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Crilly J, Huang Y, Krahe M, Wilhelms D, Ekelund U, Hörlin E, Hayes J, Keijzers G. Research priority setting in emergency care: A scoping review. J Am Coll Emerg Physicians Open 2022; 3:e12852. [PMCID: PMC9742830 DOI: 10.1002/emp2.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/13/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022] Open
Abstract
Objective Priority areas for emergency care research are emerging and becoming ever more important. The objectives of this scoping review were to (1) provide a comprehensive overview of published emergency care priority‐setting studies by collating and comparing priority‐setting methodology and (2) describe the resulting research priorities identified. Methods The Joanna Briggs Institute methodological framework was used. Inclusion criteria were peer‐review articles available in English, published between January 1, 2008 and March 31, 2019 and used 2 or more search terms. Five databases (Scopus, AustHealth, EMBASE, CINAHL, and Ovid MEDLINE) were searched. REporting guideline for PRIority SEtting of health research (REPRISE) criteria were used to assess the quality of evidence of included articles. Results Forty‐five studies were included. Fourteen themes for emergency care research were considered within 3 overarching research domains: emergency populations (pediatrics, geriatrics), emergency care workforce and processes (nursing, shared decision making, general workforce, and process), and emergency care clinical areas (imaging, falls, pain management, trauma care, substance misuse, infectious diseases, mental health, cardiology, general clinical care). Variation in the reporting of research priority areas was evident. Priority areas to drive the global agenda for emergency care research are limited given the country and professional group‐specific context of existing studies. Conclusion This comprehensive summary of generated research priorities across emergency care provides insight into current and future research agendas. With the nature of emergency care being inherently broad, future priorities may warrant population (eg, children, geriatrics) or subspecialty (eg, trauma, toxicology, mental health) focus and be derived using a rigorous framework and patient engagement.
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Affiliation(s)
- Julia Crilly
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia,School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia,Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Ya‐Ling Huang
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia,School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia,Faculty of Health (Nursing)Southern Cross UniversityQueenslandGold CoastAustralia
| | - Michelle Krahe
- Office of the Pro Vice Chancellor (Indigenous)Griffith UniversityMeadowbrookQueenslandAustralia
| | - Daniel Wilhelms
- Department of Emergency MedicineLocal Health Care ServicesCentral ÖstergötlandLinköpingSweden,Department of Biomedical and Clinical SciencesLinköping UniversitySweden
| | - Ulf Ekelund
- Department of Clinical SciencesFaculty of MedicineLund UniversityLundSweden
| | - Erika Hörlin
- Department of Emergency MedicineLocal Health Care ServicesCentral ÖstergötlandLinköpingSweden,Department of Biomedical and Clinical SciencesLinköping UniversitySweden
| | - Jessica Hayes
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia,School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
| | - Gerben Keijzers
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia,Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia,School of MedicineGriffith UniversityGold CoastQueenslandAustralia
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Snelling PJ, Shefrin AE, Moake MM, Bergmann KR, Constantine E, Deanehan JK, Dessie AS, Elkhunovich MA, Gold DL, Kornblith AE, Lin‐Martore M, Nti B, Pade KH, Parri N, Sivitz A, Lam SHF. Establishing the international research priorities for pediatric emergency medicine point-of-care ultrasound: A modified Delphi study. Acad Emerg Med 2022; 29:1338-1346. [PMID: 36043227 PMCID: PMC9826219 DOI: 10.1111/acem.14588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Pediatric Emergency Medicine (PEM) Point-of-care Ultrasound (POCUS) Network (P2Network) was established in 2014 to provide a platform for international collaboration among experts, including multicenter research. The objective of this study was to use expert consensus to identify and prioritize PEM POCUS topics, to inform future collaborative multicenter research. METHODS