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Gutiérrez CE, Lim R, Chu S. Current progress in international pediatric emergency medicine. Curr Opin Pediatr 2024; 36:282-287. [PMID: 38655809 DOI: 10.1097/mop.0000000000001355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Over the past four decades, pediatric emergency Medicine (PEM) has witnessed significant global development, with a notable increase in training programs and official recognition by regulatory bodies. However, disparities persist in the recognition of PEM as an independent subspecialty, availability of training programs on a global scale, academic recognition, and the ability to provide high-quality care to children worldwide. There is paucity of published literature regarding development of PEM globally. This review explores the current trends and challenges in international pediatric emergency medicine. RECENT FINDINGS Current trends in international pediatric emergency medicine encompass the provision of training in pediatric-focused emergency and acute care, increased propagation of evidence-based guidelines specific to the care of children, the growth of collaborative research networks and interest groups within national and international societies. Simultaneously, the field continues to face challenges such as the lack of recognition, inequities in access, and a lack of dissemination of global PEM initiatives. SUMMARY While recent advancements have significantly enhanced the state of international pediatric emergency medicine, including pediatric specific research networks and training programs, barriers still hinder its overall quality. Many of these obstacles are not unique to pediatric emergency medicine but are directly affected by financial disparities and lack of governmental and public recognition of the essential role of pediatric emergency care.
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Affiliation(s)
- Camilo E Gutiérrez
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Rodrick Lim
- Pediatric Emergency Medicine, Department of Paediatrics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Simon Chu
- Emergency Department, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
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Wolfgang M, Labudde EJ, Ruff K, Geis G, Frey M, Boyd S, Harun N, Kerrey BT. Structured Callouts, the Shared Mental Model, and Teamwork: A Video-Based Study in a Pediatric Emergency Department. Pediatr Emerg Care 2024; 40:203-207. [PMID: 37039447 DOI: 10.1097/pec.0000000000002939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVES The shared mental model is essential to high-quality resuscitations. A structured callout (SCO) is often performed to establish the shared mental model, but the literature on SCOs is limited. The objectives of this study are to describe performance of SCOs during pediatric medical emergencies and to determine whether a SCO is associated with better teamwork. METHODS This was a retrospective study in the resuscitation area of an academic pediatric emergency department, where performance of a SCO is a standard expectation. Only medical or nontrauma patients were eligible for inclusion. Data collection was performed by structured video review by 2 observers and verified by a third blinded observer. A SCO was defined as team leader (Pediatric Emergency Medicine fellow or faculty physician) verbalization of at least 1 element of the patient history/examination or an assessment of patient physiology and 1 element of the diagnostic or therapeutic plan. We independently measured teamwork using the Teamwork Emergency Assessment Measure (TEAM) tool. RESULTS We reviewed 60 patient encounters from the pediatric emergency department resuscitation area between April 2018 and June 2020. Median patient age was 6 years; the team leader was a Pediatric Emergency Medicine fellow in 55% of encounters. The physician team leader performed a SCO in 38 (63%) of patient encounters. The TEAM scores were collected for 46 encounters. Mean TEAM score (SD) was 42.3 (1.7) in patients with a SCO compared with 40.0 (3.0) in those without a SCO ( P = 0.007). CONCLUSIONS Performance of a SCO was associated with better teamwork, but the difference was of unclear clinical significance.
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Affiliation(s)
- Matthew Wolfgang
- From the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Emily J Labudde
- Pediatric Residency Program, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kristen Ruff
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Mary Frey
- From the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stephanie Boyd
- From the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nusrat Harun
- From the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Baghdassarian A, Bailey JA, Caglar D, Eckerle M, Fang A, McVety K, Ngo T, Rose JA, Ganis Roskind C, Tavarez MM, Benedict FT, Nagler J, Melissa L. Langhan ML. Virtual Interviews and the Pediatric Emergency Medicine Match Geography: A National Survey. West J Emerg Med 2024; 25:186-190. [PMID: 38596916 PMCID: PMC11000550 DOI: 10.5811/westjem.18581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/10/2024] [Accepted: 02/21/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Virtual interviews (VI) are now a permanent part of pediatric emergency medicine (PEM) recruitment, especially given the cost and equity advantages. Yet inability to visit programs in person can impact decision-making, leading applicants to apply to more programs. Moreover, the cost advantages of VI may encourage applicants to apply to programs farther away than they might otherwise have been willing or able to travel. This could create unnecessary strain on programs. We conducted this study to determine whether PEM fellowship applicants would apply to a larger number of programs and in different geographic patterns with VI (2020 and 2021) as compared to in-person interviews (2018 and 2019). Methods We conducted an anonymous national survey of all PEM fellows comparing two cohorts: current fellows who interviewed inperson (applied in 2018/2019) and fellows who underwent VIs in 2020/2021 (current fellows and those recently matched in 2021). The study took place in March-April 2022. Questions focused on geographic considerations during interviews and the match. We used descriptive statistics, chi-square and t-tests for analysis. Results Overall response rate was 42% (231/550); 32% (n = 74) interviewed in person and 68% (n = 157) virtually. Fellows applied to a median of 4/6 geographic regions (interquartile range 2, 5). Most applied for fellowship both in the same region as residency (216, 93%) and outside (192, 83%). Only the Pacific region saw a statistically significant increase in applicants during VI (59.9% vs 43.2%, P = 0.02). There was no statistical difference in the number of programs applied to during in-person vs VI (mean difference (95% confidence interval 0.72, -2.8 - 4.2). A majority matched in their preferred state both during VI (60.4%) and in-person interviews (65.7%). The difference was not statistically significant (P = 0.45). Conclusion While more PEM fellowship applicants applied outside the geographic area where their residency was and to the Pacific region, there was no overall increase in the number of programs or geographic areas PEM applicants applied to during VI as compared to in-person interview seasons. As this was the first two years of VI, ongoing data collection will further identify trends and the impactof VI.
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Affiliation(s)
- Aline Baghdassarian
- Inova L.J. Murphy Children's Hospital, Department of Pediatrics, Falls Church, Virginia
- University of Virginia, School of Education, Charlottesville, Virginia
| | - Jessica A. Bailey
- Oregon Health & Science University, Department of Pediatrics and Emergency Medicine, Portland, Oregon
| | - Derya Caglar
- University of Washington, Department of Pediatrics, Seattle, Washington
- Seattle Children’s Hospital, Department of Pediatrics, Seattle, Washington
| | - Michelle Eckerle
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio
- Cincinnati Children’s Hospital, Department of Pediatrics, Cincinnati, Ohio
| | - Andrea Fang
- Stanford University School of Medicine, Department of Pediatric Emergency Medicine, Palo Alto, California
| | - Katherine McVety
- Children’s Hospital of Michigan, Department of Pediatrics, Detroit, Michigan
- Central Michigan University, School of Medicine, Department of Pediatrics, Detroit, Michigan
| | - Thuy Ngo
- Johns Hopkins University, School of Medicine, Department of Pediatrics, Baltimore, Maryland
| | - Jerri A. Rose
- Rainbow Babies & Children’s Hospital, Department of Pediatrics, Cleveland, Ohio
- Case Western Reserve University, School of Medicine, Department of Pediatrics, Cleveland, Ohio
| | - Cindy Ganis Roskind
- Columbia University Irving Medical Center, Pediatrics in Emergency Medicine, New York, New York
| | - Melissa M. Tavarez
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, Pennsylvania
| | - Frances Turcotte Benedict
- University of Missouri of Kansas City School of Medicine, Department of Pediatrics, Kansas City, Missouri
- University of Kansas Medical Center, Kansas City, Missouri
| | - Joshua Nagler
- Boston Children’s Hospital, Department of Pediatrics and Emergency Medicine, Boston, Massachusetts
- Harvard Medical School, Department of Pediatrics and Emergency Medicine, Boston, Massachusetts
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Abstract
Approximately 30 million ill and injured children annually visit emergency departments (EDs) in the United States. Data suggest that patients seen in pediatric EDs by board-certified pediatric emergency medicine (PEM) physicians receive higher-quality care than those cared for by non-PEM physicians. These benefits, coupled with the continued growth in PEM since its inception in the early 1990s, have impacted child health broadly. This article is part of a Pediatrics supplement focused on predicting the future pediatric subspecialty workforce supply by drawing on the American Board of Pediatrics workforce data and a microsimulation model of the future pediatric subspecialty workforce. The article discusses the utilization of acute care services in EDs, reviews the current state of the PEM subspecialty workforce, and presents projected numbers of PEM subspecialists at the national, census region, and census division on the basis of this pediatric subspecialty workforce supply model through 2040. Implications of this model on education and training, clinical practice, policy, and future workforce research are discussed. Findings suggest that, if the current growth in the field of PEM continues on the basis of the increasing number and size of fellowship programs, even with a potential reduction in percentage of clinical time and attrition of senior physicians, the PEM workforce is anticipated to increase nationally. However, the maldistribution of PEM physicians is likely to be perpetuated with the highest concentration in New England and Mid-Atlantic regions and "PEM deserts" in less populated areas.
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Affiliation(s)
- Maya S Iyer
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Nationwide Children's Hospital, Columbus, Ohio
| | - Joshua Nagler
- Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts
| | - Richard B Mink
- The Lundquist Institute for Biomedical Innovation at Harbor, University of California Los Angeles Medical Center, Torrance, California
| | - Javier Gonzalez Del Rey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Fraher E, Knapton A, McCartha E, Leslie LK. Forecasting the Future Supply of Pediatric Subspecialists in the United States: 2020-2040. Pediatrics 2024; 153:e2023063678C. [PMID: 38300007 DOI: 10.1542/peds.2023-063678c] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Concerns persist about whether the United States has an adequate supply of pediatric subspecialists and whether they are appropriately distributed across the nation to meet children's health needs. This article describes the data and methods used to develop a workforce projection model that estimates the future supply of 14 pediatric subspecialities certified by the American Board of Pediatrics at the national and US census region and division levels from 2020 to 2040. The 14 subspecialties include adolescent medicine, pediatric cardiology, child abuse pediatrics, pediatric critical care medicine, developmental-behavioral pediatrics, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology-oncology, pediatric infectious diseases, neonatal-perinatal medicine, pediatric nephrology, pediatric pulmonology, and pediatric rheumatology. Hospital medicine was excluded because of the lack of historical data needed for the model. This study addresses the limitations of prior models that grouped adult and pediatric physician subspecialty workforces together and aggregated pediatric subspecialties. The model projects supply at national and subnational levels while accounting for geographic moves that pediatric subspecialists make after training and during their career. Ten "what if" scenarios included in the model simulate the effect of changes in the number of fellows entering training, the rate at which subspecialists leave the workforce, and changes in hours worked in direct and indirect clinical care. All model projections and scenarios are available on a public, interactive Web site. The model's projections can also be examined with other data to provide insight into the possible future of the pediatric subspecialty workforce and offer data to inform decision-making.
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Affiliation(s)
- Erin Fraher
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina
| | - Andy Knapton
- Strategic Modelling and Analysis Ltd., Winchester United Kingdom
| | - Emily McCartha
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina
| | - Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, North Carolina
- Tufts University School of Medicine, Boston, Massachusetts
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Aluisio YM, Sanchez AC, Norris KR, Waller J, Campbell CT. Impact of a Pediatric Emergency Medicine Pharmacist, Institutional Guideline, and Electronic Order Set on Empiric Antimicrobial Use for Febrile Neutropenia. Pediatr Emerg Care 2024; 40:151-155. [PMID: 37440312 DOI: 10.1097/pec.0000000000003009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVES This study evaluated the difference in appropriateness of antimicrobial selection in pediatric patients with febrile neutropenia (FN) after implementation of an institutional guideline, a dedicated pediatric emergency medicine (EM) pharmacist, and an electronic order set. METHODS This was a retrospective cohort study that included febrile patients aged younger than 18 years who were at risk of neutropenia, as defined by our institutional algorithm. Charts were evaluated for inclusion by searching for patients who presented to the emergency department (ED) between February 2018 and January 2022 who had International Classification of Diseases, Tenth Revision (ICD-10) codes for patients at risk of FN. Three independent groups were compared before, during, and after interventions. A historical control group (group 1), postdedicated EM pharmacist and institutional guideline cohort (group 2), and postdedicated EM pharmacist, institutional guideline, and electronic order set cohort (group 3) were compared. Secondary outcomes included time from registration in the ED to administration of the first dose of empiric antimicrobials, days to defervescence, pediatric intensive care unit length of stay, and hospital length of stay. RESULTS Seventy-eight charts were reviewed for inclusion. Among those included (n = 38), there was an increase in appropriate use of antimicrobials from 71% to 92% to 100% ( P = 0.1534) between group 1, group 2, and group 3, respectively. In addition, the interventions in this study lead to an overall decrease in the median time from registration to first dose of antibiotics from 142 minutes to 72 minutes ( P = 0.1370). CONCLUSIONS This study demonstrated the positive impact a pediatric EM pharmacist along with an institutional guideline and an electronic order set have on appropriate antimicrobial selection in pediatric FN patients. Institutions should consider multipronged approaches to improve the selection and time to administration of appropriate empiric antimicrobials in the ED.
