Differences in the quality of pediatric resuscitative care across a spectrum of emergency departments

Marc Auerbach, Travis Whitfill, Marcie Gawel, David Kessler, Barbara Walsh, Sandeep Gangadharan, Melinda Fiedor Hamilton, Brian Schultz, Akira Nishisaki, Khoon Yen Tay, Megan Lavoie, Jessica Katznelson, Robert A Dudas, Janette Baird, Vinay Nadkarni, Linda Brown

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Abstract

IMPORTANCE The quality of pediatric resuscitative care delivered across the spectrum of emergency departments (EDs) in the United States is poorly described. In a recent study, more than 4000 EDs completed the Pediatric Readiness Survey (PRS); however, the correlation of PRS scores with the quality of simulated or real patient care has not been described. OBJECTIVE To measure and compare the quality of resuscitative care delivered to simulated pediatric patients across a spectrum of EDs and to examine the correlation of PRS scores with quality measures. DESIGN, SETTING, AND PARTICIPANTS This prospective multicenter cohort study evaluated 58 interprofessional teams in their native pediatric or general ED resuscitation bays caring for a series of 3 simulated critically ill patients (sepsis, seizure, and cardiac arrest). MAIN OUTCOMES AND MEASURES A composite quality score (CQS)was measured as the sum of 4 domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. Pediatric Readiness Survey scores and health care professional demographics were collected as independent data. Correlations were explored between CQS and individual domain scores with PRS. RESULTS Overall, 58 teams from 30 hospitals participated (8 pediatric EDs [PEDs], 22 general EDs [GEDs]). The mean CQS was 71 (95%CI, 68-75); PEDs had a higher mean CQS (82; 95% CI, 79-85) vs GEDs (66; 95%CI, 63-69) and outperformed GEDs in all domains. However, when using generalized estimating equations to estimate CQS controlling for clustering of the data, PED status did not explain a higher CQS (β = 4.28; 95%CI, -4.58 to 13.13) while the log of pediatric patient volume did explain a higher CQS (β = 9.57; 95%CI, 2.64-16.49). The correlation of CQS to PRS was moderate (r = 0.51; P < .001). The correlation was weak for cardiac arrest (r = 0.24; P = .07), weak for sepsis (ρ = 0.45; P < .001) and seizure (ρ = 0.43; P = .001), and strong for teamwork (ρ = 0.71; P < .001). CONCLUSIONS AND RELEVANCE This multicenter study noted significant differences in the quality of simulated pediatric resuscitative care across a spectrum of EDs. The CQS was higher in PEDs compared with GEDs. However, when controlling for pediatric patient volume and other variables in a multivariable model, PED status does not explain a higher CQS while pediatric patient volume does. The correlation of the PRS was moderate for simulation-based measures of quality.

Original languageEnglish (US)
Pages (from-to)987-994
Number of pages8
JournalJAMA Pediatrics
Volume170
Issue number10
DOIs
Publication statusPublished - Oct 1 2016

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ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Auerbach, M., Whitfill, T., Gawel, M., Kessler, D., Walsh, B., Gangadharan, S., ... Brown, L. (2016). Differences in the quality of pediatric resuscitative care across a spectrum of emergency departments. JAMA Pediatrics, 170(10), 987-994. https://doi.org/10.1001/jamapediatrics.2016.1550