A Coordinated Effort to Improve Pediatric Emergency Care

Pediatric Emergency Care

When children require emergency care, they are much more likely to receive that care at a general emergency department (ED) than a specialized pediatric ED. So how can general EDs ensure that they are prepared to deliver optimal care to pediatric patients when the need arises?

Appointment of a pediatric emergency care coordinator (PECC) is considered the single best intervention to improve pediatric emergency care and has been recommended for all U.S. general EDs for more than a decade.

PECC roles can be filled by either a physician, nurse, or other ED staff member who has training, education and expertise in the unique needs of pediatric emergency patients.

According to the American Association of Pediatrics (AAP) and Emergency Medical Services for Children (EMSC), PECC roles and responsibilities can include:

  • Working with clinical leadership to ensure the availability and readiness of pediatric equipment, medications, staff members and other resources
  • Facilitating pediatric-focused quality improvement and performance improvement activities within the ED
  • Promoting patient and family education in topics related illness and injury prevention
  • Developing a disaster preparedness plan that incorporates the specific care needs of pediatric patients

A Decade of Advocacy

National medical organizations have been advocating for the systemwide appointment of PECCs for more than a decade.

In a 2006 report on the future of emergency care in the United States, the Institute of Medicine (IOM) wrote, “Children who are injured or ill have different medical needs than adults with the same problems. They have different heart rates, blood pressures, and respiratory rates, and these change as they grow. They often need equipment that is smaller than what is used for adults, and they require medication in much more carefully calculated doses.”

Despite these clear calls to action, the appointment rate of PECCs across the United States is still very low, notes Krislyn Boggs, MPH, Senior Research Coordinator for the Emergency Medicine Network (EMNet) Coordinating Center at Massachusetts General Hospital.

In recent years—a decade after the IOM made its initial recommendation— EMNet has found that only about 15-20% of EDs nationwide had appointed a PECC.

In 2017, the EMNet team collaborated with the MA College of Emergency Physician on a grassroots campaign to increase the appointment rates of PECCs in Massachusetts.

Their efforts, which the team recently summarized in Academic Emergency Medicine, have been remarkably successful so far.

In less than two years, the team was able to increase the PECC appointment rate in Massachusetts from 34% in early 2017 to 100% by mid-2018.

While the benefits of appointing PECCs are clear, Boggs acknowledges that the proposition is not always an easy sell, especially for ED directors who are already stretched for time, space and resources.

“We tried to make it feasible for everyone, and it required multiple callbacks at some places, but we were able to help all Massachusetts EDs to find someone who could dedicate least a few hours per month to the role,” Boggs says. “Often the ED directors took the role on themselves.”

Expanding Their Efforts

The EMNet team is now working on efforts to expand PECC appointments in additional states, in New England and beyond, through collaborations with volunteer groups in those states. They also send emails to their network of appointed PECCs in MA to keep them engaged in the process and highlight opportunities for training and education.

Additionally, the team is exploring ways to measure the impact of having a PECC on actual patient outcomes, and ways to measure changes in patient care. Finally, EMNet continues to update the availability of PECCs in all U.S. EDs in their publicly available findERnow smartphone app, which helps users quickly find the closest EDs.

While there is much work still to be done, the team has been encouraged by their progress so far.

“We all like to have this positive impact,” Boggs says. “I think it’s cool to see this change occur over a year and a half, and we are continuing to support the network and work with other states. It’s been very rewarding.”

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