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Affiliation(s)
- Yancey M Aluisio
- From the Department of Pharmaceutical Services, Emory University Hospital Midtown/Winship Cancer Institute, Atlanta, GA
| | - Alicia C Sanchez
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA
| | - Kelley R Norris
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA
| | - Jennifer Waller
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Augusta University, Augusta, GA
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Ruscica A, Dessie A, Jamal N, Roskind C. Use of a Rubric for Pediatric Emergency Medicine Fellowship Application Review. Pediatr Emerg Care 2024; 40:128-130. [PMID: 36944021 DOI: 10.1097/pec.0000000000002929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND There is a need to review a large number of applications for pediatric emergency medicine fellowship in a holistic and systemic, unbiased manner. There exists a need to restructure the application process. We sought to develop and implement a rubric screening rubric for initial evaluation of pediatric emergency medicine fellowship applications that avoided traditionally used metrics that may be biased against racially underrepresented groups who are historically excluded from medicine. METHODS An interactive process was used by key program leadership with review of prior literature and input from Diversity, Equity, and Inclusivity departmental chair to develop a holistic screening rubric with consensus reached around key factors that aligned with our fellowship program mission. All applications were reviewed with the rubric by the program director or the associate program director. A subset of applications being considered for review were additionally scored by members of the fellowship selection committee. RESULTS Numerical scores ranged from 2 to 14, with the maximum potential score being 14. Seventy percent of those applicants invited for interview scored 9 or higher. Reliability of scores between the program director and the associate program director was high (intraclass coefficient, 0.89); however, reliability between the program director or associate program director and the selection committee members was low to moderate (intraclass coefficient, 0.46). CONCLUSIONS Developmental and use of a rubric screening allowed our institution to reflect on our priorities, as well as avoid potential bias. The use of the tool allowed us to communicate about applications in an objective and consistent manner. As we continue to iterate on the rubric, we hope to incorporate additional criteria to better identify highly qualified applicants who may otherwise be overlooked in a traditional screening process and gain familiarity in reviewers use.
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Affiliation(s)
- Alice Ruscica
- From the Columbia University Medical Center Irving Medical Center, New York, NY
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Walsh H, Dliso S, Messahel S. Addressing the language barriers to inclusion in paediatric emergency medicine research. Arch Dis Child Educ Pract Ed 2024; 109:55-58. [PMID: 37963714 DOI: 10.1136/archdischild-2023-325822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Hannah Walsh
- Department of Paediatric Emergency Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Silothabo Dliso
- Department of Paediatric Research, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Shrouk Messahel
- Department of Paediatric Emergency Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Skotnicki BS, Wilson PM, Kazmerski TM, Prideaux J, Manole MD, Kinnane JM, Lunoe MM. Work-Life Integration for Women in Pediatric Emergency Medicine: Themes Identified Through Group Level Assessment. Pediatr Emerg Care 2024; 40:71-75. [PMID: 38157398 DOI: 10.1097/pec.0000000000003106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Women in medicine generally have higher burnout and lower career satisfaction and work-life integration compared with men. This study identifies factors that contribute to burnout, career satisfaction, and work-life integration in women pediatric emergency medicine (PEM) physicians. METHODS Self-identified women PEM physicians in the United States participated in a virtual focus group using Group Level Assessment methodology. Participants completed Group Level Assessment process steps of climate setting, generating, appreciating, reflecting, understanding, selecting, and action to (1) identify themes that contribute to burnout, career satisfaction, and work-life integration and (2) determine actionable factors based on these themes. Data were collected and thematically analyzed in real time through iterative processing. The group prioritized identified themes through rounds of distillation. RESULTS Seventeen women participated, representing 10 institutions (ages 30s-70s, 69% employed full-time). Participants identified 3 main themes contributing to burnout, career satisfaction, and work-life integration: (1) gender inequities, (2) supportive leadership, and (3) balance with family life. Actionable items identified were as follows: (1) development of initiatives to equalize pay, opportunity, and career advancement among genders; (2) implementation of an institutional focus on supportive and collaborative leadership; and (3) improvement of resources and supports for physicians with family responsibilities. CONCLUSIONS Women PEM physicians identified gender inequities, leadership, and balance with family life as major themes affecting their burnout, career satisfaction, and work-life integration. Several action steps were identified and can be used by individuals and institutions to improve work-life integration for women PEM physicians.
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Affiliation(s)
- Brielle Stanton Skotnicki
- From the Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Paria M Wilson
- Department of Pediatrics, University of Cincinnati College of Medicine; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Traci M Kazmerski
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Mioara D Manole
- From the Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Janet M Kinnane
- From the Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Maren M Lunoe
- From the Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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Berkowitz D, Cohen JS, McCollum N, Rojas CR, Chamberlain JM. Delays in treatment and disposition attributable to undertriage of pediatric emergency medicine patients. Am J Emerg Med 2023; 74:130-134. [PMID: 37826993 DOI: 10.1016/j.ajem.2023.09.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/20/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Triage, the initial assessment and sorting of patients in the Emergency Department (ED), determines priority of evaluation and treatment. Little is known about the impact of undertriage, the underestimation of disease severity at triage, on clinical care in pediatric ED patients. We evaluate the impact of undertriage on time to disposition and treatment decisions in pediatric ED patients. METHODS This was a case control study of ED visits for patients <22 years of age, with an assigned Emergency Severity Index (ESI) score of 4 or 5, and associated hospital admission, nebulized treatment, supplemental oxygen, and/or intravenous (IV) line placement, between January 1, 2018, to June 30, 2022. Controls were sampled from a pool of patient visits with an ESI score of 3, matched by intervention, disposition, and date and hour of arrival. Primary outcome measures were time to order of intervention (nebulized treatment, oxygen administration, or IV placement) and time to disposition decision. A secondary outcome measure was return visits requiring admission or emergency intervention within 14 days of the index visit. Continuous variables (time to orders) were analyzed using Wilcoxon rank sum test and dichotomous outcomes (return visits) were compared using odds ratios with 95% confidence intervals. Analysis was performed with Python v3.10. RESULTS The final analysis included 7245 undertriaged patients. Undertriaged patients had longer times to orders for nebulized treatments, (p < 0.001) IV placement, (p < 0.001) and admission (p < 0.001) when compared to controls. There were no significant differences in time to supplemental oxygen delivery and time to discharge compared to controls. Undertriaged patients were more likely to experience a return visit requiring admission or emergency intervention (OR 3.74, 95% CI 3.32,4.22). CONCLUSIONS Undertriage in the pediatric ED is associated with delays in care and disposition decisions and increases likelihood of return visits.
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Affiliation(s)
- Deena Berkowitz
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, United States of America; The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America.
| | - Joanna S Cohen
- Division of Pediatric Emergency Medicine, Johns Hopkins University, United States of America; Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Nichole McCollum
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, United States of America; The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Christina R Rojas
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, United States of America; The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - James M Chamberlain
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, United States of America; The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
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Reichard KG, Levine DA, Reed J, Barrick-Groskopf L, Bechtel K, Cooper G, Hall JE, White ML, Langhan ML. Spotlighting the imbalance: Gender disparities among speakers and awardees at pediatric emergency medicine conferences. Acad Emerg Med 2023; 30:1138-1143. [PMID: 37550843 DOI: 10.1111/acem.14786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND There are wide variations in the gender makeup of speakers at national pediatric emergency medicine (PEM) conferences with no significant change in recent years. OBJECTIVE Gender disparities exist among national speakers and award recipients. PEM represents the intersection of pediatrics, a female-dominated specialty with approximately 58% women, and emergency medicine, a male-dominated specialty. We describe the proportion of women speakers and award recipients at two national PEM conferences, the American Academy of Pediatrics (AAP) Section on Emergency Medicine (SOEM) and the Advanced PEM Assembly (APEMA), to the AAP National Conference & Exhibition (NCE), a national pediatric conference. METHODS Data from SOEM and APEMA, obtained from 2016 to 2021 were compared to the 2021 NCE. Invited speakers, abstract presenters, and award recipients were identified. Gender was determined by searching each individual's name for self-identification. Gender proportions were compared across conferences, speaker type, and year. RESULTS Compared to the NCE, a significantly smaller proportion of women were invited speakers at APEMA (NCE 59.9% vs. APEMA 38.8%, p < 0.001), but similar proportions of women were invited speakers (53.9%, p = 0.178) and awardees at SOEM (50% vs. 50%, p = 1.0). A larger number of women were SOEM abstract presenters than invited speakers (63.3% vs. 53.9%, p = 0.041). Between 2016 and 2021, the proportion of women invited speakers (SOEM, p = 0.744; APEMA, p = 0.947) or abstract presenters (SOEM, p = 0.632) did not significantly change. CONCLUSIONS Compared to NCE, women are underrepresented as speakers at APEMA, but not at SOEM. Abstract presenters are more likely to be women compared to invited speakers. While awards appear equally distributed, recipients do not mirror the proportion of women in PEM. Conference organizers and leaders in PEM should ensure gender equity in national recognition.
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Affiliation(s)
- Kathleen G Reichard
- Department of Emergency Medicine, Montefiore Nyack Hospital, Nyack, New York, USA
| | - Deborah A Levine
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Jennifer Reed
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Lindsey Barrick-Groskopf
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kirsten Bechtel
- Departments of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gena Cooper
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jeannine E Hall
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Marjorie L White
- Department of Pediatrics, Division of Emergency Medicine, Heersink School of Medicine/University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa L Langhan
- Departments of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Labudde EJ, Gillespie S, Wood A, Middlebrooks L, Gooding HC, Morris CR, Camacho-Gonzalez A. HIV in youth prevention in the emergency department initiative: A survey of pediatric emergency medicine providers. Am J Emerg Med 2023; 72:164-169. [PMID: 37536088 DOI: 10.1016/j.ajem.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/28/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The incidence of HIV among adolescents remains high, and adolescents are known to participate in sexual behaviors that increase their risk for HIV, such as unprotected sex and sex with multiple partners. HIV pre-exposure prophylaxis (PrEP) has been shown to be effective at preventing HIV when taken daily and is approved by the FDA for use in adolescents. Efforts to screen patients in adult emergency departments and connect them with PrEP services have been validated. We surveyed pediatric emergency medicine (PEM) providers to determine their knowledge of PrEP, prescribing practices, willingness to prescribe, and barriers to a screening protocol in the pediatric emergency department (PED). METHODS We administered a survey to a multidisciplinary group of PEM providers to measure knowledge, use, willingness, and implementation barriers to PrEP as well as elements needed for a successful referral system. RESULTS A total of 87 responses were included for analysis. While 79.1% of all providers had heard of PrEP, only 14.8% of prescribing providers had ever discussed PrEP with a patient, and none had ever prescribed PrEP. Overall, 76.3% of all providers were knowledgeable about PrEP based on answers to true/false questions, with prescribing providers significantly more likely to be knowledgeable compared to nurses (p = 0.005). Knowledgeable providers had higher willingness scores to refer for PrEP compared to providers who were not knowledgeable. Ninety-two percent of providers felt a PrEP referral process from the PED would be feasible. Creation of an eligibility algorithm and educational materials were the most common efforts providers preferred to make them more likely to refer for PrEP. The most notable barriers perceived by providers included patient noncompliance with therapy (20.9%), acceptance of PrEP discussion among patients and parents (19.8%), and cost of therapy (15.1%). CONCLUSION PEM providers are knowledgeable about PrEP but have little experience with discussing or prescribing PrEP. Their willingness to refer for PrEP and anticipated feasibility of a PrEP referral system is encouraging. These results support the need for future educational efforts among PEM providers and creation of referral systems for PrEP services from the PED.
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Affiliation(s)
- Emily J Labudde
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America.
| | - Scott Gillespie
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America
| | - Anna Wood
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America
| | - Lauren Middlebrooks
- Department of Pediatrics, Division of Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Holly C Gooding
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Claudia R Morris
- Department of Pediatrics, Division of Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Division of Infectious Disease, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
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13
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Coveney J, Khan U, Beattie T. Is high-concentration Nitrous oxide the safest option for short periods of procedural sedation in Paediatric Emergency Medicine. Ir Med J 2023; 116:844. [PMID: 37791896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
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14
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Pol A, Biagioli V, Adriani L, Fadda G, Gawronski O, Cirulli L, Stelitano R, Federici T, Tiozzo E, Dall'Oglio I. Non-urgent presentations to the paediatric emergency department: a literature review. Emerg Nurse 2023; 31:35-41. [PMID: 36727259 DOI: 10.7748/en.2023.e2154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 02/03/2023]
Abstract
It is estimated that between 58% and 82% of children and young people who present to paediatric emergency department (PEDs) have a non-urgent condition. This systematic review of the literature explores why parents of children with non-urgent conditions present to the PED rather than to community healthcare services. Five databases were searched for studies on children and young people's presentations to the PED for the treatment of a non-urgent condition, as identified by a low priority triage code. This article describes and discusses the findings of the 18 included studies.
