A Year s Progress Toward ED Pediatric Readiness in Kentucky
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- Betty Powell
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1 A Year s Progress Toward ED Pediatric Readiness in Kentucky Mark J. McDonald, M.D. Medical Director Norton Children s Hospital Associate Professor, U of L SOM Department of Pediatrics Division of Critical Care
2 Objectives Review how we got to today Current support and obstacles Guideline discussion Plan to move forward
3 Acknowledgment of funding
4 Mission All children deserve timely access to emergency departments that are ready to provide immediate and appropriate care based on national guidelines for the care of children in emergency departments
5 Definition Pediatric Readiness means that an Emergency Department has the policies, processes, staff, and equipment available to treat children, including the ability to recognize when a child may need more specialized care.
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7 Why the mission is important 26% of the US population are children 31 million children are seen in EDs each year 70% are seen in EDs that see fewer than 15 pediatric patients per day 83% are seen in nonchildren s hospitals Variability in readiness Variability in care Variability in outcomes
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13 Just go to the high volume center EMS does not transport all critically ill children Most caregivers do not know the location of the closest emergency department prepared to treat pediatric patients Caregivers will not drive past emergency signs with sick children Up to 83% of children are treated in general or community emergency departments, not in specialty children s hospitals
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16 8% of all EDs are recognized
17 8% of all EDs are recognized 5 states have greater than 25% of EDs recognized (range 1-100%)
18 States with Pediatric Readiness Recognition Programs Alaska-4 tiers Arizona-3 tiers California-3 tiers Delaware-4 tiers **Illinois-3 tiers Montana-2 tiers **New Jersey-single tier Ohio-single tier **Tennessee-4 tiers Utah-3 tiers West Virginia-single tier
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21 Lessons Learned Nationally There is not a national recognition standard Most states partner trauma and EMS Few with state legislature Most voluntary Carrot approach educational resources, guidelines, simulations, transfer agreements
22 Verifying Bodies State Department of Health State AAP chapter State EMSC Trauma verification by American College of Surgeons and Trauma Advisory Committee with KHA
23 Joint Commission Pediatric mandate 4 core areas Weights Quality improvement Pediatric coordinators Equipment child abuse policies, disaster preparedness, transport agreements, ongoing CE
24 KY Timeline January, 2016 A key stakeholders meeting around pediatric readiness. Marriott, Louisville, KY. Funded by KY EMSC. Approximately 30 people attended this meeting. 2 day meeting
25 Timeline March, applied to EMSC QI collaborative to be part of national program focused on Pediatric Readiness supported by grant # U07MC April, 2016 Accepted into National EMSC QI collaborative. May, Kentucky representatives attended 2 day EMSC QI collaborative in Bethesda Maryland.
26 Participants Colorado Connecticut District of Columbia Florida Indiana Kansas Kentucky Louisiana Michigan New York New Mexico Oklahoma Pennsylvania South Carolina Texas
27 States with Pediatric Readiness Recognition Programs Alaska-4 tiers Arizona-3 tiers California-3 tiers Delaware-4 tiers **Illinois-3 tiers Montana-2 tiers **New Jersey-single tier Ohio-single tier **Tennessee-4 tiers Utah-3 tiers West Virginia-single tier
28 Timeline May, Formed KY Pediatric Emergency Care Coalition (KPECC). June 24, 2016 AAP nationally announces its support of the National EMSC movement to establish a National Pediatric ED Facility Recognition program for all states June-July, Formed Steering Committee for KY Pediatric Readiness KPECC plus Jeff Grill, MD, President of the AAP, Wes Brewer, M.D., President of ACEP, and Mary Raley, RN, President of ENA. July, Started monthly conference calls with steering committee.
