. However, they are less important than outcomes generated by themselves. Further parents/carers in this study preferred to provide feedback that was anonymous and electronically distributed after they leave the ED.

Feasibility and usefulness of rapid 2-channel-EEG-monitoring (point-of-care EEG) for acute CNS disorders in the paediatric emergency department: an observational study

2020 ◽  
pp. emermed-2020-209891
Author(s):  
Leopold Simma ◽  
Florian Bauder ◽  
Thomas Schmitt-Mechelke
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Point Of Care ◽  
Convulsive Status Epilepticus ◽  
Monitoring Point ◽  
Cns Disorders ◽  
Targeted Interventions ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Acute Seizures

IntroductionThe aim of this study was to determine the feasibility and clinical utility of point-of-care electroencephalogram (pocEEG) in the paediatric emergency department (ED) for children presenting with acute non-traumatic central nervous system (CNS) disorders.MethodsRetrospective observational study of prospectively collected data in paediatric patients (0–16 years) with acute non-traumatic CNS-disorders presenting between April 2014 and February 2017 to a single paediatric ED in Switzerland.The 2-channel EEG was applied to all patients presenting with acute seizures or impaired consciousness to the ED. For a pocEEG, scalp surface electrodes are applied in five locations, thus allowing registration of fronto-temporal bilateral cortical activity. Neurology consultants assisted with interpretation of readings. EEG findings and clinical characteristics were collected. Feasibility and usefulness were rated via Likert scale.Results36 patients with acute seizures or altered mental status were analysed. Age range was 9 months to 15 years, median age of 34 months. 21 of 36 (58%) patients arrived out of hours. Application of electrodes was rated as ‘easy’ in 28 (77.8%) patients and rated as ‘difficult’ in 8 (22.2%). The utility of the EEG was rated by physicians as ‘very useful/diagnostic’ in 13 cases (36%), ‘useful’ in 21 cases (58%), ‘not useful’ in two cases (8%). None were rated ‘negative.’ConclusionUptake of pocEEG introduction has been very encouraging. Provider ratings were overwhelmingly positive. Recognition of non-convulsive status epilepticus was improved and pocEEG facilitated more targeted interventions.

Prospective observational study of point-of-care ultrasound for diagnosing pneumonia

2018 ◽  
Vol 104 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Claire Lissaman ◽  
Panida Kanjanauptom ◽  
Cyril Ong ◽  
Mark Tessaro ◽  
Elliot Long ◽  
...  
Keyword(s):  
Emergency Department ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Antibiotic Use ◽  
Final Diagnosis ◽  
Point Of Care Ultrasound ◽  
Antibiotic Overuse ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Registration Number

ObjectivesThe clinical diagnosis of pneumonia lacks specificity and may lead to antibiotic overuse, whereas radiological diagnoses can lack sensitivity. Point-of-care lung ultrasound is an emerging diagnostic tool. There are limited prospective data, however, on the accuracy of sonologists in the paediatric emergency department setting. We aimed to test the diagnostic accuracy of lung ultrasound for pneumonia using chest radiograph (CR) as the reference standard.MethodsThis prospective observational cohort study in a paediatric emergency department enrolled children aged 1 month to <18 years, who had a CR ordered for possible pneumonia. Lung ultrasounds were performed by two blinded sonologists with focused training. Sonographic pneumonia was defined as lung consolidation with air bronchograms. Radiograph and ultrasound results both required agreement between two readers, with final results determined by an arbiter in cases of disagreement. Patient management was decided by treating clinicians who were blinded to lung ultrasound results. Follow-up was performed by phone and medical record review to obtain final diagnosis and antibiotic use.ResultsOf 97 included patients, CR was positive for pneumonia in 44/97 (45%) and lung ultrasound was positive in 57/97 (59%). Ultrasound sensitivity was 91% (95% CI 78% to 98%) and specificity was 68% (95% CI 54% to 80%). Ultrasound results displayed greater consistency with CR and patient outcomes when sonographic consolidation exceeded 1 cm. Thirteen of 57 patients with sonographic consolidation improved without antibiotics.ConclusionLung ultrasound may have a role as first-line imaging in patients with possible pneumonia, with higher specificity for consolidations exceeding 1 cm.Trial registration numberACTRN12616000361404, http://www.ANZCTR.org.au/ACTRN12616000361404.aspx

scholarly journals Paediatric emergency department attendances during COVID-19 and SARS in Singapore

2021 ◽  
Vol 50 (2) ◽  
pp. 126-134
Author(s):  
Ronald MR Tan ◽  
Sashikumar Ganapathy ◽  
Arif Tyebally ◽  
Khai Pin Lee ◽  
Shu-Ling Chong ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Absolute Number ◽  
Hospital Inpatient ◽  
Paediatric Hospital ◽  
Paediatric Emergency Department ◽  
Health Measures ◽  
Paediatric Emergency ◽  
Outbreak Period ◽  
The Impact

Introduction: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. Methods: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). Results: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January–July 2019, to 274 per day in January–July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January–July 2019 (19,629) to January–July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January–July 2019 and 21% in January–July 2020. Conclusion: Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally. Keywords: COVID-19, paediatric emergency department, public health measures, SARS

scholarly journals Paediatric emergency department dog bite attendance during the COVID-19 pandemic: an audit at a tertiary children’s hospital

2021 ◽  
Vol 5 (1) ◽  
pp. e001040
Author(s):  
John S P Tulloch ◽  
Simon Minford ◽  
Vicky Pimblett ◽  
Matt Rotheram ◽  
Robert M Christley ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Attendance Rates ◽  
Dog Bite ◽  
Child Exposure ◽  
Paediatric Hospital ◽  
Paediatric Emergency Department ◽  
Dog Bites ◽  
Health Measures ◽  
Paediatric Emergency

BackgroundResponses to the COVID-19 pandemic include strict public health measures, such as national lockdowns. During these measures, paediatric emergency department attendances have declined and the prevalence of presenting complaints has changed. This study sought to identify whether dog bite attendance and victim demographics changed during COVID-19 public health measures.MethodsAn audit was conducted of emergency department attendance data from a UK tertiary paediatric hospital between January 2016 and September 2020. Dog bite attendance and victim demographics were explored using χ2 tests and multivariable Poisson regression. The mean monthly percentage of attendance due to dog bites in 2020 was compared against predicted percentages based on previous years’ data.ResultsDog bite attendance rose in conjunction with the introduction of COVID-19 public health measures and reached a peak in July 2020 (44 dog bites, 1.3% of all attendances were due to dog bites). This was a threefold increase in dog bite attendance. By September 2020, attendance had returned to normal. The demographic profile of child dog bite victims remained the same. Boys had the highest attendance rates in 7–12 year-olds, girls in 4–6 year-olds. Girls showed higher attendance rates in the summer, while boys’ attendance rates were constant throughout the year. COVID-19 public health measures were associated with a 78% increase in attendance for boys and a 66% increase in girls.ConclusionsCOVID-19 national public health measures were associated with an increase in paediatric emergency department dog bite attendance, and may be due to increased child exposure to dogs via ‘stay at home’ orders and school closures. National lockdowns are likely to continue globally throughout the COVID-19 pandemic; this is likely to result in more dog bites. Urgent public health communication and injury prevention strategies are needed to help prevent these avoidable injuries.

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