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Affiliation(s)
- Alessandra Pol
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Valentina Biagioli
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
| | - Luca Adriani
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Giulia Fadda
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
| | - Orsola Gawronski
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
| | - Luisa Cirulli
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Rocco Stelitano
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Tatiana Federici
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Emanuela Tiozzo
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
| | - Immacolata Dall'Oglio
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
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15
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Park JM, McDonald E, Buren Y, McInnes G, Doan Q. Assessing the reliability of pediatric emergency medicine billing code assignment for future consideration as a proxy workload measure. PLoS One 2023; 18:e0290679. [PMID: 37624824 PMCID: PMC10456198 DOI: 10.1371/journal.pone.0290679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVES Prediction of pediatric emergency department (PED) workload can allow for optimized allocation of resources to improve patient care and reduce physician burnout. A measure of PED workload is thus required, but to date no variable has been consistently used or could be validated against for this purpose. Billing codes, a variable assigned by physicians to reflect the complexity of medical decision making, have the potential to be a proxy measure of PED workload but must be assessed for reliability. In this study, we investigated how reliably billing codes are assigned by PED physicians, and factors that affect the inter-rater reliability of billing code assignment. METHODS A retrospective cross-sectional study was completed to determine the reliability of billing code assigned by physicians (n = 150) at a quaternary-level PED between January 2018 and December 2018. Clinical visit information was extracted from health records and presented to a billing auditor, who independently assigned a billing code-considered as the criterion standard. Inter-rater reliability was calculated to assess agreement between the physician-assigned versus billing auditor-assigned billing codes. Unadjusted and adjusted logistic regression models were used to assess the association between covariables of interest and inter-rater reliability. RESULTS Overall, we found substantial inter-rater reliability (AC2 0.72 [95% CI 0.64-0.8]) between the billing codes assigned by physicians compared to those assigned by the billing auditor. Adjusted logistic regression models controlling for Pediatric Canadian Triage and Acuity scores, disposition, and time of day suggest that clinical trainee involvement is significantly associated with increased inter-rater reliability. CONCLUSIONS Our work identified that there is substantial agreement between PED physician and a billing auditor assigned billing codes, and thus are reliably assigned by PED physicians. This is a crucial step in validating billing codes as a potential proxy measure of pediatric emergency physician workload.
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Affiliation(s)
- Justin M. Park
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada
| | - Erica McDonald
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada
| | - Yijinmide Buren
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada
| | - Gord McInnes
- Department of Emergency Medicine, University of British Columbia, Kelowna, Canada
| | - Quynh Doan
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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16
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Velasco R, Alonso-Cadenas JA, de la Torre M, Martínez-Mejias A, Mintegi S, Yañez S, Gomez B. Setting priorities for an agenda within the Spanish pediatric emergency medicine research network. Eur J Pediatr 2023; 182:3549-3558. [PMID: 37211549 DOI: 10.1007/s00431-023-04957-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 05/23/2023]
Abstract
The research network of the Spanish Pediatric Emergency Society (RISeuP-SPERG Network) needs to establish its research agenda relevant to pediatric emergency medicine (PEM) to guide the development of future projects, as other networks have done before. The aim of our study was to identify priority areas in PEM for a collaborative network of pediatric emergency research in Spain. A multicenter study was developed including pediatric emergency physicians from 54 Spanish emergency departments, endorsed by the RISeuP-SPERG Network. Initially, a group of seven PEM experts was selected among the members of the RISeuP-SPERG. In the first phase, these experts elaborated a list of research topics. Then, using a Delphi method, we sent a questionnaire with that list to all RISeuP-SPERG members, to rank each item using a 7-point Likert scale. Finally, the seven PEM experts, using a modified Hanlon Process of Prioritization, weighted prevalence (A), seriousness of the condition (B), and feasibility of conducting research projects (C) on that condition to prioritize the selected items. Once the list of topics was chosen, the seven experts selected a list of research questions for each of the selected items. The Delphi questionnaire was answered by 74/122 (60.7%) members of RISeuP-SPERG. We established a list of 38 research priorities related to quality improvement (11), infectious diseases (8), psychiatric/social emergencies (5), sedoanalgesia (3), critical care (2), respiratory emergencies (2), trauma (2), neurologic emergencies (1), and miscellanea (4). Conclusion: The RISeuP-SPERG prioritization process identified high-priority PEM topics specific to multicenter research that may help guide further collaborative research efforts within the RISeuP-SPERG network to improve PEM care in Spain. What is Known: • Some pediatric emergency medicine networks have established their priorities for research. What is New: • After a structured process, we have set the research agenda for pediatric emergency medicine in Spain. By identifying high-priority pediatric emergency medicine research topics specific to multicenter research, we may guide further collaborative research efforts within our network.
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Affiliation(s)
- Roberto Velasco
- Pediatric Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
- , Valladolid, Spain.
| | | | - Mercedes de la Torre
- Pediatric Emergency Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | | | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Sandra Yañez
- Pediatric Emergency Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Borja Gomez
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
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17
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Levine MC, Lin T, Baird J, Constantine E. The Gender Landscape of Academic Pediatric Emergency Medicine: An Observational Study of Leadership Positions as Described by Fellowship Programs' Online Presence. Pediatr Emerg Care 2023; 39:418-422. [PMID: 37159344 DOI: 10.1097/pec.0000000000002962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Although many areas of medicine are male dominated, pediatric emergency medicine (PEM) is a female-dominated subspecialty. Despite this, executive leadership within PEM remains male dominated. The aim of this study was to describe the gender landscape of the key positions within academic PEM fellowship programs within the United States, as described by PEM fellowships' online presence. METHODS Using the 2021-2022 Electronic Residency Application Service American Association of Medical Colleges Pediatric Fellowships ( services.aamc.org/eras/erasstats/par/ ) application service, we were able to identify published information from 84 academic PEM fellowship programs in the United States. Each program's Web site was evaluated to determine which individuals held the position of chief or chair, medical director, and fellowship director. These individuals' genders were then cross-referenced with the National Provider Inventory database. RESULTS There were 154 executive leadership roles (division chief or medical director) in total. The executive leadership role was significantly different by gender ( z score: 2.54, P < 0.01), with greater male representation (n = 61; 62.9%) among identified executive leadership roles (n = 97). There were significantly more men for the medical director role ( z score: 2.06, P < 0.05). Female representation was greater than male in the fellowship program director role (n = 53; 67.9%) among listed roles ( z score: -3.17, P < 0.001). This gender landscape among key leadership positions was not influenced by the geographic location of the PEM fellowship program. CONCLUSIONS Although PEM is a female-dominated specialty, executive leadership positions continue to be male dominated. To promote improved gender representation within leadership positions in PEM, PEM fellowship programs must provide consistent and easily accessible executive leadership descriptions within their online storefront.
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Affiliation(s)
- Marla C Levine
- From the Division of Emergency Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Timmy Lin
- Department of Emergency Medicine, Warren Alpert School of Medicine at Brown University and Injury Prevention Center, Providence, RI
| | - Janette Baird
- Department of Emergency Medicine, Warren Alpert School of Medicine at Brown University and Injury Prevention Center, Providence, RI
| | - Erika Constantine
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
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18
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Nickerson J, McCollum N, Abdulrahman E, Marko K, Soghier L, Rucker A, Madati J, Zhao X. Asynchronous Learning Module for Pediatric Emergency Medicine Physicians on How to Manage Vaginal Birth and Neonatal Resuscitation in the Emergency Department. Pediatr Emerg Care 2023; 39:397-401. [PMID: 37163676 DOI: 10.1097/pec.0000000000002959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Newborn deliveries and neonatal resuscitation events are rare but essential skills for pediatric emergency medicine (PEM) physicians. We sought to evaluate the effect of an online module on PEM physicians' knowledge and confidence in managing newborn deliveries and neonatal resuscitation. METHODS A team of experts in PEM, obstetrics, neonatology, and medical education developed a self-directed, 1-hour online module on managing newborn deliveries with neonatal resuscitation. The module was designed to address the learning needs of the targeted group. The module was piloted before dissemination to PEM faculty. A 10-question multiple choice test was given to assess knowledge of the material covered. A 10-point Likert scale questions survey was used to evaluate confidence. Measures were administered before initiation, after module completion, and 6 months after completion. Paired t tests were used to compare mean knowledge scores, and rank sum tests were used to compare median confidence levels. RESULTS Most (n = 47, 89%) of the PEM faculty members completed the module. The majority (n = 43, 91%) thought the information was relevant to their practice. After completing the module, physicians' overall knowledge scores improved by 18% (mean [SD]: 74% [14.7] vs 92% [8.0], P < 0.01). Self-assessed confidence improved after the module in terms of managing uncomplicated vaginal deliveries (median 5 vs 7, P < 0.01), care of patients with complicated vaginal deliveries (2 vs 5, P < 0.01), and managing neonatal resuscitation (7 vs 8, P < 0.01). During the 6-month follow-up, there was sustained improvement in physicians' overall knowledge score (82% [16.9], P = 0.007) and self-assessed confidence in managing complicated vaginal deliveries (median 2 vs 4, P = 0.0012); however, other measures were not statistically significant. CONCLUSIONS An online module is an appropriate method for training PEM providers about rarely used but essential skills such as managing vaginal deliveries and neonatal resuscitation.
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Affiliation(s)
| | | | | | - Kathryn Marko
- Obstetrics and Gynecology, The George Washington School of Medicine and Health Sciences
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19
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Kharasch SJ, Cohen SG. Pediatric Emergency Medicine Ultrasound Fellowship Programs. Pediatr Emerg Care 2023; 39:454-456. [PMID: 37256284 DOI: 10.1097/pec.0000000000002956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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20
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Wells JM, Walker VP. "Do No Harm": Promoting Anti-Racist Policing in Pediatric Emergency Departments Through 20 Practice Change Considerations. Health Promot Pract 2023; 24:406-410. [PMID: 36648067 DOI: 10.1177/15248399221145160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Children represent some of the most vulnerable and most valuable members of society. When acutely ill or injured, pediatric emergency departments (EDs) provide first line, specialized care for children and adolescents. Unique and unpredictable, the pediatric ED environment requires a wide range of health care professionals to care for children and their families and often includes hospital-employed security professionals and local law enforcement personnel to ensure safe and protective spaces paramount for optimal patient care. However, an active policing presence within environments designed to promote healing can paradoxically contribute to harm, particularly for Black and Brown patients. As health care systems pledge to dismantle structural racism and achieve health equity, efforts must include anti-racist reforms of threat management systems within clinical environments. We propose assessment and evaluation of current security and police encounters within pediatric EDs. We call for institution of policies that mitigate biases, address medical mistrust, distinguish clinical from criminal aggression, and minimize punitive contact with police. We outline a multitiered, patient-centered approach to disruptive and violent acts that prioritizes prevention, early intervention, and de-escalation strategies with a goal of reducing the perceived need for policing presence in pediatric EDs.
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Affiliation(s)
- Jordee M Wells
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Valencia P Walker
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
- University of California, Los Angeles, Los Angeles, CA, USA
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21
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Henretig FM, Wood JN, Shea JA, Schapira MM, Ruddy RM. Pediatric Emergency Medicine Physicians' Perceptions of Colleagues' Clinical Performance Over Career Span. Pediatr Emerg Care 2023; 39:304-310. [PMID: 35766881 DOI: 10.1097/pec.0000000000002785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The US physician workforce is aging, prompting concerns regarding clinical performance of senior physicians. Pediatric emergency medicine (PEM) is a high-acuity, multitasking, diagnostically complex and procedurally demanding specialty. Aging's impact on clinical performance in PEM has not been examined. We aimed to assess PEM physician's' perceptions of peers' clinical performance over career span. METHODS We surveyed 478 PEM physician members of the American Academy of Pediatrics' Section on Emergency Medicine survey study list-serve in 2020. The survey was designed by the investigators with iterative input from colleagues. Respondents rated, using a 5-point Likert scale, the average performance of 4 age categories of PEM physicians in 9 clinical competencies. Additional items included concerns about colleague's performance and preferences for age of physician managing a critically ill child family member. RESULTS We received 232 surveys with responses to core initial items (adjusted response rate, 49%). Most respondents were 36 to 49 (34.9%) or 50 to 64 (47.0%) years old. Fifty-three percent reported ever having concern about a colleague's performance. For critical care-related competencies, fewer respondents rated the ≥65-year age group as very good or excellent compared with midcareer physicians (36-49 or 50-64 years old). The ratings for difficult communications with families were better for those 65 years or older than those 35 years or younger. Among 129 of 224 respondents (58%) indicating a preferred age category for a colleague managing a critically ill child relative, most (69%) preferred a 36 to 49-year-old colleague. CONCLUSIONS Pediatric emergency medicine physicians' perceptions of peers' clinical performance demonstrated differences by peer age group. Physicians 65 years or older were perceived to perform less well than those 36 to 64 years old in procedural and multitasking skills. However, senior physicians were perceived as performing as well if not better than younger peers in communication skills. Further study of age-related PEM clinical performance with objective measures is warranted.
