Newsletters

POSTED: October 14th, 2022
POSTED IN: EM Pulse - The Official Newsletter of MOCEP, September/October 2022,

Results of a Statewide Pediatric Emergency Medicine Needs Assessment Survey

MaryBeth Bernardin MD FAAP,¹ Allie Grither MD²
1. Assistant Professor of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, Columbia MO
2. Assistant Professor of Pediatric Emergency Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis MO

Over 30 million children are evaluated in emergency departments (ED) in the US annually, but the vast majority (90%) of these pediatric patients are cared for by general rather than pediatric emergency providers [1]. While general emergency medicine (GEM) physicians receive training in the care of pediatric patients and are considered qualified to provide such care, studies have shown that many (73%) express difficulties managing pediatric emergencies, and most (96%) report that their pediatric training should be improved [2]. Similarly, graduates of pediatric residency often struggle to provide pediatric care in emergent/urgent care settings, and 81% of respondents in one study recommended that pediatricians received additional training in order to practice in these locations [3]. With the hopes of addressing issues related to the emergency medical care of pediatric patients across Missouri, MOCEP recently created a pediatric emergency medicine (PEM) committee. The first action item on the PEM committee’s agenda was the creation and administration of a PEM needs assessment, aimed at evaluating specific barriers to providing ideal pediatric care. This electronic survey was administered via email to providers across Missouri from June 17-July 15, 2022.

Forty-nine providers completed the survey, 69% of whom were MOCEP members. Respondents were mostly general EM boarded attending physicians (49%) and PEM attendings (25%), in addition to 16% EM residents, 6% fellows and 2% physician assistants. Among the attending physicians, 51% had been practicing EM for over 10 years, 22% for 6-10 years, and 27% for 0-5 years. Sixty-seven percent reported practicing at an academic/teaching hospital while 37% practice in a community hospital and 2% in an urgent care clinic.

Thirty-five percent of respondents reported that at their institution, pediatric patients are primarily cared for in the general ED, versus 31% of children receiving care in an affiliated freestanding pediatric ED, and 29% in a designated pediatric ED/pod within a general ED. The majority of respondents (65%) believed that most pediatric patients at their facility are cared for by PEM trained physicians, while 31% reported most are cared for by GEM physicians, 2% by physician assistants or advanced practice nurses, and 2% by pediatricians. Most respondents (60%) estimated that less than 25% of their personal patient encounters are pediatric, while 32% estimated having more than 75% pediatric patient encounters.

A previous study reported that 64% of GEMs expressed discomfort and difficulty caring for specific types of pediatric emergencies [2]. Ninety-five percent of GEM attendings in our study reported having identified personal pediatric knowledge deficiencies, the most common of which were managing medically complex children (55%) and critically ill infants (30%), followed by pediatric medical resuscitations (5%), pediatric traumatic injuries (5%) and pediatric behavioral health crises (5%). Amongst PEM attendings, 73% reported no pediatric knowledge deficiencies, while others reported deficiencies managing medically complex children (18%) and critically ill infants (9%).

Previous research has shown that health care professionals would prefer to obtain pediatric care recommendations through protocols, clinical pathways and practice guidelines [4]. However, since these resources are often not available, providers in one study reported that they obtained most of their pediatric information through talking to coworkers (82%) or visiting websites (68%) [4]. When asked in what ways respondents and/or their organizations could benefit from a PEM MOCEP committee, sharing of PEM practice guidelines/evidence-based protocols was the primary answer amongst 85% of respondents, including being the top answer amongst GEM (88%) and PEM (75%) providers. In addition to PEM guidelines/protocols, GEMs felt that they would most benefit from help with pediatric readiness (63%), access to educational webinars (38%) and online informational papers on PEM topics (33%), as well as opportunities for professional development (33%). Following PEM guidelines/protocols, PEM providers felt that they would benefit most from opportunities to collaborate on PEM research (58%), participate in PEM quality improvement projects (58%), child advocacy (58%) and child health policy (50%), in addition to opportunities to network with other providers interested in PEM (50%). Similarly, to GEM and PEM attending respondents, sharing of PEM guidelines/protocols was the top answer amongst 100% of EM resident respondents, followed by access to online informational papers on PEM topics (63%), help with pediatric readiness (50%) and opportunities to participate in child advocacy (50%).

In a previous qualitative study of knowledge sharing between general and pediatric EDs, researchers found that embedding easily accessible information and resources into local systems promoted standards of care and supported practice change [5]. In response to consistent calls for accessible PEM resources, the MOCEP PEM committee will prioritize dissemination of clinical pathways, protocols and practice guidelines to enhance pediatric knowledge, streamline management of PEM emergencies and enhance pediatric readiness. Facilitating opportunities for pediatric research collaboration in addition to child advocacy and health policy will also be a top priority. We thank you for your participation and feedback regarding PEM-related practice needs and look forward to strengthening and supporting the care of ill and injured children across Missouri.

References:

[1]      Whitfill T, Auerbach M, Scherzer DJ, Shi J, Xiang H, Stanley RM. Emergency Care for Children in the United States: Epidemiology and Trends Over Time. J Emerg Med 2018;55:423–34. https://doi.org/10.1016/j.jemermed.2018.04.019.

[2]      Lecadet N, Roupie E, Macrez R, Jokic M, Brossier D. Assessment of general emergency medicine physicians’ medical education regarding management of pediatric emergencies in western Normandy, France. Arch Pediatr 2020;27:239–43. https://doi.org/10.1016/j.arcped.2020.05.005.

[3]      Zhao X, Koutroulis I, Cohen J, Berkowitz D. Pediatric urgent care education: A survey-based needs assessment. BMC Health Serv Res 2019;19:1–6. https://doi.org/10.1186/s12913-019-4241-8.

[4]      Scott SD, Albrecht L, Given LM, Hartling L, Johnson DW, Jabbour M, et al. Pediatric information seeking behaviour, information needs, and information preferences of health care professionals in general emergency departments: Results from the Translating Emergency Knowledge for Kids (TREKK) Needs Assessment. Can J Emerg Med 2018;20:89–99. https://doi.org/10.1017/cem.2016.406.

[5]      Crockett LK, Leggett C, Curran JA, Knisley L, Brockman G, Scott SD, et al. Knowledge sharing between general and pediatric emergency departments: connections, barriers and opportunities. Can J Emerg Med 2018;22:1–9. https://doi.org/10.1017/cem.2018.7.