Online surveys were administered in a two-stage, modified Delphi study. A steering committee of 16 PEM POCUS experts was identified within the P2Network, with representation from the United States, Canada, Italy, and Australia. We solicited the participation of international PEM POCUS experts through professional society mailing lists, research networks, social media, and "word of mouth." After each round, responses were refined by the steering committee before being reissued to participants to determine the ranking of all the research questions based on means and to identify the high-level consensus topics. The final stage was a modified Hanlon process of prioritization round (HPP), which emphasized relevance, impact, and feasibility. RESULTS Fifty-four eligible participants (16.6%) provided 191 items to Survey 1 (Round 1). These were refined and consolidated into 52 research questions by the steering committee. These were issued for rating in Survey 2 (Round 2), which had 45 participants. At the completion of Round 2, all questions were ranked with six research questions reaching high-level consensus. Thirty-one research questions with mean ratings above neutral were selected for the HPP round. Highly ranked topics included clinical applications of POCUS to evaluate and manage children with shock, cardiac arrest, thoracoabdominal trauma, suspected cardiac failure, atraumatic limp, and intussusception. CONCLUSIONS This consensus study has established a research agenda to inform future international multicenter PEM POCUS trials. This study has highlighted the ongoing need for high-quality evidence for PEM POCUS applications to guide clinical practice.
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Affiliation(s)
- Peter J. Snelling
- Department of Emergency MedicineGold Coast University Hospital and Griffith UniversitySouthportQueenslandAustralia
| | - Allan E. Shefrin
- Department of PediatricsChildren's Hospital of Eastern OntarioOttawaOntarioCanada
| | - Matthew M. Moake
- Department of Pediatric Emergency MedicineMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Kelly R. Bergmann
- Department of Pediatric Emergency MedicineChildren's MinnesotaMinneapolisMinnesotaUSA
| | - Erika Constantine
- Division of Pediatric Emergency MedicineHasbro Children's Hospital/Rhode Island Hospital and Brown UniversityProvidenceRhode IslandUSA
| | - J. Kate Deanehan
- Division of Pediatric Emergency MedicineJohns Hopkins Children's Center BaltimoreBaltimoreMarylandUSA
| | - Almaz S. Dessie
- Department of Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Marsha A. Elkhunovich
- Division of Emergency and Transport MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Delia L. Gold
- Division of Emergency MedicineNationwide Children's Hospital and Ohio State UniversityColumbusOhioUSA
| | - Aaron E. Kornblith
- Department of Emergency MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Margaret Lin‐Martore
- Department of PediatricsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Benjamin Nti
- Riley Hospital for Children at Indiana University HealthIndianapolisIndianaUSA
| | - Kathryn H. Pade
- Division of Pediatric Emergency MedicineRady Children's Hospital San Diego and University of California at San DiegoSan DiegoCaliforniaUSA
| | - Niccolò Parri
- Department of Emergency MedicineMeyer University Children's HospitalFlorenceItaly
| | - Adam Sivitz
- Children's Hospital of New JerseyNewark Beth Israel Medical CenterNewarkNew JerseyUSA
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Mahajan P, Chong SL, Kumar V, Batra P, Belle A, Bloom B, Chaou CH, Ekelund U, Galwankar S, Kaartinen J, Krishnan V, Ma Q, Middleton P, Morais A, Ng C, Osei-Kwame D, Roth D. The Emergency Medicine Education and Research by Global Experts (EMERGE) Network: Challenges and Lessons Learned. West J Emerg Med 2022; 23:947-951. [DOI: 10.5811/westjem.2022.7.56398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/02/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: The Emergency Medicine Education and Research by Global Experts (EMERGE) network was formed to generate and translate evidence to improve global emergency care. We share the challenges faced and lessons learned in establishing a global research network.
Methods: We describe the challenges encountered when EMERGE proposed the development of a global emergency department (ED) visit registry. The proposed registry was to be a six-month, retrospective, deidentified, minimal dataset of routinely collected variables, such as patient demographics, diagnosis, and disposition.