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Affiliation(s)
| | - Joanne N Wood
- General Pediatrics, Children's Hospital of Philadelphia, Departments of Pediatrics
| | | | - Marilyn M Schapira
- Division of General Internal Medicine, Veteran's Administration Medical Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Richard M Ruddy
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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22
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Rees CA, Brousseau DC, Ahmad FA, Bennett J, Bhatt S, Bogie A, Brown KM, Casper TC, Chapman LL, Chumpitazi CE, Cohen DM, Dampier C, Ellison AM, Grasemann H, Hatabah D, Hickey RW, Hsu LL, Bakshi N, Leibovich S, Patil P, Powell EC, Richards R, Sarnaik S, Weiner DL, Morris CR. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Am J Hematol 2023; 98:620-627. [PMID: 36606705 PMCID: PMC10023395 DOI: 10.1002/ajh.26837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/23/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
Children with sickle cell disease (SCD) commonly experience vaso-occlusive pain episodes (VOE) due to sickling of erythrocytes, which often requires care in the emergency department. Our objective was to assess the use and impact of intranasal fentanyl for the treatment of children with SCD-VOE on discharge from the emergency department in a multicenter study. We conducted a cross-sectional study at 20 academic pediatric emergency departments in the United States and Canada. We used logistic regression to test bivariable and multivariable associations between the outcome of discharge from the emergency department and candidate variables theoretically associated with discharge. The study included 400 patients; 215 (54%) were female. The median age was 14.6 (interquartile range 9.8, 17.6) years. Nineteen percent (n = 75) received intranasal fentanyl in the emergency department. Children who received intranasal fentanyl had nearly nine-fold greater adjusted odds of discharge from the emergency department compared to those who did not (adjusted odds ratio 8.99, 95% CI 2.81-30.56, p < .001). The rapid onset of action and ease of delivery without intravenous access offered by intranasal fentanyl make it a feasible initial parenteral analgesic in the treatment of children with SCD presenting with VOE in the acute-care setting. Further study is needed to determine potential causality of the association between intranasal fentanyl and discharge from the emergency department observed in this multicenter study.
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Affiliation(s)
- Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - David C. Brousseau
- Section of Pediatric Emergency Medicine, Medical College of Wisconsin and the Children’s Research Institute of the Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Fahd A. Ahmad
- Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | | | - Seema Bhatt
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amanda Bogie
- Univesrsity of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | | | - Laura L. Chapman
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Corrie E. Chumpitazi
- Division of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Carlton Dampier
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | | | - Dunia Hatabah
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Robert W. Hickey
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Lewis L. Hsu
- University of Illinois at Chicago, Chicago, Illinois
| | - Nitya Bakshi
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Sara Leibovich
- UCSF-Benioff Children’s Hospital at Oakland, Oakland, California
| | | | - Elizabeth C. Powell
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rachel Richards
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | | | - Debra L. Weiner
- Division of Pediatric Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Claudia R. Morris
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
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23
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Boggs KM, Glew D, Rahman KN, Gao J, Boyle TP, Samuels-Kalow ME, Sullivan AF, Zachrison KS, Camargo CA. Pediatric Telehealth Use in U.S. Emergency Departments in 2019. Telemed J E Health 2023; 29:551-559. [PMID: 36103263 PMCID: PMC10079250 DOI: 10.1089/tmj.2022.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives: Little is known about the recent usage of pediatric telehealth across all emergency departments (EDs) in the United States. Building upon our prior work, we aimed to characterize the usage of ED pediatric telehealth in the pre-COVID-19 era. Methods: The 2019 National ED Inventory-USA survey characterized all U.S. EDs open in 2019. Among EDs reporting receipt of pediatric telehealth services, we selected a random sample (n = 130) for a second survey on pediatric telehealth usage (2019 ED Pediatric Telehealth Survey). We also recontacted a random sample of EDs that responded to a prior, similar 2017 ED Pediatric Telehealth Survey (n = 107), for a total of 237 EDs in the 2019 ED Pediatric Telehealth Survey sample. Results: Overall, 193 (81%) of the 237 EDs responded to the 2019 Pediatric Telehealth Survey. There were 149 responding EDs that confirmed pediatric telehealth receipt in 2019. Among these, few reported ever having a pediatric emergency medicine (PEM) physician (10%) or pediatrician (9%) available for emergency care. Although 96% of EDs reported availability of pediatric telehealth services 24 h per day, 7 days per week, the majority (60%) reported using services less than once per month and 20% reported using services every 3-4 weeks. EDs most frequently used pediatric telehealth to assist with placement and transfer coordination (91%). Conclusions: Most EDs receiving pediatric telehealth in 2019 had no PEM physician or pediatrician available. Most EDs used pediatric telehealth services infrequently. Understanding barriers to assimilation of telehealth once adopted may be important to enable improved access to pediatric emergency care expertise.
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Affiliation(s)
- Krislyn M. Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dorsey Glew
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kashfia N. Rahman
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jingya Gao
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tehnaz P. Boyle
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Ashley F. Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kori S. Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Eze JN, Edelu BO, Ndu IK, Oguonu T. Paediatric emergency medicine practice in Nigeria: a narrative review. BMC Emerg Med 2023; 23:31. [PMID: 36927266 PMCID: PMC10022062 DOI: 10.1186/s12873-023-00790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/08/2023] [Indexed: 03/18/2023] Open
Abstract
The practice of paediatric emergency medicine in Nigeria is still evolving, and laden with enormous challenges which contribute to adverse outcomes of childhood illnesses in emergency settings. Deaths from childhood illnesses presenting as emergencies contribute to overall child mortality rates in Nigeria. This narrative review discusses existing structures, organization, and practice of paediatric emergency in Nigeria. It highlights some of the challenges and suggests ways of surmounting them in order to reduce deaths in the children emergency units in Nigerian hospitals. Important aspects of this review include current capacity and need for capacity development, equipment needs for emergency care, quality of service in the context of inadequate healthcare funding and the need for improvement.
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Affiliation(s)
- Joy N Eze
- Department of Pediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, 400001, Nigeria.
- University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
| | - Benedict O Edelu
- Department of Pediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, 400001, Nigeria
- University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Ikenna K Ndu
- Department of Paediatrics, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
- Enugu State University of Science and Technology Teaching Hospital, Enugu, Nigeria
| | - Tagbo Oguonu
- University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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Smirnova A, Chahine S, Milani C, Schuh A, Sebok-Syer SS, Swartz JL, Wilhite JA, Kalet A, Durning SJ, Lombarts KM, van der Vleuten CP, Schumacher DJ. Using Resident-Sensitive Quality Measures Derived From Electronic Health Record Data to Assess Residents' Performance in Pediatric Emergency Medicine. Acad Med 2023; 98:367-375. [PMID: 36351056 PMCID: PMC9944759 DOI: 10.1097/acm.0000000000005084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Traditional quality metrics do not adequately represent the clinical work done by residents and, thus, cannot be used to link residency training to health care quality. This study aimed to determine whether electronic health record (EHR) data can be used to meaningfully assess residents' clinical performance in pediatric emergency medicine using resident-sensitive quality measures (RSQMs). METHOD EHR data for asthma and bronchiolitis RSQMs from Cincinnati Children's Hospital Medical Center, a quaternary children's hospital, between July 1, 2017, and June 30, 2019, were analyzed by ranking residents based on composite scores calculated using raw, unadjusted, and case-mix adjusted latent score models, with lower percentiles indicating a lower quality of care and performance. Reliability and associations between the scores produced by the 3 scoring models were compared. Resident and patient characteristics associated with performance in the highest and lowest tertiles and changes in residents' rank after case-mix adjustments were also identified. RESULTS 274 residents and 1,891 individual encounters of bronchiolitis patients aged 0-1 as well as 270 residents and 1,752 individual encounters of asthmatic patients aged 2-21 were included in the analysis. The minimum reliability requirement to create a composite score was met for asthma data (α = 0.77), but not bronchiolitis (α = 0.17). The asthma composite scores showed high correlations ( r = 0.90-0.99) between raw, latent, and adjusted composite scores. After case-mix adjustments, residents' absolute percentile rank shifted on average 10 percentiles. Residents who dropped by 10 or more percentiles were likely to be more junior, saw fewer patients, cared for less acute and younger patients, or had patients with a longer emergency department stay. CONCLUSIONS For some clinical areas, it is possible to use EHR data, adjusted for patient complexity, to meaningfully assess residents' clinical performance and identify opportunities for quality improvement.
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Affiliation(s)
- Alina Smirnova
- A. Smirnova is clinical assistant professor, Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada, and adjunct assistant professor, Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin; ORCID: https://orcid.org/0000-0003-4491-3007
| | - Saad Chahine
- S. Chahine is associate professor of measurement and assessment, Faculty of Education, Queen’s University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0488-773X
| | - Christina Milani
- C. Milani is clinical research assistant, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Abigail Schuh
- A. Schuh is associate professor of pediatrics, Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; ORCID: http://orcid.org/0000-0002-6422-2361
| | - Stefanie S. Sebok-Syer
- S.S. Sebok-Syer is assistant professor, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California; ORCID: http://orcid.org/0000-0002-3572-5971
| | - Jordan L. Swartz
- J.L. Swartz is clinical associate professor, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, and director of clinical informatics, Department of Emergency Medicine, NYU Langone Health, New York, New York
| | - Jeffrey A. Wilhite
- J.A. Wilhite is senior research coordinator, Department of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0003-4096-8473
| | - Adina Kalet
- A. Kalet is professor and Steven and Shelagh Roell Chair, Robert D. and Patricia P. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin; ORCID: http://orcid.org/0000-0003-4855-0223
| | - Steven J. Durning
- S.J. Durning is professor and vice chair, Department of Medicine, and director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0001-5223-1597
| | - Kiki M.J.M.H. Lombarts
- K.M.J.M.H. Lombarts is professor of professional performance, Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, and Amsterdam Public Health research institute, Amsterdam, The Netherlands; ORCID: https://orcid.org/0000-0001-6167-0620
| | - Cees P.M. van der Vleuten
- C.P.M. van der Vleuten is professor of education, Department of Educational Development and Research. Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; ORCID: http://orcid.org/0000-0001-6802-3119
| | - Daniel J. Schumacher
- D.J. Schumacher is professor of pediatrics, Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: http://orcid.org/0000-0001-5507-8452
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Andersen AM, Jensen TL, Sørensen JL, Gjærde LK, Lund S, Paulsen L, Poulsen A, Kjærgaard J. [Not Available]. Ugeskr Laeger 2023; 185:V09220581. [PMID: 36892231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Managing critically ill children is a rare and challenging event requiring training to ensure adequate and timely quality of care. Thus, health professionals train for pediatric emergencies in a simulated setting. Virtual reality (VR) is a promising modality for simulation, and current evidence highlights the potential of VR for simulating pediatric emergencies. However, more studies are needed to determine the aspects of VR design and implementation that support transfer of learning.
