Dare to Lead…and Reap the Rewards Wallin, Dina
Annals of Emergency Medicine,
November 2019, 2019-11-00, Volume:
74, Issue:
5
Book Review, Journal Article
The role of telehealth in pediatric emergency care Saidinejad, Mohsen; Barata, Isabel; Foster, Ashley ...
Journal of the American College of Emergency Physicians Open,
June 2023, Volume:
4, Issue:
3
Journal Article
Peer reviewed
Open access
In 2006, the Institute of Medicine published a report titled “Emergency Care for Children: Growing Pains,” in which it described pediatric emergency care as uneven at best. Since then, telehealth has ...emerged as one of the great equalizers in care of children, particularly for those in rural and underresourced communities. Clinicians in these settings may lack pediatric‐specific specialization or experience in caring for critically ill or injured children. Telehealth consultation can provide timely and safe management for many medical problems in children and can prevent many unnecessary and often long transport to a pediatric center while avoiding delays in care, especially for time‐sensitive and acute interventions. Telehealth is an important component of pediatric readiness of hospitals and is a valuable tool in facilitating health care access in low resourced and critical access areas. This paper provides an overview of meaningful applications of telehealth programs in pediatric emergency medicine, discusses the impact of the COVID‐19 pandemic on these services, and highlights challenges in setting up, adopting, and maintaining telehealth services.
Abstract Background Osteomyelitis is not an uncommon emergency department diagnosis in pediatric patients, and most cases are in the lower extremities. Children can present with acute, subacute, or ...chronic erythema, pain, swelling, or decreased use of the extremity; some patients will also have fever or elevated serum inflammatory markers, or both. Case Report We present the case of a healthy 5-year-old girl who presented to the emergency department with 3 weeks of painless chin swelling and 2 days of erythema and pain. While laboratory testing was normal, magnetic resonance imaging demonstrated osteomyelitis of the mandible, later confirmed by biopsy. After 4 weeks of intravenous antibiotics and an additional 2 weeks of oral antibiotics, the patient recovered completely without any residual findings. Why Should an Emergency Physician Be Aware of This? This case demonstrates that osteomyelitis can develop in previously healthy, fully vaccinated children with competent immune systems. Systemic findings (ie, fever and elevated serum inflammatory markers) may be absent, and osteomyelitis should always be considered in the differential diagnosis for a child presenting with subacute to chronic cutaneous findings without other clear explanation.
OBJECTIVESThe percentage of discharged emergency department (ED) patients who read discharge instructions (DCIs) is unknown. In this study of parents of pediatric ED patients, we attempt to quantify ...the DCI readership rate and identify variables associated with readership. We hypothesized that few families would read their childʼs DCIs.
METHODSWe conducted a prospective, randomized study of parents of pediatric patients who were discharged home from the ED. We randomized participants to receive a study invitation as either the second or the second to last page of their DCIs. We incentivized study participation with a $10 gift card and then used the invitation response rate as a proxy for DCI readership. We utilized logistic regression to identify predictor variables showing significant association with readership.
RESULTSOne thousand patients were randomized; 963 were included in the final analysis. Eighty-four subjects, 8.8% (95% confidence interval, 7.0%–10.7%), responded to investigators. In the final regression model, private insurance (adjusted odds ratio, 1.76; P = 0.036), placement of the study invitation early within DCIs (adjusted odds ratio, 1.93; P = 0.011), and laceration diagnosis (adjusted odds ratio, 2.97; P = 0.012) predicted readership, whereas parents of Hispanic children were less likely to respond, even after adjustment for language spoken (adjusted odds ratio, 0.57; P = 0.028).
CONCLUSIONSA minority of parents of patients discharged from the pediatric ED appear to read through their childʼs DCIs, with Hispanic families and those without private insurance least likely to read. Future research can explore how best to reach these particularly vulnerable families.
Traditional recommendations suggest placement of a subclavian central venous catheter (CVC) ipsilateral to a known pneumothorax to minimize risk of bilateral pneumothorax. We present the case of a ...65-year-old male with a right hemopneumothorax who was found to have intrathoracic placement of his right subclavian CVC at thoracotomy despite successful aspiration of blood and transduction of central venous pressure (CVP). We thus recommend extreme caution with the interpretation of CVC placement by blood aspiration and CVP measurement alone in patients with large volume ipsilateral hemothorax.
Advance care planning (ACP) benefits emergency department (ED) patients with advanced illness. Although Medicare implemented physician reimbursement for ACP discussions in 2016, early studies found ...limited uptake.
We conducted a pilot study to assess ACP documentation and billing to inform the development of ED-based interventions to increase ACP.
We conducted a retrospective chart review to quantify the proportion of ED patients with advanced illness with Physician Orders for Life-Sustaining Treatment (POLST) or coding of ACP discussion in the medical record. We surveyed a subset of patients via phone to evaluate ACP participation.
Of 186 patients included in the chart review, 68 (37%) had a POLST and none had ACP discussions billed. Of 50 patients surveyed, 18 (36%) recalled prior ACP discussions.
Given the low uptake of ACP discussions in ED patients with advanced illness, the ED may be an underused setting for interventions to increase ACP discussions and documentation.
Pediatric patients cared for in emergency departments (EDs) are at high risk of medication errors for a variety of reasons. A multidisciplinary panel was convened by the Emergency Medical Services ...for Children program and the American Academy of Pediatrics Committee on Pediatric Emergency Medicine to initiate a discussion on medication safety in the ED. Top opportunities identified to improve medication safety include using kilogram-only weight-based dosing, optimizing computerized physician order entry by using clinical decision support, developing a standard formulary for pediatric patients while limiting variability of medication concentrations, using pharmacist support within EDs, enhancing training of medical professionals, systematizing the dispensing and administration of medications within the ED, and addressing challenges for home medication administration before discharge.
Pediatric Readiness in the Emergency Department Remick, Katherine; Gausche-Hill, Marianne; Joseph, Madeline M. ...
Annals of emergency medicine,
December 2018, 2018-12-00, 20181201, Volume:
72, Issue:
6
Journal Article
Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for ...children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are referred to the ED for evaluation of a broad spectrum of MBH emergencies, from depression and suicidality to disruptive and aggressive behavior. However, challenges in providing optimal care to these patients include lack of personnel, capacity, and infrastructure, challenges with timely access to a mental health professional, the nature of a busy ED environment, and paucity of outpatient post-ED discharge resources. These factors contribute to prolonged ED stays and boarding, which negatively affects patient care and ED operations. Strategies to improve care for MBH emergencies, including systems level coordination of care, is therefore essential. The goal of this policy statement and its companion technical report is to highlight strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH.
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