Results: Obtaining reliable, accurate, and pertinent data from participating EDs is challenging in a global context. Barriers experienced ranged from variable taxonomies, need for language translation, varying site processes for curation and transfer of deidentified data, navigating institution- and country-specific data protection regulations, and substantial variation in each participating institution’s research infrastructure including training in research-related activities. We have overcome many of these challenges by creating detailed data-sharing agreements with bilateral regulatory oversight agreements between EMERGE and participating EDs, developing relationships with and training health informaticians at each site to ensure secure transfer of deidentified data, and formalizing an electronic transfer process ensuring data privacy.
Conclusion: We believe that networks like EMERGE are integral to providing the necessary platforms for education, training, and research collaborations for emergency care. We identified substantial challenges in data sharing and variation in local sites’ research infrastructure and propose potential approaches to address these challenges.
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Affiliation(s)
- Prashant Mahajan
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Shu-Ling Chong
- KK Women’s and Children’s Hospital, Department of Emergency Medicine, Singapore
| | | | | | | | | | | | | | | | | | | | | | | | | | - Chip Ng
- Chang Gung Memorial Hospital
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Lam SHF, Berant R, Chang TP, Friedman L, Gold DL, Kornblith AE, Lin-Martore M, Pade KH, Skaugset LM, Toney AG, Wang-Flores H. The P2Network-Advancing Pediatric Emergency Care With Point-of-Care Ultrasound. Pediatr Emerg Care 2022; 38:e1014-e1018. [PMID: 34787985 DOI: 10.1097/pec.0000000000002369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Over the last 2 decades, the use of point-of-care ultrasound (POCUS) in pediatric emergency medicine (PEM) has grown exponentially. In 2014, a group of PEM POCUS leaders met and formed the P2Network. The P2Network provides a platform to build collaborative relationships and share expertise among members from various countries and practice settings. It works with educators and researchers within and outside of the field to advance POCUS practice in PEM. As an organization, the P2Network promotes the evidence-based application of POCUS to facilitate and improve care in the PEM setting and addresses issues related to integration of the PEM POCUS practitioner in this nascent field. The P2Network is building and augmenting its infrastructure for PEM POCUS research and education and has already made some progress in the areas, with published manuscripts and ongoing clinical research studies under its sponsorship. Future goals include developing a PEM POCUS research agenda, formalizing teaching and assessment of PEM POCUS skills, and implementing multicenter research studies on potentially high impact applications.
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Affiliation(s)
- Samuel H F Lam
- From the Sutter Medical Center Sacramento, Sacramento, CA
| | | | - Todd P Chang
- Children's Hospital Los Angeles, Los Angeles, CA
| | - Lucas Friedman
- University of California Riverside School of Medicine, Riverside CA
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DesPain AW, Gutman CK, Cruz AT, Aronson PL, Chamberlain JM, Chang TP, Florin TA, Kaplan RL, Nigrovic LE, Pruitt CM, Thompson AD, Gonzalez VM, Mistry RD. Research environment and resources to support pediatric emergency medicine fellow research. AEM EDUCATION AND TRAINING 2021; 5:e10585. [PMID: 34124527 PMCID: PMC8171771 DOI: 10.1002/aet2.10585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is a need for pediatric emergency medicine (PEM) researchers, but the current state of PEM fellow research training is not well described. We sought to (1) describe resources and gaps in PEM fellowship research training and (2) assess agreement between fellow and program director (PD) perceptions of these in fellow research experience. METHODS Surveys were distributed electronically to U.S. PEM fellows and PDs from March to April 2020. Fellows and PDs were queried on program research infrastructure and current gaps in fellow research experience. For programs that had at least one fellow and PD response, each fellow response was compared to their PD's corresponding response (reference standard). For each binary survey item, we determined the percent of responses with agreement between the fellow and PD. RESULTS Of 79 fellowship programs, 70 (89%) were represented with at least one response, including responses from 59 PDs (75%) and 218 fellows (39% of all fellows, representing 80% of programs). Fellows and PDs identified mentorship and faculty engagement as the most important needs for successful fellowship research; for every one fellow there was a median of 0.8 potential faculty mentors in the division. Twenty percent of fellows were not satisfied with mentorship opportunities. There was no association between fellow career research intent (high, defined as ≥20% dedicated time, or low) with current year of training (p = 0.88), program size (p = 0.67), and area of research focus (p = 0.40). Fellows were often unaware of research being performed by division faculty. CONCLUSION PEM fellows were not consistently aware of resources available to support research training. To better support PEM fellows' research training, many programs may need to expand mentorship and increase fellows' awareness of local and external resources and opportunities.