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Affiliation(s)
| | - Thomas Leth Jensen
- Afdeling for Børn og Unge, Københavns Universitetshospital - Rigshospitalet
| | | | | | - Stine Lund
- Afdeling for Intensiv behandling af nyfødte og mindre børn, Københavns Universitetshospital - Rigshospitalet
| | - Lone Paulsen
- H.C. Andersen Børne- og Ungehospital, Odense Universitetshospital
| | - Anja Poulsen
- Afdeling for Børn og Unge, Københavns Universitetshospital - Rigshospitalet
| | - Jesper Kjærgaard
- Afdeling for Børn og Unge, Københavns Universitetshospital - Rigshospitalet
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Baiardi G, Sacco F, Calvini G, Pasquariello S, Negro I, Mattioli F, Debbia C. [Clinical care pathway appropriateness of the intoxicated paediatric patient: a retrospective evaluation with Poisoning Severity Score]. Epidemiol Prev 2023; 47:20-25. [PMID: 36987931 DOI: 10.19191/ep23.1-2.a473.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVES to assess the clinical care impact resulting from the lack of a regional reference Centre for Paediatric Poisoning in Liguria Region (Northern Italy) and to describe the demographic and clinical characteristics of paediatric patients who accessed the Emergency Department of the 'Gaslini' Paediatric Hospital (Genoa, Liguria Region) for intoxication. DESIGN retrospective cohort study. SETTING AND PARTICIPANTS patients' cases of both sexes, <18 years old, who accessed the Emergency Department of the 'Gaslini' Paediatric Hospital between January 2017 and December 2019 for intoxication. MAIN OUTCOME MEASURES the Poisoning Severity Score (PSS), a simple and reliable scoring system to describe poisonings and define their severity, was used. The primary objective was pursued by investigating the percentage of cases of intoxication which followed, in the study period, a clinical care pathway inconsistent with the degree of severity ascertained through the retrospective application of the PSS. Clinical-demographic data, triage tag color-coding, and causes of intoxication of cases were also collected. Descriptive statistics were used to summarize results. RESULTS a total of 172 cases were identified over the study period; 28 did not meet the inclusion criteria. The final analysis involved 144 cases of intoxication, 70 were from females and 74 from males, with a median age of 3 years-old; 60% of study cases followed a clinical care pathway consistent with the intoxication severity ascertained trough the PSS, in 40% of study cases the clinical care pathway was inconsistent with PSS. The triage tag colour-code assigned was green in 16% of accesses, yellow in 82%, and red in only 2%. Out of the total of accesses, 40% of cases were attributed to drug intoxication in which the agents most involved were analgesics and sedative-hypnotic drugs, 30% to carbon monoxide and fumes poisoning, 23% to food/other substance intoxication, and 7% to alcohol intoxication. CONCLUSIONS implementing a referral Centre for Paediatric Poisoning could potentially affect 40% of access to the Emergency Department. Further analysis should be carried out to clarify whether an integrated Telemedicine Service could guide the correct management of intoxicated paediatric patients by referring them, through the Poisoning Severity Score system, for home monitoring or immediate hospitalization, if necessary.
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Affiliation(s)
- Giammarco Baiardi
- Sezione di farmacologia e tossicologia, Dipartimento di medicina interna, Università di Genova
- UO a direzione universitaria farmacologia clinica, EO Ospedali Galliera, Genova
- These authors equally contributed to the study
| | - Fabio Sacco
- Sezione di farmacologia e tossicologia, Dipartimento di medicina interna, Università di Genova
- UO a direzione universitaria farmacologia clinica, EO Ospedali Galliera, Genova
- These authors equally contributed to the study
| | - Giulia Calvini
- Sezione di farmacologia e tossicologia, Dipartimento di medicina interna, Università di Genova
- UO a direzione universitaria farmacologia clinica, EO Ospedali Galliera, Genova
| | - Stefano Pasquariello
- Sezione di farmacologia e tossicologia, Dipartimento di medicina interna, Università di Genova
- UO a direzione universitaria farmacologia clinica, EO Ospedali Galliera, Genova
| | - Ilaria Negro
- UOC Pediatria d'urgenza e pronto soccorso, Ospedale pediatrico - IRCCS Istituto "Giannina Gaslini", Genova
| | - Francesca Mattioli
- Sezione di farmacologia e tossicologia, Dipartimento di medicina interna, Università di Genova
- UO a direzione universitaria farmacologia clinica, EO Ospedali Galliera, Genova
| | - Carla Debbia
- UOC Pediatria d'urgenza e pronto soccorso, Ospedale pediatrico - IRCCS Istituto "Giannina Gaslini", Genova;
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Tedford NJ, Keating EM, Ou Z, Holsti M, Wallace AS, Robison JA. Social Needs Screening During Pediatric Emergency Department Visits: Disparities in Unmet Social Needs. Acad Pediatr 2022; 22:1318-1327. [PMID: 35537675 PMCID: PMC9910325 DOI: 10.1016/j.acap.2022.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/15/2022] [Accepted: 05/01/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine the prevalence of unmet social needs (USN) in a pediatric emergency department (PED) patient population and examine disparities in USN by self-selected language and patient demographics. METHODS We surveyed a convenience sample of English- and Spanish-speaking caregivers of patients <18-years-old presenting to a free-standing children's hospital in Salt Lake City, Utah. In the caregiver's self-selected language, the pediatric version of the Screener for Intensifying Community Referrals for Health (p-SINCERE) assessed patient demographics and 10 areas of social needs. The primary outcome was presence of USN. Descriptive statistics compared 1) self-selected languages and 2) absence versus presence of USN. Patient and caregiver-level risk factors associated with USN were identified using multivariable logistic regression. RESULTS Of the 10,156 patients seen in our PED from 04/01/2021 to 08/03/2021, there were 9922 eligible, 5357 approached, and 3987 enrolled caregivers. Of the 3987 caregivers enrolled, self-selected language was English for 3662 (91.8%) and Spanish for 325 (8.2%). There were 1680 enrolled caregivers with ≥1 USN, representing 39.7% of English-speaking and 70.2% of Spanish-speaking caregivers (P < .001). The odds of having ≥1 USN was more than 2 times higher in Spanish-speakers than in English-speakers after adjustment. CONCLUSIONS USN are common for families presenting for care to a PED, especially among Spanish-speaking caregivers. Furthermore, this study demonstrates disparities in limited English proficiency, race and ethnicity, and child insurance status. These findings support the practicality of utilizing the PED as an access point to initiate social need screening and referrals to address social determinants of health and health disparities.
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Affiliation(s)
- Natalie J Tedford
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah (EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah; Intermountain Primary Children's Hospital (NJ Tedford, EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah.
| | - Elizabeth M Keating
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah (EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah; Intermountain Primary Children's Hospital (NJ Tedford, EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah (Z Ou), Salt Lake City, Utah
| | - Maija Holsti
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah (EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah; Intermountain Primary Children's Hospital (NJ Tedford, EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah
| | - Andrea S Wallace
- University of Utah, College of Nursing (AS Wallace), Salt Lake City, Utah; Department of Population Sciences, University of Utah (AS Wallace), Salt Lake City, Utah
| | - Jeff A Robison
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah (EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah; Intermountain Primary Children's Hospital (NJ Tedford, EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah
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Kosoko AA, Khoei AA, Khose S, Genisca AE, Mackey JM. Evaluating the Clinical Impact of a Novel Pediatric Emergency Medicine Curriculum on Asthma Outcomes in Belize. Pediatr Emerg Care 2022; 38:598-604. [PMID: 36314861 PMCID: PMC9640288 DOI: 10.1097/pec.0000000000002850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Respiratory-related complaints prompt most pediatric visits to Karl Heusner Memorial Hospital Authority's (KHMHA) Emergency Department (ED) in Belize. We developed and taught a novel pediatric respiratory emergencies module for generalist practitioners there. We assessed the curriculum's clinical impact on pediatric asthma emergency management. OBJECTIVE This study assesses the clinical impact of a pediatric emergency medicine curriculum on management of pediatric asthma emergencies at KHMHA in Belize City, Belize. METHODS We conducted a randomized chart review of pediatric (aged 2-16 y) visits for asthma-related diagnosis at the KHMHA ED between 2015 and 2018 to assess the training module's clinical impact. Primary outcomes included time to albuterol and steroids. Secondary outcomes included clinical scoring tool (Pediatric Respiratory Assessment Measure [PRAM]) usage, ED length of stay, usage of chest radiography, return visit within 7 days, and hospital admission rates. Kaplan-Meier survival analysis and Cox proportional hazard regression were used. RESULTS Two hundred eighty-three pediatric asthma-related diagnoses met our inclusion criteria. The patients treated by trained and untrained physician groups were demographically and clinically similar. The time to albuterol was significantly faster in the trained (intervention) group compared with the untrained (control) physician group when evaluating baseline of the group posttraining (P < 0.05). However, the time to steroids did not reach statistical significance posttraining (P = 0.93). The PRAM score utilization significantly increased among both control group and intervention group. The untrained physician group was more likely to use chest radiography or admit patients. The trained physician group had higher return visit rates within 7 days and shorter ED length of stay, but this did not reach statistical significance. CONCLUSIONS The curriculum positively impacted clinical outcomes leading to earlier albuterol administration, increased PRAM score use, obtaining less chest radiographs, and decreased admission rates. The timeliness of systemic steroid administration was unaffected.
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Affiliation(s)
- Adeola A. Kosoko
- From the Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | | | - Swapnil Khose
- From the Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Alicia E. Genisca
- Departments of Emergency Medicine and Pediatrics, The Warren Alpert Medical School of Medicine, Brown University/Hasbro Children's Hospital, Providence, RI
| | - Joy M. Mackey
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
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Kou M, Baghdassarian A, Khanna K, Jamal N, Carney M, Fein DM, Kim I, Langhan ML, Rose JA, Zuckerbraun NS, Roskind CG. Guiding Fellows to Independent Practice: Current Trends in Pediatric Emergency Medicine Fellow Supervision. Pediatr Emerg Care 2022; 38:517-520. [PMID: 35353795 DOI: 10.1097/pec.0000000000002676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies highlight the importance of physician readiness to practice beyond graduate training. The Accreditation Council for Graduate Medical Education mandates that pediatric emergency medicine (PEM) fellows be prepared for independent practice by allowing "progressive responsibility for patient care." Prior unpublished surveys of program directors (PDs) indicate variability in approaches to provide opportunities for more independent practice during fellowship training. OBJECTIVES The aims of the study were to describe practices within PEM fellowship programs allowing fellows to work without direct supervision and to identify any barriers to independent practice in training. DESIGN/METHODS An anonymous electronic survey of PEM fellowship PDs was performed. Survey items were developed using an iterative modified Delphi process and pilot tested. Close-ended survey responses and demographic variables were summarized with descriptive statistics. Responses to open-ended survey items were reviewed and categorized by theme. RESULTS Seventy two of 84 PDs (88%) responded to the survey; however, not all surveys were completed. Of the 68 responses to whether fellows could work without direct supervision (as defined by the Accreditation Council for Graduate Medical Education) during some part of their training, 31 (45.6%) reported that fellows did have this opportunity. In most programs, clinical independence was conditional on specific measures including the number of clinical hours completed, milestone achievement, and approval by the clinical competency committee. Reported barriers to fellow practice without direct oversight included both regulatory and economic constraints. CONCLUSIONS Current training practices that provide PEM fellows with conditional clinical independence are variable. Future work should aim to determine best practices of entrustment, identify ideal transition points, and mitigate barriers to graduated responsibility.
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Affiliation(s)
| | | | - Kajal Khanna
- Stanford University School of Medicine, Stanford, CA
| | - Nazreen Jamal
- Columbia University Irving Medical Center, New York, NY
| | | | - Daniel M Fein
- Albert Einstein College of Medicine/Children's Hospital at Montefiore, New York City, NY
| | - In Kim
- University of Louisville, Louisville, KY
| | | | - Jerri A Rose
- UH Rainbow Babies and Children's Hospital, Cleveland, OH
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Wismer AC, Rakic M, Kuehni CE, Jaboyedoff M, Romano F, Kopp MV, Brandenberger J, Staubli G, Keitel K. Consensus Minimal Dataset for Pediatric Emergency Medicine in Switzerland. Pediatr Emerg Care 2022; 38:511-516. [PMID: 36099537 PMCID: PMC9555753 DOI: 10.1097/pec.0000000000002841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Standardized, harmonized data sets generated through routine clinical and administrative documentation can greatly accelerate the generation of evidence to improve patient care. The objective of this study was to define a pediatric emergency medicine (PEM) minimal dataset for Switzerland (Swiss PEM minimal dataset) and to contribute a subspecialty module to a national pediatric data harmonization process (SwissPedData). METHODS We completed a modified Delphi survey, inviting experts from all major Swiss pediatric emergency departments (PEDs). RESULTS Twelve experts from 10 Swiss PEDs, through 3 Delphi survey rounds and a moderated e-mail discussion, suggested a subspecialty module for PEM to complement the newly developed SwissPedData main common data model (CDM). The PEM subspecialty CDM contains 28 common data elements (CDEs) specific to PEM. Additional CDEs cover PEM-specific admission processes (type of arrival), timestamps (time of death), greater details on investigations and treatments received at the PED, and PEM procedures (eg, procedural sedation). In addition to the 28 CDEs specific to PEM, 43 items from the SwissPedData main CDM were selected to create a Swiss PEM minimal dataset. The final Swiss PEM minimal dataset was similar in scope and content to the registry of the Pediatric Emergency Care Applied Research Network. CONCLUSIONS A practical minimal dataset for PEM in Switzerland was developed through recognized consensus methodology. The Swiss PEM minimal dataset developed by Swiss PEM experts will facilitate international data sharing for PEM research and quality improvement projects.
