Schumacher, DJ; Holmboe, ES; van der Vleuten, C; Busari, JO; Carraccio, C. Developing Resident-Sensitive Quality Measures A Model From Pediatric Emergency Medicine. Academic Medicine. 2018; 93(7):1071-1078.
To begin closing the gap with respect to quality measures available for use among residents, the authors sought to identify and develop resident-sensitive quality measures (RSQMs) for use in the pediatric emergency department setting. The review of national quality measures identified 28 of 183 as being potentially resident sensitive. A nominal group technique ranked 18 measures for asthma, 21 for bronchiolitis, and 21 for closed head injury. This study describes a template for identifying and developing RSQMs that may promote high-quality care delivery during and following training.
Merianos, AL; Jandarov, RA; Mahabee-Gittens, EM. Adolescent Tobacco Smoke Exposure, Respiratory Symptoms, and Emergency Department Use. Pediatrics. 2018; 142(3).
This study examined the relationship between distinct tobacco smoke exposure (TSE) measures and TSE-related symptoms and emergency department (ED) and/or urgent care (UC) use among nonsmoking adolescents without asthma diagnoses in a national survey of adolescent health. Different TSE measures uniquely increased the risk of TSE-related symptoms, but any TSE increased the risk of having a higher number of ED and/or UC visits. Providers at these high-volume settings should offer interventions to adolescents who are exposed to tobacco smoke and their families to decrease these symptoms and related morbidity.
Chan, S; Babcock, L; Geis, G; Frey, M; Robinson, V; Kerrey, B. In Situ Simulation to Mitigate Threats to Participation in a Multicenter Clinical Trial in High-Acuity, Low-Frequency Setting. Simulation in Healthcare. 2019; 14(1):9-Jan.
Multicenter clinical trials of high-acuity, low-frequency emergencies are expensive and resource intensive. This study described use of in situ simulation (ISS) to identify and mitigate threats to enrollment, protocol adherence, and patient safety in preparation for a multicenter clinical trial of antiepileptics for status epilepticus in the emergency department. The addition of ISS to standard preparation for a multicenter clinical trial facilitated the identification and mitigation of threats to study participation and patient safety.
Hoehn, EF; Overmann, KM; Fananapazir, N; Simonton, K; Makoroff, KL; Bennett, BL; Duma, EM; Kurowski, EM. Improving Emergency Department Care for Pediatric Victims of Sexual Abuse. Pediatrics. 2018; 142(6).
Evidence-based medical care of sexual abuse victims who present to the pediatric emergency department (PED) is necessary to facilitate forensic evidence collection and prevent pregnancy and sexually transmitted infections. Using improvement methodology, algorithm-adherent evaluation and management of patients presenting for sexual abuse were improved close to the goal of 90%. Targeted education and an electronic order set were associated with improved adherence to a novel care algorithm.
Frey, TM; Florin, TA; Caruso, M; Zhang, N; Zhang, Y; Mittiga, MR. Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children The PRIME Randomized Clinical Trial. JAMA Pediatrics. 2019; 173(2):140-146.
In this noninferiority randomized clinical trial of 90 children presenting to emergency departments with pain due to traumatic limb injury, intranasal ketamine was noninferior to intranasal fentanyl for pain relief, with mean reductions in visual analog scale pain scores of 30.6 mm and 31.9 mm, respectively, at 30 minutes after intervention. Ketamine provides effective analgesia that is not inferior to fentanyl, although participants who received ketamine had an increase in adverse events that were minor and transient; intranasal ketamine may be an appropriate alternative to opioids for pain associated with acute extremity injuries.