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Affiliation(s)
- Angelica W. DesPain
- Division of Emergency MedicineChildren’s National HospitalThe George Washington University School of MedicineWashingtonDCUSA
| | - Colleen K. Gutman
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Andrea T. Cruz
- Sections of Emergency Medicine & Infectious DiseasesDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA
| | - Paul L. Aronson
- Section of Pediatric Emergency MedicineDepartments of Pediatrics and Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - James M. Chamberlain
- Division of Emergency MedicineChildren’s National HospitalThe George Washington University School of MedicineWashingtonDCUSA
| | - Todd P. Chang
- Division of Emergency Medicine & TransportChildren’s Hospital Los Angeles/University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Todd A. Florin
- Division of Emergency MedicineAnn and Robert H. Lurie Children’s Hospital of ChicagoDepartment of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ron L. Kaplan
- Department of PediatricsDivision of Emergency MedicineUniversity of Washington School of MedicineSeattle Children’s HospitalSeattleWashingtonUSA
| | - Lise E. Nigrovic
- Division of Emergency MedicineBoston Children’s HospitalBostonMassachusettsUSA
| | - Christopher M. Pruitt
- Department of PediatricsMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Amy D. Thompson
- Department of PediatricsDivision of Emergency MedicineSydney Kimmel Medical College of Thomas Jefferson UniversityNemours/Alfred I duPont Hospital for ChildrenWilmingtonDelawareUSA
| | - Victor M. Gonzalez
- Section of Emergency MedicineDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA
| | - Rakesh D. Mistry
- Section of Emergency MedicineChildren's Hospital ColoradoAuroraColoradoUSA
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Morbidity and Mortality in Critically Ill Children. II. A Qualitative Patient-Level Analysis of Pathophysiologies and Potential Therapeutic Solutions. Crit Care Med 2021; 48:799-807. [PMID: 32301845 DOI: 10.1097/ccm.0000000000004332] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe at the individual patient level the pathophysiologic processes contributing to morbidity and mortality in PICUs and therapeutic additions and advances that could potentially prevent or reduce morbidity and mortality. DESIGN Qualitative content analysis of intensivists' conclusions on pathophysiologic processes and needed therapeutic advances formulated by structured medical record review. SETTING Eight children's hospitals affiliated with the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. PATIENTS A randomly selected cohort of critically ill children with a new functional morbidity or mortality at hospital discharge. New morbidity was assessed using the Functional Status Scale and defined as worsening by two or more points in a single domain from preillness baseline. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 292 children, 175 (59.9%) had a new morbidity and 117 (40.1%) died. The most common pathophysiology was impaired substrate delivery (n = 158, 54.1%) manifesting as global or regional hypoxia or ischemia due to low cardiac output or cardiac arrest. Other frequent pathophysiologies were inflammation (n = 104, 35.6%) related to sepsis, respiratory failure, acute respiratory distress syndrome, or multiple organ dysfunction; and direct tissue injury (n = 64, 21.9%) including brain and spinal cord trauma. Chronic conditions were often noted (n = 156, 53.4%) as contributing to adverse outcomes. Drug therapies (n = 149, 51.0%) including chemotherapy, inotropes, vasoactive agents, and sedatives were the most frequently proposed needed therapeutic advances. Other frequently proposed therapies included cell regeneration (n = 115, 39.4%) mainly for treatment of neuronal injury, and improved immune and inflammatory modulation (n = 79, 27.1%). CONCLUSIONS Low cardiac output and cardiac arrest, inflammation-related organ failures, and CNS trauma were the most common pathophysiologies leading to morbidity and mortality in PICUs. A research agenda focused on better understanding and treatment of these conditions may have high potential to directly impact patient outcomes.