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Affiliation(s)
- Alice C. Wismer
- From the Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Milenko Rakic
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Claudia E. Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Manon Jaboyedoff
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Fabrizio Romano
- From the Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Matthias V. Kopp
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Julia Brandenberger
- From the Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Georg Staubli
- Department of Pediatric Emergency Medicine, Childrens' University Hospital Zurich, Zurich, Switzerland
| | - Kristina Keitel
- From the Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Parri N, Berant R, Giacalone M, Jones SD, Friedman N. Dissemination and Use of Point-of-Care Ultrasound by Pediatricians in Europe: A Research in European Pediatric Emergency Medicine Network Collaborative Survey. Pediatr Emerg Care 2022; 38:e1594-e1600. [PMID: 35608533 DOI: 10.1097/pec.0000000000002767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We surveyed the dissemination and use of point-of-care ultrasound (POCUS), physician training levels, and barriers and limitations to use of POCUS among pediatricians and pediatric emergency medicine (PEM) physicians across Europe and Israel. METHODS A questionnaire was distributed through the PEM section of the European Society for Emergency Medicine and the Research in European Pediatric Emergency Medicine Network. RESULTS A total of 581 physicians from 22 countries fully completed the questionnaire. Participants were primarily pediatric attending physicians (34.9% [203 of 581]) and PEM attending physicians (28.6% [166 of 581]). Most of the respondents, 58.5% (340 of 581), reported using POCUS in their practice, and 61.9% (359/581) had undergone POCUS training. Point-of-care ultrasound courses represented the most common method of becoming proficient in POCUS. Overall, the Focused Assessment with Sonography in Trauma scan was the mostly taught application, with 76.3% (274 of 359). Resuscitative, diagnostic, and procedural POCUS were rated as very useful or useful by the most of respondents.The lack of qualified personnel to train (76.9% [447 of 581]), and the insufficient time for physicians to learn, POCUS (63.7% [370 of 581]) were identified as the main limitations to POCUS implementation. CONCLUSIONS The dissemination of pediatric POCUS in the European and Israeli centers we surveyed is limited, and its applications are largely restricted to the Focused Assessment with Sonography in Trauma examination. This is likely related to lack of training programs. In contrast, the potential value of use of POCUS in PEM practice is recognized by the majority of respondents.
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Affiliation(s)
- Niccolò Parri
- From the Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Ron Berant
- Emergency Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Martina Giacalone
- From the Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Sarah Dianne Jones
- Department of Emergency Medicine, Alder Hey Alder Hey Children's NHS Foundation Trust, Liverpool, England, United Kingdom
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Chumpitazi CE, Allister L, Cho C, Hoffmann JA, Hsu D, Iyer M, Mangold K, Marino M, Randell KA, Ponce H, Hariharan S. Career Development in Pediatric Emergency Medicine: What Do We Need? Pediatr Emerg Care 2022; 38:e1552-e1556. [PMID: 35470318 PMCID: PMC9912171 DOI: 10.1097/pec.0000000000002720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The Women in Pediatric Emergency Medicine (PEM) subcommittee of the American Academy of Pediatrics Section on Emergency Medicine identified 2 top priorities for 2021: career development and mentorship/sponsorship. The objective of this study was to catalog and delineate the career development domains for women physicians in PEM. METHODS After a review of the literature to identify the key areas for gaps for women in PEM, we used Q sort methodology to elicit domains for this subcommittee to address by survey of a national sample. RESULTS One hundred fourteen discrete potential areas of interest for career development were identified by the working group based on salient themes from the literature and personal experiences. Forty-one Women in PEM subcommittee members (27%) completed the survey. The career development topics were sorted into the domains of personal (40.4%; n = 46), administrative (28.1%; n = 32), research (10.5%; n = 12), teaching (10.5%; n = 12), service (7.0%; n = 8), and clinical (3.5%; n = 4). CONCLUSIONS This study demonstrates that the career development needs of women in PEM include a range of personal, teaching, research, administrative, clinical, and service domains. However, more than two-thirds of the career development topics were categorized into just 2 domains, administrative and personal.
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Affiliation(s)
- Corrie E. Chumpitazi
- Department of Pediatrics, Division of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Lauren Allister
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Christine Cho
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Jennifer A. Hoffmann
- Department of Pediatrics, Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Deborah Hsu
- Department of Pediatrics, Division of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Maya Iyer
- Department of Pediatrics, Division of EmergencyMedicine, Nationwide Children's Hospital, Columbus, OH
| | - Karen Mangold
- Department of Pediatrics, Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Meg Marino
- Department of Pediatrics, Division of Emergency Medicine, New Orleans, LA
| | - Kimberly A. Randell
- Department of Pediatrics, Division of Emergency Medicine, Children's Mercy Kansas City, Kansas City, MO
- University of Missouri-Kansas City School of Medicine, Kansas City, MO; University of Kansas School of Medicine, Kansas City, KS
| | - Haley Ponce
- Department of Pediatrics, Division of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Selena Hariharan
- Department of Pediatrics, Division of Emergency Medicine, University of Cincinnati, Cincinnati, OH
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Cheng CW, Huang YB, Chao HY, Ng CJ, Chen SY. Impact of the COVID-19 Pandemic on Pediatric Emergency Medicine: A Systematic Review. Medicina (Kaunas) 2022; 58:1112. [PMID: 36013580 PMCID: PMC9413323 DOI: 10.3390/medicina58081112] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 02/05/2023]
Abstract
(1) Background and Objectives: The COVID-19 pandemic has considerably affected clinical systems, especially the emergency department (ED). A decreased number of pediatric patients and changes in disease patterns at the ED have been noted in recent research. This study investigates the real effect of the pandemic on the pediatric ED comprehensively by performing a systematic review of relevant published articles. (2) Materials and Methods: A systematic review was conducted based on a predesigned protocol. We searched PubMed and EMBASE databases for relevant articles published until 30 November 2021. Two independent reviewers extracted data by using a customized form, and any conflicts were resolved through discussion with another independent reviewer. The aggregated data were summarized and analyzed. (3) Results: A total of 25 articles discussing the impact of COVID-19 on pediatric emergencies were included after full-text evaluation. Geographic distribution analysis indicated that the majority of studies from the European continent were conducted in Italy (32%, 8/25), whereas the majority of the studies from North America were conducted in the United States (24%, 6/25). The majority of the studies included a study period of less than 6 months and mostly focused on the first half of 2020. All of the articles revealed a decline in the number of pediatric patients in the ED (100%, 25/25), and most articles mentioned a decline in infectious disease cases (56%, 14/25) and trauma cases (52%, 13/25). (4) Conclusions: The COVID-19 pandemic resulted in a decline in the number of pediatric patients in the ED, especially in the low-acuity patient group. Medical behavior changes, anti-epidemic policies, increased telemedicine use, and family financial hardship were possible factors. A decline in common pediatric infectious diseases and pediatric trauma cases was noted. Researchers should focus on potential child abuse and mental health problems during the pandemic.
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Affiliation(s)
- Chien-Wei Cheng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University College of Medicine, Taoyuan City 333, Taiwan
| | - Yan-Bo Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
| | - Hsiao-Yun Chao
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Division of Medical Education, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
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Howard MB, Guse S. Liquid Nicotine, E-Cigarettes, and Vaping: Information for the Pediatric Emergency Medicine Provider. Pediatr Emerg Care 2022; 38:399-403. [PMID: 35904953 DOI: 10.1097/pec.0000000000002793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT E-cigarettes, or electronic cigarettes, are electronic nicotine delivery systems that are marketed as a healthier alternative to tobacco cigarettes. There has been an exponential increase in their use among youth since their introduction to the United States market in 2007. With increased use and popularity, there has been an increase in calls to poison control centers regarding liquid nicotine toxicity in children and adolescents. Recent US Food and Drug Administration and other federal regulations of e-cigarettes have attempted to limit availability to youth. This article reviews trends in e-cigarette use among youth, the background and mechanism of action of e-cigarettes, liquid nicotine toxicity, management of liquid nicotine toxicity, and recent policy updates regarding e-cigarettes.
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Affiliation(s)
- Mary Beth Howard
- From the Assistant Professor of Pediatrics, Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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Pulcini CD, Dubuque A, Lamberson M, Macy ML, Mistry RD, Pruitt CM, Schnadower D, Zorc JJ, Stevens MW. Pediatric Emergency Medicine Physicians' Perspectives on Emergency Care of Children With Medical Complexity: A Multi-institution Mixed-Methods Assessment. Pediatr Emerg Care 2022; 38:e1423-e1427. [PMID: 35436769 DOI: 10.1097/pec.0000000000002712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Children with medical complexity (CMC) compose 1% of the pediatric population but account for 20% of pediatric emergency department (ED) visits. Previous descriptions of challenges and interventions to ensure quality of care are limited. Our objective was to elicit pediatric emergency medicine (PEM) physicians' perspectives on challenges and opportunities for improvement of emergency care of CMC, with a focus on emergency information forms (EIFs). METHODS We conducted a web-based survey of PEM physicians participating the American Academy of Pediatrics Section on Emergency Medicine Survey listserv. The survey was designed using an expert panel, and subsequently piloted and revised to an 18-item survey. Data were analyzed with descriptive statistics. RESULTS One hundred fifty-one of 495 respondents (30%) completed the survey. Most respondents (62.9%) reported caring for >10 CMC per month. Whereas overall medical fragility and time constraints were major contributors to the challenges of caring for CMC in the ED, communication with known providers and shared care plans were identified as particularly helpful. Most respondents did not report routine use of EIFs. Anticipated emergencies/action plan was deemed the most important component of EIFs. CONCLUSIONS Most PEM physicians view the care for CMC in the ED as challenging despite practicing in high-resource environments. Further research is needed to develop and implement strategies to improve care of CMC in the ED. Understanding experiences of providers in general ED settings is also an important next step given that 80% of CMC present for emergency care outside of major children's hospitals.
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Affiliation(s)
- Christian D Pulcini
- From the Division of Emergency Medicine, Department of Surgery and Pediatrics
| | - Amy Dubuque
- Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
| | - Miles Lamberson
- Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
| | - Michelle L Macy
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph J Zorc
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Martha W Stevens
- From the Division of Emergency Medicine, Department of Surgery and Pediatrics
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Lavoie ME, Tay KY, Nadel F. Who Trains the Trainers?: Development of a Faculty Bootcamp for Pediatric Emergency Medicine Resuscitation Procedures. Pediatr Emerg Care 2022; 38:353-357. [PMID: 35787583 DOI: 10.1097/pec.0000000000002776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Attending physicians in pediatric emergency medicine (PEM) must be able to perform lifesaving procedures, yet guidelines for maintaining procedural competency do not exist. We implemented a biannual 2-hour "bootcamp" designed to help PEM faculty maintain procedural competency. METHODS A survey-based needs assessment was used to create a set of goals and objectives for the session and determine which procedural skills to include. Sessions of 4 simulated skills were held twice a year and limited to 12 faculty. Post-bootcamp evaluations were administered at the 1-year and 6-year marks to evaluate the usefulness of the training. RESULTS Twenty-eight of our 55 current faculty members (50%) responded to the 6-year follow-up evaluation. Overall, the bootcamp was felt to be beneficial, with 64% of faculty rating it "great" (5) or "highly useful" (6) on a 6-point Likert scale. The majority of participants also rated the airway, vascular access, and cardiopulmonary resuscitation/defibrillator training favorably. Faculty who later had the opportunity to perform specific resuscitation procedures clinically felt that the circulation (cardiopulmonary resuscitation/defibrillator) and airway stations contributed to the success of their procedure performance. CONCLUSIONS The clinical setting alone may be insufficient in maintaining procedural competency in lifesaving skills in PEM. Giving faculty the opportunity to practice these skills is feasible and can be effective in increasing confidence. Future training sessions should aim toward practicing to a defined mastery level.
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Affiliation(s)
- Megan E Lavoie
- From the Perelman School of Medicine at the University of Pennsylvania; and Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
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Malik RN, Langhan ML. Pediatric Residency Preparedness for Pediatric Emergency Medicine Fellowship. Pediatr Emerg Care 2022; 38:e1462-e1468. [PMID: 35904957 DOI: 10.1097/pec.0000000000002705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to examine the perception of pediatric emergency medicine (PEM) program directors (PDs), associate PDs (APDs) and first-year fellows regarding the preparedness of new PEM fellows who have graduated from pediatric residency programs. METHODS Unique surveys were created and electronically distributed to PEM PDs/APDs and first-year PEM fellows. Individual and institutional demographic information was collected. Using a 5-point Likert scale, survey items centered the perceived preparedness of first-year PEM fellows within 5 domains: professionalism, independence/autonomy, psychomotor skills, clinical evaluation and management, and academia/scholarship. RESULTS Forty percent (48/119) of eligible PDs and APDs and 56% (82/147) of eligible first-year PEM fellows responded. Most PDs/APDs strongly agreed or agreed that incoming fellows perform adequately in areas of professionalism, independence/autonomy, and clinical evaluation and management. The PDs/APDs perceived fellows to be less prepared in the academia/scholarship domain and several psychomotor skills. Most first-year PEM fellows perceived themselves as prepared in areas of professionalism and clinical evaluation and management. Fellows had varied feelings of preparedness in the domains of independence/autonomy, psychomotor skills, and academia/scholarship. Overall, most PDs/APDs (54%) and fellows (84%) feel that pediatric residency training was strong or very strong. CONCLUSIONS Most respondents in both groups felt that in general, pediatric residency programs adequately train residents for PEM fellowship. Both groups felt that the strengths of general pediatric training were among the domains of professionalism and clinical evaluation and management, whereas psychomotor skills and academia and scholarship were areas of improvement. These findings may be used by general pediatric residency and PEM fellowship programs to guide curriculum development.
