RESUMEN
OBJECTIVE: This study was designed to assess the impact of a brief educational video shown to parents during an emergency department visit for minor febrile illnesses. We hypothesized that a video about home management of fever would reduce medically unnecessary return emergency department visits for future febrile episodes. METHODS: A convenience sample of 280 caregivers presenting to one urban pediatric emergency department was enrolled in this prospective, randomized cohort study. All the caregivers presented with a child aged 3 to 36 months with complaint of fever and were independently triaged as nonemergent. A pretest and posttest were administered to assess baseline knowledge and attitudes about fever. One hundred forty subjects were randomized to view either an 11-minute video about home management of fever or a control video about child safety. Subjects were tracked prospectively, and all return visits for fever complaints were independently reviewed by 3 pediatric emergency physicians to determine medical necessity. RESULTS: There were no differences between the fever video and the control groups in baseline demographics (eg, demographically comparable). The fever video group had a significant improvement in several measures relating to knowledge and attitudes about childhood fever. There was no statistical difference between the intervention and control groups in subsequent return visits or in the determination of medical necessity. CONCLUSIONS: A brief standardized video about home management of fever improved caregiver knowledge of fever but did not decrease emergency department use or increase medical necessity for subsequent febrile episodes.
Asunto(s)
Fiebre/diagnóstico , Educación en Salud , Unidades de Cuidado Intensivo Pediátrico , Padres/educación , Adolescente , Adulto , Preescolar , Escolaridad , Femenino , Fiebre/terapia , Estudios de Seguimiento , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Triaje , Estados Unidos , Adulto JovenRESUMEN
PURPOSE: One of the most critical resuscitation skills in pediatric emergency medicine is establishing and maintaining a patent airway. This often requires tracheal intubation (TI). The purpose of this survey study was to determine the practice of TI in pediatric emergency departments (PEDs) and the methods used by PED medical directors to maintain TI competency among PED physicians. METHODS: This is an observational survey study. Medical directors of PEDs were surveyed through e-mail (http://web-online-surveys.com). There were 20 survey questions: 4 yes/no and 16 multiple choice. RESULTS: Of the 108 PED medical directors who were surveyed, 61 (57%) completed the questionnaire. The mean number of TI per PED for 1 year was 63.7; SD, 79.3; median, 37; range, 3 to 400. The mean percentage of TI that were rapid sequence intubations was 76%; SD, 19.8%; median, 83%; range, 30% to 100%. The physician types most commonly performing TI on nontrauma versus trauma patients were as follows: pediatric emergency medicine, 50 (82%) versus 43 (70%); emergency medicine, 4 (7%) versus 4 (7%); and anesthesiology, 1 (2%) versus 4 (7%). The physician types most commonly consulted for difficult airway patients were: anesthesiology, 40 (66%); and pediatric critical care, 14 (23%). Alternative or rescue airway equipment/procedures available to PED were as follows: laryngeal mask airway (LMA), 50 (90%); needle cricothyroidotomy, 47 (77%); fiberoptic scope, 34 (56%); and tracheal tube introducer, 22 (36%). There were 38 (62%) PED medical directors who judged the number of TI opportunities to be inadequate to maintain TI competency among their physicians. The following activities reported as required for remedial training or to maintain TI competency were: pediatric advanced life support/advanced pediatric life support courses, 42 (69%); simulation training, 29 (48%); perform TI under the supervision of an anesthesiologist, 23 (38%); advance airway course, 21 (34%); and/or none, 1 (2%). CONCLUSIONS: Most PED TI for both nontrauma and trauma patients were performed by PED physicians. Most of these were rapid sequence intubations. The number of TI per PED had a large range. Most PED medical directors judged this number to be inadequate to maintain TI competency. Didactic activities to maintain TI skills were most common, but many other activities were used.
Asunto(s)
Competencia Clínica , Servicio de Urgencia en Hospital/estadística & datos numéricos , Intubación Intratraqueal/estadística & datos numéricos , Pediatría , Ejecutivos Médicos , Hospitales Pediátricos , Humanos , Intubación Intratraqueal/instrumentación , Medicina , Especialización , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To describe the practice reported by pediatric emergency department (PED) medical directors regarding age limits and transition of health care in their emergency departments and institutions. METHODS: A 28-question survey was sent by e-mail to 116 PED medical directors. Descriptive statistics were used to report results; chi tests were used for comparing categorical data. RESULTS: The survey was completed by 73 PED medical directors (63%). Age-limit policies were present in 58 (79%) of the PEDs, and 56 reported a specific age. The 18th and 21st birthdays were the most common specific ages cited. Thirty-six PEDs (64%) had an age limit of younger than 21 years. Pediatric emergency departments with age limits of 21 years or older versus younger than 21 years had a significantly higher rate of being associated with freestanding children's hospitals (P = 0.037). Appropriate exceptions to the age-limit policy included patients both over and under the age limit. The most common overage limit exception was cystic fibrosis, and the most common underage limit exception was teenage pregnancy. Thirteen PED medical directors (18%) were aware of a transition-of-care (pediatric to adult care provider) policy or work group at their institution, and 47 (64%) thought that such a work group would be valuable to addressing transition-of-care issues. CONCLUSION: In pediatric emergency medicine, the age of transition from pediatric to adult emergency care providers is variable both between and within institutions. Most PEDs have age limits of younger than 21 years. Most PED medical directors support a multidisciplinary work group or committee as a method of addressing transition of care. Known barriers to transition of care previously reported in the literature are reviewed.