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Chua WJ, Alpern ER, Powell EC. Emergency Medical Services for Children: Pediatric Emergency Medicine Research. Pediatr Ann 2021; 50:e155-e159. [PMID: 34039173 DOI: 10.3928/19382359-20210317-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Caring for children who are acutely ill and injured involves coordinated efforts in multiple settings, including primary care, prehospital, the emergency department, and in the hospital. Research is essential to identify new science to improve health outcomes and to deliver resource-efficient emergency care to pediatric populations. This article reviews the current state of research in emergency medical services for children (EMSC). Efforts over the past 20 years have strengthened the emergency medical services infrastructure, as pediatric readiness in emergency medical services continues to be a critical area of focus, because more than 80% of children are cared for outside of pediatric-specific health centers. Research on sepsis, trauma, and respiratory illnesses is part of the core agenda for the Pediatric Emergency Care Research Network and EMSC research. These domains represent a mix of high-frequency illnesses and low-frequency illnesses with potential for high morbidity or mortality, which, if studied, can help optimize care of pediatric patients. [Pediatr Ann. 2021;50(4):e155-e159.].
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Oulasvirta J, Harve-Rytsälä H, Lääperi M, Kuisma M, Salmi H. Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study. Scand J Trauma Resusc Emerg Med 2021; 29:13. [PMID: 33413571 PMCID: PMC7789394 DOI: 10.1186/s13049-020-00816-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 11/24/2020] [Indexed: 12/04/2022] Open
Abstract
Background The challenges encountered in emergency medical services (EMS) contacts with children are likely most pronounced in infants, but little is known about their out-of-hospital care. Our primary aim was to describe the characteristics of EMS contacts with infants. The secondary aims were to examine the symptom-based dispatch system for nonverbal infants, and to observe the association of unfavorable patient outcomes with patient and EMS mission characteristics. Methods In a population-based 5-year retrospective cohort of all 1712 EMS responses for infants (age < 1 year) in Helsinki, Finland (population 643,000, < 1-year old population 6548), we studied 1) the characteristics of EMS missions with infants; 2) mortality within 12 months; 3) pediatric intensive care unit (PICU) admissions; 4) medical state of the infant upon presentation to the emergency department (ED); 5) any medication or respiratory support given at the ED; 6) hospitalization; and 7) surgical procedures during the same hospital visit. Results 1712 infants with a median age of 6.7 months were encountered, comprising 0.4% of all EMS missions. The most common complaints were dyspnea, low-energy falls, and choking. Two infants died on-scene. The EMS transported 683 (39.9%) infants. One (0.1%) infant died during the 12-month follow-up period. Ninety-one infants had abnormal clinical examination upon arrival at the ED. PICU admissions (n = 28) were associated with young age (P < 0.01), a history of prematurity or problems in the neonatal period (P = 0.01), and previous EMS contacts within 72 h (P = 0.04). The adult-derived dispatch codes did not associate with the final diagnoses of the infants. Conclusions Infants form a small but distinct group in pediatric EMS care, with specific characteristics differing from the overall pediatric population. Many EMS contacts with infants were nonurgent or medically unjustified, possibly reflecting an unmet need for other family services. The use of adult-derived symptom codes for dispatching is not optimal for infants. Unfavorable patient outcomes were rare. Risk factors for such outcomes include quickly renewed contacts, young age and health problems in the neonatal period.