29 Kentucky Aim Statement: The KY Pediatric Emergency Care Coalition will develop and approve an implementation plan for the recognition of EDs who are ready to stabilize and/or manage children based on national guidelines. Describe Last Test for Change (Improvement Effort): We have completed our improvement team and are meeting monthly via GoToMeeting. Several team members have had speaking engagements with various stakeholder groups and articles in several publications. Regional Healthcare Preparedness Coalitions Regional Rural Health Networking groups KY Office of Rural Health quarterly magazine - profile of KYEMSC and peds ready issues ACEP Board of Directors KHA physician leadership Hospital corporation newsletter article on pediatric readiness Statewide Trauma and Emergency Medicine Symposium Plan/Objective for next cycle/month: Review existing criteria in other states and begin selection of KY criteria. Planning for larger stakeholder meeting in Jan/Feb Anticipated Enablers and/or Barriers: Challenges with time and scheduling, concerns about financial impact, competing interests. Increasing awareness and interest in program. Tools/Resources: Shared copies of articles and slide sets.
30 July October, Raised awareness about Pediatric Readiness. Ashlee Melendez presented a Pediatric Readiness PowerPoint presentation at the ACEP Board of Directors meeting. Discussed with multiple CMOs in the state including Timothy Jahn (Baptist Healthcare), Pat Alagia (KentuckyOne Health), Steve Hester (Norton Healthcare) Print: Emergency Department Pediatric Readiness, Kentucky One Health Doc to Doc, 7/25/2016. Emergency Department Pediatric Readiness White Paper, Norton Healthcare, 7/2016. Emergency Department Pediatric Readiness, Kentucky Hospital Research & Education Foundation Emergency Preparedness Update for 8/3/2016 (Update 1).
31 July October, Raised awareness about Pediatric Readiness. Presented to Baptist Health KY System Emergency Medicine Service Line, 8/2016 Emergency Department Pediatric Readiness, Physician Leadership Forum, Kentucky Hospital Association, Louisville, KY 10/2016 Sept, The hospital preparedness program at a federal level adds a number of pediatric readiness performance measures to their guidelines to take effect in July, Oct, KHA asks to distribute pediatric readiness PowerPoint to other Hospital emergency departments across the state.
32 Timeline Discussed with Hiram Polk, MD, State Health Commissioner for the KY Department for Public Health, 10/2016 Emergency Department Pediatric Readiness, Kentucky Trauma Symposium, 10/2016 Oct-Nov, 2016 Discussed with Senator Alvarado. Wants KHA on board.
33 Nov 10, 2016 KHA Memorandum KHA is not willing to sponsor or endorse any legislation or regulations related to Pediatric Readiness or Facility Recognition at this time - even if it is intended to create an enabling processes for a voluntary program like the trauma care system. majority of the people in Hospital C suites do not have any idea what this program is about want a completely voluntary program
34 First KY Pediatric Emergency Care Coalition (KPECC) meeting January 18, 2017
35 EMSC QI Collaborative Work Groups Analytics work group Intervention work group Education work group
36 Analytics Phase 1 Understanding Your State s Framework Phase 2 Research Phase 3 Stakeholder Agreement Phase 4 Implementation Plan Phase 5 Piloting and Recognition
37 Education work group
38 Intervention work group Criteria necessary for ED pediatric readiness Criteria necessary to encourage voluntary participation What score on a 100 point scale = pediatric ready?
39 Intervention work group Minimum criteria Attainable with support Stretch goals
40 Intervention Guideline Domains Administration and coordination MDs, RNs and other healthcare providers QI Patient safety Policies, procedures, protocols Support services Equipment, supplies, and medications
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43 JAMA Pediatr. 2015;169(6):
44 JAMA Pediatr. 2015;169(6):
45 National Either physician, advanced practice provider, or nurse coordinator at the minimum Stretch goal both physician and nurse coordinator. An advanced practice provider may substitute for the physician?
