12/11/12 GUIDELINES FOR PEDIATRIC PREPAREDNESS. Na#onal Pediatric Readiness Project Institute of Medicine Report on EMS for Children

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1 Na#onal Pediatric Readiness Project A Na%onal Assessment of Emergency Department Readiness for Children Katherine Remick, MD Visiting Assistant Professor in Medicine David Geffen School of Medicine at UCLA Emergency Medical Services Fellow Los Angeles County EMS Agency Marianne Gausche-Hill, MD, FACEP, FAAP Professor of Clinical Medicine, David Geffen School of Medicine at UCLA Vice Chair and Chief of the Division of Pediatric Emergency Medicine Director Pediatric Emergency Medicine and EMS Fellowships Harbor-UCLA Medical Center, Department of Emergency Medicine 1993 Institute of Medicine Report on EMS for Children The needs of children must be more widely recognized and made a genuine priority for policymakers at national, state, and local levels, particularly those in the position to influence the future directions of EMS and EMSC. Regulatory agencies should require that hospital emergency departments and emergency response and transport vehicles have available and maintain equipment and supplies appropriate for the emergency care of children. GUIDELINES FOR PEDIATRIC PREPAREDNESS 1

2 Care of Children in the Emergency Department: Guidelines for Preparedness Joint policy statement published by ACEP and AAP in April 2001 issue of Annals of Emergency Medicine and Pediatrics - Supported by 17 national and professional organizations Previous Studies: Guidelines Implementation 1. National Electronic Injury Surveillance System (NEISS) Survey Ability of Hospitals to Care for Pediatric Emergency Patients (US Consumer Product Safety Commission, Pediatric Emergency Care, Jun 2001) 2. Availability of Pediatric Services and Equipment in Emergency Departments: United States, (Adv Data. Feb 2006; 367: 1-16) 3. Pediatric Preparedness of US Emergency Departments: A 2003 Survey (Pediatrics. Dec 2007; 120(6): ) 4. Availability of Pediatric Services and Equipment in Emergency Departments: United States, 2006 (National Health Statistics Reports. 2012; 47: 1-21) Previous Studies: Guidelines Implementation 50% of ED s see <10 pediatric patients per day 26% of children seen in rural or remote areas 10% of hospitals have a PICU 50% of hospitals without a PICU have written transfer agreements for critically ill children 7-10% of hospitals without a PICU admit critically ill or injured children 33% of hospitals have a pediatric ward or department >75% of hospitals admit pediatric patients 2

3 Previous Studies: Guidelines Implementation <60% of hospitals aware of the guidelines 6% of hospitals have all recommended equipment Presence of physician or nurse coordinator increases pediatric readiness by as much as 60% 18% of hospitals have a physician coordinator 12% of hospitals have a nurse coordinator Factors Associated with Poor Pediatric Preparedness Lack of nurse and physician coordinator Low percentage of pediatric visits (<10%) Lack of an on-call pediatrician Lack of a PALS-trained physician 2006 IOM Report If there is one word to describe the current state of pediatric emergency care in 2006 it is UNEVEN. a regionalized, coordinated, and accountable system 3

4 Video Can You Improve on This Scenario? 2009 Guidelines for Care of Children in the Emergency Department Continued support of 2001 guidelines, plus: Patient safety recommendations Expansion of family centered care recommendations Care of children in disasters Supported by 22 organizations including American Medical Association, American Heart Association and the Joint Commission PEDIATRICS Vol. 124 No. 4 October 2009, pp Joint Policy Statement Guidelines for Care of Children in the Emergency Department American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, American College of Emergency Physicians, Pediatric Committee and Emergency Nurses Association Pediatric Committee 2009 Guidelines for Care of Children in the Emergency Department 1. Administration and Coordination 2. Physicians, Nurses, and Other Healthcare Providers 3. Quality Improvement 4. Patient Safety 5. Policies, Procedures, and Protocols 6. Support Services 7. Equipment, Supplies, and Medications 4

5 A statewide assessment of all 335 acute care hospitals in California for compliance with national guidelines for pediatric readiness Assessment Tool Based on 2009 Guidelines for Care of Children in the Emergency Department National EMS for Children Data Analysis and Resource Center National Working Group EMS for Children National Resource Center American Academy of Pediatrics American College of Emergency Physicians Emergency Nurses Association Section I. Guidelines for Administration and Coordination of the ED for the Care of Children (19 points) Section II. Guidelines for Physicians and Other Practitioners Staffing the ED (10 points) Section III. Quality Improvement Guidelines for the ED (7 points) Weighting Section IV. Guidelines for Improving Patient Safety (14 points) Section V. Guidelines for Policies, Procedures, and Protocols for the ED (17 points) Section VI. Guidelines for Support Services in the ED (0 points) Section VII. Guidelines for Equipment, Supplies, and Medications for Children in the ED (33 points) Weighted score normalized to 100pt scale 5