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Affiliation(s)
- Jelena Oulasvirta
- Division of Anesthesiology; Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, HUS, P.O. Box 340, FI-00029, Helsinki, Finland. .,Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HUS, P.O.Box 340, FI-00029, Helsinki, Finland.
| | - Heini Harve-Rytsälä
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HUS, P.O.Box 340, FI-00029, Helsinki, Finland
| | - Mitja Lääperi
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HUS, P.O.Box 340, FI-00029, Helsinki, Finland
| | - Markku Kuisma
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HUS, P.O.Box 340, FI-00029, Helsinki, Finland
| | - Heli Salmi
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, HUS, P.O. Box 347, FI-00029, Helsinki, Finland
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Ortiz-Barrios M, Alfaro-Saiz JJ. An integrated approach for designing in-time and economically sustainable emergency care networks: A case study in the public sector. PLoS One 2020; 15:e0234984. [PMID: 32569319 PMCID: PMC7307761 DOI: 10.1371/journal.pone.0234984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/05/2020] [Indexed: 01/01/2023] Open
Abstract
Emergency Care Networks (ECNs) were created as a response to the increased demand for emergency services and the ever-increasing waiting times experienced by patients in emergency rooms. In this sense, ECNs are called to provide a rapid diagnosis and early intervention so that poor patient outcomes, patient dissatisfaction, and cost overruns can be avoided. Nevertheless, ECNs, as nodal systems, are often inefficient due to the lack of coordination between emergency departments (EDs) and the presence of non-value added activities within each ED. This situation is even more complex in the public healthcare sector of low-income countries where emergency care is provided under constraint resources and limited innovation. Notwithstanding the tremendous efforts made by healthcare clusters and government agencies to tackle this problem, most of ECNs do not yet provide nimble and efficient care to patients. Additionally, little progress has been evidenced regarding the creation of methodological approaches that assist policymakers in solving this problem. In an attempt to address these shortcomings, this paper presents a three-phase methodology based on Discrete-event simulation, payment collateral models, and lean six sigma to support the design of in-time and economically sustainable ECNs. The proposed approach is validated in a public ECN consisting of 2 hospitals and 8 POCs (Point of Care). The results of this study evidenced that the average waiting time in an ECN can be substantially diminished by optimizing the cooperation flows between EDs.
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Affiliation(s)
- Miguel Ortiz-Barrios
- Department of Industrial Management, Agroindustry and Operations, Universidad de la Costa CUC, Barranquilla, Colombia
| | - Juan-José Alfaro-Saiz
- Research Centre on Production Management and Engineering, Universitat Politècnica de València, Valencia, Spain
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Balamuth F, Alpern ER, Kan M, Shumyatcher M, Hayes K, Lautenbach E, Himes BE. Gene Expression Profiles in Children With Suspected Sepsis. Ann Emerg Med 2020; 75:744-754. [PMID: 31983492 DOI: 10.1016/j.annemergmed.2019.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/09/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE Sepsis recognition is a clinical challenge in children. We aim to determine whether peripheral blood gene expression profiles are associated with pathogen type and sepsis severity in children with suspected sepsis. METHODS This was a prospective pilot observational study in a tertiary pediatric emergency department with a convenience sample of children enrolled. Participants were older than 56 days and younger than 18 years, had suspected sepsis, and had not received broad-spectrum antibiotics in the previous 4 hours. Primary outcome was source pathogen, defined as confirmed bacterial source from sterile body fluid or confirmed viral source. Secondary outcome was sepsis severity, defined as maximum therapy required for shock reversal in the first 3 hospital days. We drew peripheral blood for ribonucleic acid isolation at the sepsis protocol activation, obtained gene expression measures with the GeneChip Human Gene 2.0 ST Array, and conducted differential expression analysis. RESULTS We collected ribonucleic acid samples from a convenience sample of 122 children with suspected sepsis and 12 healthy controls. We compared the 66 children (54%) with confirmed bacterial or viral infection and found 558 differentially expressed genes, many related to interferon signaling or viral immunity. We did not find statistically significant gene expression differences in patients according to sepsis severity. CONCLUSION The study demonstrates feasibility of evaluating gene expression profiling data in children evaluated for sepsis in the pediatric emergency department setting. Our results suggest that gene expression profiling may facilitate identification of source pathogen in children with suspected sepsis, which could ultimately lead to improved tailoring of sepsis treatment and antimicrobial stewardship.