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Affiliation(s)
- Rabia N Malik
- From the Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven
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Mistry RD, Hogan PG, Parrish KL, Thompson RM, Fritz SA. Skin and Soft Tissue Infection Treatment and Prevention Practices by Pediatric Emergency Medicine Providers. Pediatr Emerg Care 2022; 38:e1348-e1354. [PMID: 35766929 DOI: 10.1097/pec.0000000000002618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate skin and soft tissue infection (SSTI) treatment and prevention practices among pediatric emergency medicine (PEM) clinicians in the context of current clinical practice guidelines and contemporary evidence. METHODS This was a cross-sectional survey of PEM clinicians belonging to the American Academy of Pediatrics Section on Emergency Medicine Survey listserv. Four varying hypothetical clinical scenarios of children with SSTI were posed to respondents; subsequent items assessed SSTI treatment and prevention practices. Provider demographics were collected. RESULTS Of 160 survey respondents, more than half stated that they would prescribe oral antibiotics for each clinical scenario, particularly for more complex presentations (small uncomplicated abscess, 51.8%; large uncomplicated abscess, 71.5%; recurrent abscess, 83.5%; febrile abscess, 90.3%; P < 0.001). Most commonly selected antibiotics were clindamycin and trimethoprim-sulfamethoxazole. Across scenarios, more than 80% selected a duration of treatment 7 days or more. Of the 121 respondents who prescribe preventive measures, 85.1% recommend hygiene measures; 52.5% would prescribe decolonization with topical antibiotic ointment and 77.5% would recommend antiseptic body washes. Half of the respondents reported that their institution has standard guidance for SSTI management. CONCLUSIONS Although current evidence supports adjuvant antibiotics for all drained SSTI and decolonization for the index patient and household contacts, PEM clinicians do not consistently adhere to these recommendations. In light of these findings, development and implementation of institutional guidelines are necessary to aid PEM clinicians' point-of-care decision making and improving evidence-based practice.
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Affiliation(s)
- Rakesh D Mistry
- From the Department of Pediatrics-Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Patrick G Hogan
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Katelyn L Parrish
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Ryley M Thompson
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO
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Bansal BB, Mathew MS, Booker-Nubie Q, Messiah SE, Wang VJ. Retiring From Pediatric Emergency Medicine Too Soon?: A Survey to Discover the Reasons and Start a Conversation About Solutions. Pediatr Emerg Care 2022; 38:253-257. [PMID: 35639430 PMCID: PMC9162071 DOI: 10.1097/pec.0000000000002697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pediatric emergency medicine is a subspecialty known for high acuity, high stress, and variable scheduling that may be difficult to maintain as one gets older. This survey sought to gain information on the reasons or plans for early retirement in pediatric emergency medicine and offer ways to address these concerns to improve longevity in the field. METHODS A cross-sectional survey was sent via email to board-certified pediatric emergency medicine physicians who were older than 50 years to assess preretirement and postretirement considerations. Results were collected from October 3, 2019, through March 15, 2020. RESULTS Pediatric emergency medicine physicians who find it more difficult to perform simple procedures are 3.02 (1.23-7.36) times more likely to retire before the age of 66 years. In addition, women were significantly more likely to report an intention to retire before the age of 66 years versus men (50% vs 31%, P = 0.022). DISCUSSION The topic of retirement in a field that requires a wide range of procedural skills as well as constantly evolving technology is important. Understanding when and why physicians choose to retire may identify strategies to make it possible for pediatric emergency medicine physicians to prolong their careers. This may involve changes in work hours, a shift in responsibilities to a greater educational or mentor role, and/or providing opportunities to maintain skills. CONCLUSIONS Perceived basic procedure skills deterioration significantly increased the risk for early retirement. In addition, women were significantly more likely to express intention to retire before the age of 66 years. Further research should be directed toward obtaining more detailed information to develop strategies to retain pediatric emergency medicine physicians in a capacity that benefits the physician, their institution, and their patients.
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Affiliation(s)
| | | | | | - Sarah E. Messiah
- Human Genetics and Environmental Science, Center for Pediatric Population Health University of Texas Health Science Center at Houston, School of Public Health Dallas
| | - Vincent J. Wang
- UT Southwestern Medical Center, Children's Health, Dallas, TX
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Cardenas S, Scolnik D, Jarvis DA, Thull-Freedman J. Impact of a 1-Year Pediatric Emergency Medicine Training Program for International Medical Graduates. Pediatr Emerg Care 2022; 38:273-278. [PMID: 35507369 DOI: 10.1097/pec.0000000000002742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The Hospital for Sick Children in Toronto has offered a 1-year subspecialty residency training program in pediatric emergency medicine (PEM) to Canadian and internationally trained pediatricians and emergency physicians since 1993. The program is intended to support clinical service delivery while simultaneously offering a unique educational opportunity to Canadian and international physicians who desire 1 year of clinically focused training. We describe the experiences and career outcomes of participants who completed this program. METHODS Two surveys were sent to the 68 individuals who completed the clinical fellowship program from its inception in 1993 until 2014. A blinded survey focused on the fellowship experience and subsequent career activities. A nonblinded survey subsequently determined whether participants had served as a medical director or training program director. RESULTS Sixty of the 68 participants (88%) completed the blinded survey. Ninety-one percent were in practice in emergency medicine. Twenty-five percent of the participants were living in Canada, compared with 17% before completing the program. This net migration of 8% was not significant (P = 0.26). Thirty-six of the 50 participants (72%) who applied from outside Canada responded to the nonanonymous survey; 18 (50%) had served as an emergency department medical director, and 18 (50%) reported serving as a PEM training program director. CONCLUSIONS Many participants attained leadership positions in PEM in countries outside of North America and/or participated in training program development. There was no significant change in the proportion of participants living in North America at the time of application compared with the time of survey completion.
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Affiliation(s)
- Sandra Cardenas
- From the Department of Paediatrics, School of Medicine and Health Sciences TecSalud ITESM, Monterrey, Mexico
| | - Dennis Scolnik
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - D Anna Jarvis
- Department of Paediatrics, University of Toronto, Toronto, Canada
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Solomon L, Emma M, Gibbons LM, Kusulas MP. Current risk landscape of point-of-care ultrasound in pediatric emergency medicine in medical malpractice litigation. Am J Emerg Med 2022; 58:16-21. [PMID: 35623178 DOI: 10.1016/j.ajem.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (PoCUS) is expanding as a diagnostic tool in pediatric emergency medicine. Pediatricians are apprehensive to take on the risk of malpractice from incorrect interpretation of PoCUS imaging, therefore limiting its use. Although current studies provide reassurance to this concern, none look directly at the risk for pediatric emergency medicine physicians. Our study aims to evaluate the current medicolegal risk landscape posed by PoCUS in pediatric emergency medicine. METHODS A search of case law was performed utilizing the LexisNexis caselaw database for the period of January 2011 through December 2021. Initial search results were reviewed by the attorney co-authors for relevance to medical malpractice surrounding PoCUS. The remaining cases were reviewed by physician co-authors to ensure their relevance to both ultrasound and the acute care setting. Identified cases were then classified into categories as per the reason for the claim. RESULTS No cases of malpractice litigation were identified that directly related to PoCUS. Ten cases of ultrasound in the acute care setting were identified, 7 of which were in pediatric patients. The majority of these cases related to appendicitis or testicular torsion. Of these 10 cases, 2 cases claimed failure to consider the ultimate diagnosis, but ultrasound would have been an appropriate study had the diagnosis been considered. Of the 8 remaining cases, 6 were based on failure to perform or delay performing ultrasound, 1 claimed that improper ultrasound study was initially performed, and 1 case was based on an improper diagnosis made by ultrasound. DISCUSSION PoCUS does not appear to pose a significant risk of malpractice litigation in pediatric emergency medicine.
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Affiliation(s)
- Linda Solomon
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States of America.
| | - Maggie Emma
- Risk Management, Northwell Health, New Hyde Park, NY, United States of America
| | - Lisa M Gibbons
- Claims Management, Northwell Health, Great Neck, NY, United States of America
| | - Matthew P Kusulas
- Departments of Pediatrics and Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
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Barrett MJ, Dalziel S, Lyttle M, O'Sullivan R. A Bibliometric Analysis of Global Pediatric Emergency Medicine Research Networks. Pediatr Emerg Care 2022; 38:e1179-e1184. [PMID: 35358148 DOI: 10.1097/pec.0000000000002543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES During the last 3 decades newly formed pediatric emergency medicine (PEM) research networks have been publishing research. A desire of these networks is to produce and disseminate research to improve patient health and outcomes. The aims of the study were to quantitatively analyze and compare the literature by PEM research networks globally through numeric and visual bibliometrics. METHODS A bibliometric analysis of articles published from 1994 to 2019 (26 years) by authors from PEM research networks globally were retrieved using PubMed, Web of Science (Thompson Reuters), and accessing individual research network databases. Bibliometric analysis was performed utilizing Web of Science, VOSviewer, and Dimensions. Research was quantified to ascertain the number of articles, related articles, citations, and Altmetric attention score. RESULTS A total of 493 articles were published across 9 research networks in 3 decades. Pediatric Emergency Care Applied Research Network produced the most articles, citations, and h-index of all networks. We identified 3 main groupings of productive authors across the networks who collaborate globally. The sex of the first author was female in 46% of publications, and the corresponding author(s) was female in 45%. A nonsignificant moderate positive correlation between the number of years publishing and the number of publications was identified. There was nonsignificant moderate negative association between the number of countries in a network and total publications per annum. CONCLUSIONS This study is the first bibliometric analysis of publications from PEM research networks that collaborate globally. Exploring the relationships of numerical bibliometric indicators and visualizations of productivity will benefit the understanding of the generation, reach, and dissemination of PEM research within the global research community.
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van der Laan L, George R, Nesiama JA, Nagler J, Langhan ML, Yen K, Ngo TL, Rose JA, Caglar D, Kant S, Ciener D, Feng SY. Virtual Interviewing for Pediatric Emergency Medicine Fellowship-A National Survey. Pediatr Emerg Care 2022; 38:e1207-e1212. [PMID: 34608060 DOI: 10.1097/pec.0000000000002549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate both applicant and interviewer satisfaction with the virtual interviewing process for pediatric emergency medicine (PEM) fellowship in hopes to improve the fellowship interviewing process. It was proposed that fellowship programs and applicants would prefer virtual interviews over traditional interviews. METHODS A survey developed in collaboration with UT Southwestern PEM fellowship leaders and national PEM leaders was sent to all PEM fellowship applicants and programs at the conclusion of the 2020 interview season and rank list submission. The applicant survey obtained information on ease of virtual interviews and whether applicants felt that they obtained adequate information from virtual interviews to make informed program selections. Program director surveys collected data on thoughts and feelings about virtual interviews and obstacles encountered during the recruitment season. Both surveys asked about costs for interviews and interview type preference. RESULTS A response rate of 49% from applicants and 47% from programs was obtained. Virtual interview days were similar in the amount of time and staff hours used compared with traditional days. Applicants spent less on virtual interviews compared with those who underwent traditional interviews (average $725 vs $4312). Programs received more applications than the prior year and spent less money during the virtual cycle. The majority of the applicants (90%) were comfortable with the virtual interview platform, and most (66%) agreed that virtual interviews provided adequate information to determine program rank. Geography was the number 1 rank determining factor. Programs and applicants preferred a form of in-person interviews. CONCLUSIONS Virtual interviews provide cost savings for both applicants and programs. Despite this, both parties prefer a form of in-person interviews.