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47 MD, RN Competencies Minimum MD/advanced care providers who staff the ED have specific CE and/or life support classes Only Non Ped/EM/PEM MDs?? RNs and other ED providers have specific CE and/or life support classes Baseline and periodic competency evaluations completed for nurses Stretch Baseline and periodic competency evaluations completed for MDs and advanced practitioners
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49 JAMA Pediatr. 2015;169(6):
50 70 of 103 KY hospitals said their QI/PI Process does not include children
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52 JAMA Pediatr. 2015;169(6):
53 Kentucky 44 hospitals record only kilogram weights 38 hospitals do not weigh and record weight in kilograms 21 hospitals record weights in kilograms and pounds
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57 JAMA Pediatr. 2015;169(6):
58 Kentucky 53 hospitals said their disaster plan does not address issues specific to the care of children
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60 Kentucky Does your hospital or medical facility have written inter-facility guidelines that outline procedural and administrative policies with other hospitals for the transfer of patients of all ages including children in need of care not available at your hospital? Yes 63 No 38 In Development 2 Does your hospital or medical facility have written inter-facility agreement(s) with other hospitals for the transfer of patient of all ages including children in need of care not available at your hospital? Yes 60 No 38 In Development 5
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66 Magill Studies show that 17% of emergency departments lack the equipment (pediatric Magill forceps) to remove the foreign body from the airway (JAMA Pediatrics 2015) Kentucky 26/101 EDs lacked Magill forceps
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70 Other Unavailable Items In 103 KY EDs 26 pediatric difficult airway kits 26 pediatric-sized Magill forceps 25 tracheostomy tube, size 4.0 mm 23 ETCO2 monitoring equipment 12 infant-sized NRB 9 infant-sized mask for BMV 8 ETT size 2.5 mm 7 childs-sized NRB 3 infant-sized, self-inflating, bag mask device
3+ 3+ N = 155, 442 3+ R 2 =.32 < < < 3+ N = 149, 685 3+ R 2 =.27 < < < 3+ N = 99, 752 3+ R 2 =.4 < < < 3+ N = 98, 887 3+ R 2 =.6 < < < 3+ N = 52, 624 3+ R 2 =.28 < < < 3+ N = 36, 281 3+ R 2 =.5 < < < 7+
TABLE 3c: Congressional Districts with Number and Percent of Hispanics* Living in Hard-to-Count (HTC) Census Tracts**
living Alaska 00 47,808 21,213 44.4 Alabama 01 20,661 3,288 15.9 Alabama 02 23,949 6,614 27.6 Alabama 03 20,225 3,247 16.1 Alabama 04 41,412 7,933 19.2 Alabama 05 34,388 11,863 34.5 Alabama 06 34,849 4,074
TABLE 3b: Congressional Districts Ranked by Percent of Hispanics* Living in Hard-to- Count (HTC) Census Tracts**
Rank State District Count (HTC) 1 New York 05 150,499 141,567 94.1 2 New York 08 133,453 109,629 82.1 3 Massachusetts 07 158,518 120,827 76.2 4 Michigan 13 47,921 36,145 75.4 5 Illinois 04 508,677 379,527
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States Ranked by August 2017 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 North Dakota 2.3 18 Maryland 3.9 36 New York 4.8 2 Colorado 2.4 18 Michigan 3.9 38 Delaware 4.9
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States Ranked by March 2016 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 South Dakota 2.5 19 Delaware 4.4 37 Georgia 5.5 2 New Hampshire 2.6 19 Massachusetts 4.4 37 North
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States Ranked by September 2017 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 North Dakota 2.4 17 Indiana 3.8 36 New Jersey 4.7 2 Colorado 2.5 17 Kansas 3.8 38 Pennsylvania
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States Ranked by November 2014 Unemployment Rate Seasonally Adjusted Unemployment Unemployment Unemployment 1 North Dakota 2.7 19 Pennsylvania 5.1 35 New Mexico 6.4 2 Nebraska 3.1 20 Wisconsin 5.2 38 Connecticut
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