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Affiliation(s)
- Fran Balamuth
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Elizabeth R Alpern
- Department of Pediatrics, Northwestern School of Medicine, Division of Emergency Medicine, and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Mengyuan Kan
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Maya Shumyatcher
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Katie Hayes
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ebbing Lautenbach
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Blanca E Himes
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
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Woolfall K, O’Hara C, Deja E, Canter R, Khan I, Mouncey P, Carter A, Jones N, Watkins J, Lyttle MD, Tume L, Agbeko R, Tibby SM, Pappachan J, Thorburn K, Rowan KM, Peters MJ, Inwald D. Parents' prioritised outcomes for trials investigating treatments for paediatric severe infection: a qualitative synthesis. Arch Dis Child 2019; 104:1077-1082. [PMID: 31175125 PMCID: PMC6837249 DOI: 10.1136/archdischild-2019-316807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/22/2019] [Accepted: 05/11/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify parents' prioritised outcomes by combining qualitative findings from two trial feasibility studies of interventions for paediatric suspected severe infection. DESIGN Qualitative synthesis combining parent interview data from the Fluids in Shock (FiSh) and Fever feasibility studies. Parents had experience of their child being admitted to a UK emergency department or intensive care unit with a suspected infection. PARTICIPANTS n=: 85 parents. FiSh study: n=41 parents, 37 mothers, 4 fathers, 7 were bereaved. Fever study: n=44 parents, 33 mothers, 11 fathers, 7 were bereaved. RESULTS In addition to survival, parents prioritised short-term outcomes including: organ and physiological functioning (eg, heart rate, breathing rate and temperature); their child looking and/or behaving more like their normal self; and length of time on treatments or mechanical support. Longer term prioritised outcomes included effects of illness on child health and development. We found that parents' prioritisation of outcomes was influenced by their experience of their child's illness, survival and the point at which they are asked about outcomes of importance in the course of their child's illness. CONCLUSIONS Findings provide insight into parent prioritised outcomes to inform the design of future trials investigating treatments for paediatric suspected or proven severe infection as well as core outcome set development work.
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Affiliation(s)
- Kerry Woolfall
- Health Services Research, University of Liverpool, Liverpool, UK
| | - Caitlin O’Hara
- Health Services Research, University of Liverpool, Liverpool, UK
| | - Elizabeth Deja
- Health Services Research, University of Liverpool, Liverpool, UK
| | - Ruth Canter
- Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Imran Khan
- Centre of Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Paul Mouncey
- Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | | | | | | | - Mark David Lyttle
- Emergency Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK,Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Lyvonne Tume
- Emergency Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rachel Agbeko
- Paediatric Intensive Care, Great North Children’s Hospital, Newcastle upon Tyne, UK
| | - Shane M Tibby
- Department of Paediatric Intensive Care, Evelina Childrens Hospital, Guys St Thomas NHS Foundation Trust, London, UK
| | - John Pappachan
- Paediatric Intensive Care, Southampton Children’s Hospital, Southampton, UK
| | - Kent Thorburn
- Paediatric Intensive Care, Royal Liverpool Childrens Hospital Alder Hey, Liverpool, UK
| | - Kathryn M Rowan
- Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Mark John Peters
- Paediatric Intensive Care, Great Ormond St Hospital NHS Trust, London, UK
| | - David Inwald
- Paediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, London, UK
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Nursing Research Priorities in the Pediatric Emergency Care Applied Research Network (PECARN): Reaching Consensus Through the Delphi Method. J Emerg Nurs 2019; 45:614-621. [DOI: 10.1016/j.jen.2019.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 12/19/2022]