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Affiliation(s)
- Lyndsey van der Laan
- From the Division of Pediatric Emergency Medicine, University of Texas Southwestern Dallas/Children's Health
| | - Rachel George
- Department of Graduate Medical Education/Pediatric Residency, University of Texas Southwestern Dallas, Dallas, TX
| | - Jo-Ann Nesiama
- From the Division of Pediatric Emergency Medicine, University of Texas Southwestern Dallas/Children's Health
| | - Joshua Nagler
- Division of Pediatric Emergency Medicine, Boston Children's Hospital/Harvard, Boston, MA
| | - Melissa L Langhan
- Division of Pediatric Emergency Medicine, Yale New Haven Children's Hospital, New Haven, CT
| | - Kenneth Yen
- From the Division of Pediatric Emergency Medicine, University of Texas Southwestern Dallas/Children's Health
| | - Thuy L Ngo
- Division of Pediatric Emergency Medicine, John Hopkins Hospital, Baltimore, MD
| | - Jerri A Rose
- Division of Pediatric Emergency Medicine, University Hospital Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Derya Caglar
- Division of Pediatric Emergency Medicine, Seattle Children's Hospital, Seattle, WA
| | - Shruti Kant
- Division of Pediatric Emergency Medicine, UCSF Benioff Children's Hospital, San Francisco, CA
| | - Daisy Ciener
- Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Sing-Yi Feng
- From the Division of Pediatric Emergency Medicine, University of Texas Southwestern Dallas/Children's Health
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Burger RK, Taylor TR, Chumpitazi CE, Robinson LC, Sims MJ, Tunc EM, Mulcrone AE, Caglar D, Sulton CD, Little-Wienert K, Klein EJ, Titus MO, Jackson BF. Pediatric Emergency Medicine Fellowship Procedural Sedation Training: Consensus Educational Guidelines. Pediatr Emerg Care 2022; 38:162-166. [PMID: 35358144 DOI: 10.1097/pec.0000000000002568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pediatric procedural sedation (PPS) is a core clinical competency of pediatric emergency medicine (PEM) fellowship training mandated by both the Accreditation Council for Graduate Medical Education and the American Board of Pediatrics. Neither of these certifying bodies, however, offers specific guidance with regard to attaining and evaluating proficiency in trainees. Recent publications have revealed inconsistency in educational approaches, attending oversight, PPS service rotation experiences, and evaluation practices among PEM fellowship programs. METHODS A select group of PEM experts in PPS, PEM fellowship directors, PEM physicians with educational roles locally and nationally, PEM fellows, and recent PEM fellowship graduates collaborated to address this opportunity for improvement. RESULTS This consensus driven educational guideline was developed to outline PPS core topics, evaluation methodology, and resources to create or modify a PPS curriculum for PEM fellowship programs. This curriculum was developed to map to fellowship Accreditation Council for Graduate Medical Education core competencies and to use multiple modes of dissemination to meet the needs of diverse programs and learners. CONCLUSIONS Implementation and utilization of a standardized PPS curriculum as outlined in this educational guideline will equip PEM fellows with a comprehensive PPS knowledge base. Pediatric emergency medicine fellows should graduate with the competence and confidence to deliver safe and effective PPS care. Future study after implementation of the guideline is warranted to determine its efficacy.
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Affiliation(s)
- Rebecca K Burger
- From the Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
| | - Taryn R Taylor
- From the Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
| | - Corrie E Chumpitazi
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Lauren C Robinson
- Division of Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Morgan J Sims
- Division of Emergency Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Emine M Tunc
- Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Amanda E Mulcrone
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Derya Caglar
- Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Carmen D Sulton
- From the Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
| | - Kim Little-Wienert
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Eileen J Klein
- Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - M Olivia Titus
- Division of Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Benjamin F Jackson
- Division of Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
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Weber E, Chao J, Koyama A, Sinert R. Pediatric Emergency Medicine Fellowship Education on Adolescent Sexual Health Care. Pediatr Emerg Care 2022; 38:97-103. [PMID: 35226617 DOI: 10.1097/pec.0000000000002612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Many adolescents use the emergency department as their sole resource for primary care and sexual health care. This provides an opportunity to prevent sexually transmitted infections and unintended pregnancy as well as to educate teenagers about their bodies and sexual health. There is no standard curriculum on sexual health as part of pediatric emergency medicine (PEM) fellowship education. Our goal is to evaluate what is taught in PEM fellowship about adolescent sexual health. METHODS We administered an anonymous questionnaire to both PEM fellows and program directors (PDs). The questionnaire was distributed through the PEM Program Director Survey Committee. The questionnaire was sent to 88 PDs and 305 fellows total. An introductory email explaining the purpose of the study and a link to the online questionnaire was sent. The questionnaire was created using SurveyMonkey (www.surveymonkey.com). Data were analyzed using descriptive statistics. RESULTS We achieved a 43% survey response rate from PDs (38 of 88) and a 24% survey response rate from fellows (73 of 305). The PD respondents included 61% females, and almost all (86%) are between ages 35 and 54 years. Seventy-three percent of the fellows are female, and they are all between 25 to 44 years old. There was a great deal of variability in the amount of adolescent sexual health education PDs provide their fellows in the form of lectures and bedside teaching cases. A majority of survey respondents (86% of fellows and 66% of the PDs) agreed that there should be a standard PEM curriculum to teach about adolescent sexual health. More than half (53% of PDs and 56% of fellows) are not satisfied with the number of training opportunities for adolescent sexual health. CONCLUSIONS We found variability in adolescent sexual health training during PEM fellowship, although fellows and PDs agree that there should be a standardized curriculum. We recommend that the American Board of Pediatrics form a committee to decrease variability in the training of PEM fellows on adolescent sexual health.
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Affiliation(s)
- Emily Weber
- From the Division of Pediatrics, Department of Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital Center, Brooklyn, NY
| | - Jennifer Chao
- From the Division of Pediatrics, Department of Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital Center, Brooklyn, NY
| | - Atsuko Koyama
- Department of Child Health and Emergency Medicine, University of Arizona, College of Medicine-Phoenix, Arizona
| | - Richard Sinert
- Department of Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital Center, Brooklyn, NY
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Singh D, Nagaraj S, Mashouri P, Drysdale E, Fischer J, Goldenberg A, Brudno M. Assessment of Machine Learning-Based Medical Directives to Expedite Care in Pediatric Emergency Medicine. JAMA Netw Open 2022; 5:e222599. [PMID: 35294539 PMCID: PMC8928004 DOI: 10.1001/jamanetworkopen.2022.2599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Increased wait times and long lengths of stay in emergency departments (EDs) are associated with poor patient outcomes. Systems to improve ED efficiency would be useful. Specifically, minimizing the time to diagnosis by developing novel workflows that expedite test ordering can help accelerate clinical decision-making. OBJECTIVE To explore the use of machine learning-based medical directives (MLMDs) to automate diagnostic testing at triage for patients with common pediatric ED diagnoses. DESIGN, SETTING, AND PARTICIPANTS Machine learning models trained on retrospective electronic health record data were evaluated in a decision analytical model study conducted at the ED of the Hospital for Sick Children Toronto, Canada. Data were collected on all patients aged 0 to 18 years presenting to the ED from July 1, 2018, to June 30, 2019 (77 219 total patient visits). EXPOSURE Machine learning models were trained to predict the need for urinary dipstick testing, electrocardiogram, abdominal ultrasonography, testicular ultrasonography, bilirubin level testing, and forearm radiographs. MAIN OUTCOMES AND MEASURES Models were evaluated using area under the receiver operator curve, true-positive rate, false-positive rate, and positive predictive values. Model decision thresholds were determined to limit the total number of false-positive results and achieve high positive predictive values. The time difference between patient triage completion and test ordering was assessed for each use of MLMD. Error rates were analyzed to assess model bias. In addition, model explainability was determined using Shapley Additive Explanations values. RESULTS There was a total of 42 238 boys (54.7%) included in model development; mean (SD) age of the children was 5.4 (4.8) years. Models obtained high area under the receiver operator curve (0.89-0.99) and positive predictive values (0.77-0.94) across each of the use cases. The proposed implementation of MLMDs would streamline care for 22.3% of all patient visits and make test results available earlier by 165 minutes (weighted mean) per affected patient. Model explainability for each MLMD demonstrated clinically relevant features having the most influence on model predictions. Models also performed with minimal to no sex bias. CONCLUSIONS AND RELEVANCE The findings of this study suggest the potential for clinical automation using MLMDs. When integrated into clinical workflows, MLMDs may have the potential to autonomously order common ED tests early in a patient's visit with explainability provided to patients and clinicians.
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Affiliation(s)
- Devin Singh
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sujay Nagaraj
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Pouria Mashouri
- DATA Team, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Erik Drysdale
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jason Fischer
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna Goldenberg
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario Canada
- Canadian Institute for Advanced Research, Toronto, Ontario Canada
| | - Michael Brudno
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- DATA Team, Techna Institute, University Health Network, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario Canada
- Canadian Institute for Advanced Research, Toronto, Ontario Canada
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Abstract
OBJECTIVES Concussion is a commonly encountered diagnosis for pediatric emergency medicine (PEM) providers, yet little is known regarding referral patterns to specialists. Our goal was to assess PEM providers' referral patterns and current usage of standardized evaluation tools. METHODS This study was conducted as cross-sectional survey of PEM providers recruited from the American Academy of Pediatrics Section on Emergency Medicine Listserv. Surveys were distributed at 3 time points between December 1, 2020, and February 28, 2021, and included multiple choice, Likert scale, and free text questions. Descriptive statistics and bivariate analyses were used to describe the sample and compare responses between those with variable experience and confidence in concussion management. RESULTS In total, 162 of 491 Listserv members (33.0%) completed the survey. The factors most often reported to assist in referral decisions were history of severe (92.6%) or multiple (90.7%) prior concussions, prolonged symptom duration (89.5%), and severity of current symptoms (84.6%). Most providers reported having large experience (63.0%) and confidence (54.9%) in managing concussion. Standardized symptom scales (8.0%), vestibular (11.7%) and balance assessments (13.0%), and prognostic tools (6.8%) were infrequently used. Most (64.2%) providers felt specialty referral was important. More than 80% reported high likelihood to use an accurate risk stratification tool to facilitate referral. CONCLUSIONS Although most PEM providers reported significant experience and confidence in managing pediatric concussion, standardized assessment tools were infrequently used. Most were likely to use a risk stratification tool to assist in specialty referral. Future studies should assess the ability of targeted referral strategies to improve recovery for concussed youth.
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Affiliation(s)
- Daniel J Corwin
- From the Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jeremy M Root
- Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC
| | - Mark R Zonfrillo
- Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI
| | - Danny G Thomas
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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Foutch J, Jackson B, Titus MO, Taylor T. Assessment of Pediatric Emergency Medicine Fellow Competency in Procedural Sedation: An Adjunct to the Recently Published Pediatric Emergency Medicine Procedural Sedation Training: Consensus Educational Guidelines. Pediatr Emerg Care 2022; 38:e1092-e1093. [PMID: 35226637 DOI: 10.1097/pec.0000000000002655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nti BK, Kennedy S, Sarmiento E, Weinstein E, Russell F. Performance of Pediatric Emergency Medicine Faculty After Point-of-Care Ultrasound Credentialing Implementation. Pediatr Emerg Care 2022; 38:e482-e487. [PMID: 35025189 DOI: 10.1097/pec.0000000000002381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE As point-of-care ultrasound (POCUS) continues to evolve, a national standardized curriculum for training and credentialing pediatric emergency medicine (PEM) physicians is still lacking. The goal of this study was to assess PEM faculty in performing and interpreting POCUS during implementation of a training curriculum. METHODS Sixteen full-time PEM faculty with either limited or no prior POCUS experience were trained to perform 4 ultrasound studies. Twelve of the 16 completed the training with a goal of credentialing within 12 months of implementation. For each faculty, we assessed competency by comparing precurriculum and postcurriculum test assessments and by evaluating quality of POCUS acquisition and accuracy of interpretation. We also monitored the amount of continuing medical education (CME) hours completed to ensure a minimum didactic component. RESULTS We found a significant improvement in POCUS competency comparing precurriculum to postcurriculum test assessments (55.4% vs 75.6%, P < 0.0002). One thousand two hundred seventy images were submitted over the course of the curriculum. Accuracy, sensitivity, and specificity were 98.23% (confidence interval [CI] = 97.18-98.97), 97.01% (CI = 92.53-99.81), and 98.43% (CI = 97.33-99.81), respectively. Faculty self-rating of image quality was significantly higher than expert reviewer rating of image quality (3.4 ± 0.86 vs 3.2 ± 0.56, P < 0.0001). We found no change in expert reviewer rating of image quality over time. Faculty completed a combined 232.5 CME hours (average, 17.4 ± 10.8), with the majority of hours coming from an institutional POCUS CME workshop. CONCLUSIONS These results show that a structured curriculum can improve PEM faculty POCUS competency.
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Affiliation(s)
| | - Sarah Kennedy
- Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Elisa Sarmiento
- Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | - Frances Russell
- Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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