6 12/11/12 Assessment Tool 60 questions Time to complete: 30-60min Voluntary and confidential Paper and web-based versions Piloted by 10 hospitals California Most-populous state in the US (>38 million) 87% live in urban areas 13% live in rural areas 3rd largest state by land mass 58 counties: 11/58 have >50% of population living in rural areas Represented by 32 Local EMS Agencies 413 hospitals (335 acute care hospitals) California Launches tile,, NATIONAL RE ESS The Federal Emergency Medical Services for Children (EMSC) Program working with the National EMSC Data Analysis and Resource Center (NEDARC), the California EMS Authority, and researchers at Harbor-UCLA Medical Center, Torrance, CAr Drs. Gausche-Hill and Remick, developed a confidential web-based survey based on the 2009 "Guidelines for the Care of Children in the Emergency Department. "This is the first national survey of pediatric readiness in emergency departments across the United States. The overall objective is to assess pediatric readiness of emergency departments while increasing awareness of the national guidelines developed by the American College of Emergency Physicians, the American Academy of Pediatrics and the Emergency Nurses Association and sponsored by 22 other organizations including the Joint Commission and the American Medical Association. The National Pediatric Readiness Survey is the first step in a comprehensive quality improvement program called "The National Pediatric Readiness Project:' Perf! t1{r!c "R~t1rf!Mt:t: 'A,?!~d Ensuring Emergency Care lor All Children Hospitals for the first time will be able to benchmark their readiness against other hospitals within their state and the nation. provide resources to hospitals and regions that are least pediatric ready so that children in every city throughout the nation have access to the emergency care resources they need. In January 2012 California hospitals began logging-in to assess their emergency department's readiness to care for children. We are the first state to participate in this national roll out! Over 150 ED managers and nursing leaders have already responded... PLEASE log in and make your data count. Voluntary, confidential, and web-based Individual gap analysis to assist with accreditation goals Participating hospitals receive PEMSoft subscription Immediate feedback Broselow tape consistent with new 2010 American Heart Association Guidelines Comparison to like-hospitals Detailed analysis and target areas for improvement Live national results By participating in this web-based survey hospitals receive immediate feedback on their pediatric readiness and can compare their results to other hospitals nationwide. This ongoing self-assessment is part of a larger initiative to ensure pediatric readiness and, thus, day-to-day pediatric disaster preparedness. The ultimate goal is to APRIL 2012 I 7 6

7 Participation Incentives Immediate feedback with comparison to similar hospitals Gap analysis to assist with meeting accreditation goals One year subscription to PEMSoft Broselow tape Live statewide/national results Preliminary Results Survey open from January April /335 (90%) completed the survey 252/335 (75%) will share data with LEMSAs 7

8 Preliminary Results Median number of children seen 5,000/yr [IQR ] Median overall volume 34,000 [IQR 18,660-50,599] ED Configuration: General ED 92% Standby 3% Peds ED or Separate Peds area 5% Preliminary Results Median overall readiness score: 70 [IQR ] 9 (3%) hospitals with a perfect readiness score Results by hospital pediatric ED volume Pediatric ED Volume Median ED Readiness Score Low (< 3700) 64.3 [IQR ] Med ( ) 71 [IQR ] High (> 7000) 79 [IQR ] p< How Are We Improving? 2003 vs 2012 Overall Median Pediatric Readiness Score

9 Median Pediatric Readiness Score for Emergency Departments by Pediatric Patient Volume Low Volume (<1800pts/yr) Medium Volume ( pts/yr) Medium-High Volume ( pts/yr) High Volume ( 10,000pts/yr) 2012 Median 2003 Median 2012 Median 2003 Median 2012 Median 2003 Median 2012 Median 2003 Median Preliminary Results: Areas for Focus Physician and Nurse Coordinators Quality Improvement Plans Disaster Plans Pediatric Triage Tool National Pediatric Readiness Project beginning in January 2013 GET READY FOR KIDS! 9

10 Na#onal Project Implementa#on WHAT ROLE CAN EMS PLAY IN PEDIATRIC READINESS? Los Angeles County: Emergency Departments Approved for Pediatrics 73 acute care hospitals 44 EDAP s, 29 non-edap s ED designation by EMS agency to receive 911 traffic of pediatric patients Requirements Pediatric equipment Physician coverage Ongoing pediatric education Pediatric policies A designated Pediatric Liaison Nurse (PdLN) 10

11 Los Angeles County: Emergency Departments Approved for Pediatrics PdLN responsible for pediatric-specific quality improvement via chart audits and development of response programs EDAP standards mirror state and national guidelines for pediatric readiness Annual verification process to ensure ongoing pediatric readiness Requirement for continuing education in pediatric emergency care What Role Can EMS Play in Pediatric Readiness? State of California EMS Authority State partnership grant to support the California Pediatric Readiness Project Fund a statewide educational forum Increase awareness of pediatric readiness Develop a system to recognize hospitals capable of managing pediatric emergencies Address EMSC performance measures 11

12 What Role Can EMS Play in Pediatric Readiness? Appoint a pediatric emergency medicine coordinator to oversee regional activities Develop a pediatric advisory council to ensure the needs of children are met Develop a verification system to encourage pediatric readiness Goal: Universal Baseline Readiness - transport children regardless of geographic location Pediatric Readiness Toolkit 12