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Bressan S, Titomanlio L, Gomez B, Mintegi S, Gervaix A, Parri N, Da Dalt L, Moll HA, Waisman Y, Maconochie IK, Oostenbrink R. Research priorities for European paediatric emergency medicine. Arch Dis Child 2019; 104:869-873. [PMID: 31023707 PMCID: PMC6788884 DOI: 10.1136/archdischild-2019-316918] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Research in European Paediatric Emergency Medicine (REPEM) network is a collaborative group of 69 paediatric emergency medicine (PEM) physicians from 20 countries in Europe, initiated in 2006. To further improve paediatric emergency care in Europe, the aim of this study was to define research priorities for PEM in Europe to guide the development of future research projects. DESIGN AND SETTING We carried out an online survey in a modified three-stage Delphi study. Eligible participants were members of the REPEM network. In stage 1, the REPEM steering committee prepared a list of research topics. In stage 2, REPEM members rated on a 6-point scale research topics and they could add research topics and comment on the list for further refinement. Stage 3 included further prioritisation using the Hanlon Process of Prioritisation (HPP) to give more emphasis to the feasibility of a research topic. RESULTS Based on 52 respondents (response rates per stage varying from 41% to 57%), we identified the conditions 'fever', 'sepsis' and 'respiratory infections', and the processes/interventions 'biomarkers', 'risk stratification' and 'practice variation' as common themes of research interest. The HPP identified highest priority for 4 of the 5 highest prioritised items by the Delphi process, incorporating prevalence and severity of each condition and feasibility of undertaking such research. CONCLUSIONS While the high diversity in emergency department (ED) populations, cultures, healthcare systems and healthcare delivery in European PEM prompts to focus on practice variation of ED conditions, our defined research priority list will help guide further collaborative research efforts within the REPEM network to improve PEM care in Europe.
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Affiliation(s)
- Silvia Bressan
- Department of Pediatrics, University of Padova, Padova, Italy
| | - Luigi Titomanlio
- Pediatric Emergency Department, Hopital Universitaire Robert-Debre, Paris, France,Inserm U1141, Paris, France
| | - Borja Gomez
- Pediatric Emergency Department, Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
| | - Santiago Mintegi
- Pediatric Emergency Department, Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
| | - Alain Gervaix
- Pediatrics, University of Geneva, Geneva, Switzerland
| | - Niccolo Parri
- Emergency Department & Trauma Center, Ospedale Pediatrico Meyer Firenze, Florence, Italy
| | - Liviana Da Dalt
- Department of Pediatrics, University of Padova, Padova, Italy
| | - Henriette A Moll
- General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Yehezkel Waisman
- Pediatric Emergency Department, Schneider Children’s Medical Center, Day Care Unit, Petah Tikva, Israel
| | - Ian K Maconochie
- Paediatric Emergency Department, Imperial College Hospital NHS Healthcare Trust, London, UK
| | - Rianne Oostenbrink
- General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
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14
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Tavender E, Babl FE, Middleton S. Review article: A primer for clinical researchers in the emergency department: Part VIII. Implementation science: An introduction. Emerg Med Australas 2019; 31:332-338. [DOI: 10.1111/1742-6723.13296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Emma Tavender
- Emergency Research, Murdoch Children's Research Institute Melbourne Victoria Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT) Melbourne, Victoria Australia
- Department of PaediatricsThe University of Melbourne Melbourne Victoria Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute Melbourne Victoria Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT) Melbourne, Victoria Australia
- Department of PaediatricsThe University of Melbourne Melbourne Victoria Australia
- Emergency DepartmentThe Royal Children's Hospital Melbourne Victoria Australia
| | - Sandy Middleton
- Nursing Research InstituteSt Vincent's Health Australia and Australian Catholic University Sydney New South Wales Australia
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