Dataset Information

Pediatric emergency care coordinator workforce: A survey study.

ABSTRACT:

Objectives

The appointment of pediatric emergency care coordinators (PECC) in emergency departments (EDs) enhances pediatric readiness, yet little is understood regarding this workforce. We describe PECC role characteristics, responsibilities, barriers, and threats to the role among a national cohort.

Methods

We surveyed a sample of PECCs from all regions of the United States who participated in the Emergency Medical Services for Children PECC Workforce and Trauma Collaboratives (2021-2022). EDs were categorized by annual pediatric patient volume: low (<1800), medium (1800-4999), medium-high (5000-9999), and high (≥10,000). Trend tests were performed to explore the relationship between pediatric volume and PECC characteristics.

Results

Among 187 PECCs, 114 (61.0%) responded. The majority (75.2%) identified as a nurse. There was a significant difference in median hours per week spent on PECC activities by pediatric volume ranging from a median of 2 hours (interquartile range [IQR] 0.0-2.3) for low pediatric volume to 16 hours (IQR 4.0-37.0) for high pediatric volume (P < 0.001). Most respondents reported more time was needed for PECC activities (58.4%), and desired additional training to support the role (70.8%). Most (74.6%) felt the PECC position should be paid, yet 30.7% reported the role was voluntary. The most frequently assigned responsibilities were education of staff (77.2%) and oversight of quality improvement (QI) efforts (72.8%).

Conclusion

Characteristics of PECC workforce vary but PECC activities of education and QI work are common among all. There is a reported need for additional training and support. Further studies will determine the impact of PECC characteristics on pediatric readiness.

SUBMITTER: Foster AA

PROVIDER: S-EPMC10353296 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Publications

Pediatric emergency care coordinator workforce: A survey study.

Foster Ashley A AA Li Joyce J Wilkinson Matthew H MH Ely Michael M Gausche-Hill Marianne M Newgard Craig C Remick Katherine K

Journal of the American College of Emergency Physicians open 20230718 4

<h4>Objectives</h4>The appointment of pediatric emergency care coordinators (PECC) in emergency departments (EDs) enhances pediatric readiness, yet little is understood regarding this workforce. We describe PECC role characteristics, responsibilities, barriers, and threats to the role among a national cohort.<h4>Methods</h4>We surveyed a sample of PECCs from all regions of the United States who participated in the Emergency Medical Services for Children PECC Workforce and Trauma Collaboratives ( ...[more]

PMID: 37469489

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Project description:ImportanceHigher pediatric readiness has been associated with improved quality and outcomes of care for children. Pediatric emergency care coordinators (PECCs) are a component of pediatric readiness, but the specific association between PECCs and quality-of-care measures is undefined.ObjectiveTo examine the association between PECC presence and emergency department (ED) performance as reflected by quality-of-care measures.Design, setting, and participantsThis cohort study of ED patients 18 years or younger used data across 8 states, combining the 2019 National Emergency Department Inventory-USA, 2019 State Emergency Department Database and State Inpatient Database, 2020 Supplemental National Emergency Department Inventory PECC Survey, and the 2021 National Pediatric Readiness Project Survey. This analysis was conducted from February 15, 2023, to July 9, 2024.ExposurePresence of a PECC.Main outcomes and measuresHospitals were stratified by presence of pediatric resources (ie, pediatric intensive care and inpatient units), with exclusion of children's hospitals and comparison between pediatric-resourced and non-pediatric-resourced (unable to admit children, no pediatric intensive care unit) hospitals. The 7 measures chosen were length of stay longer than 1 day for discharged patients, left against medical advice or without completing treatment, death in the ED, return visits within 3 days, return visits with admission within 3 days, use of chest radiography in patients with asthma, and use of head computed tomography for patients with head trauma. For each stratum, multilevel generalized linear models were constructed to examine the association between PECC presence and process and utilization measure performance, adjusted for patient-level factors (age, sex, race and ethnicity, insurance, and complex chronic conditions) and ED-level factors (visit volume, patient census, and case mix [race and ethnicity, insurance, and complex chronic conditions]).ResultsThere were 4 645 937 visits from pediatric patients (mean [SD] age, 7.8 [6.1] years; 51% male and 49% female) to 858 hospitals, including 849 non-freestanding pediatric hospitals, in the analytic sample. Highly resourced pediatric centers were most likely to have a PECC (52 of 59 [88%]) compared with moderately resourced (54 of 156 [35%]) and non-pediatric-resourced hospitals (66 of 519 [13%]). Among the 599 non-pediatric-resourced hospitals, PECC presence was associated with decreased rates of computed tomography in head trauma (adjusted odds ratio [AOR], 0.76; 95% CI, 0.66-0.87); in the pediatric-resourced hospitals, the AOR was 0.85 (95% CI, 0.73-1.00). For patients with asthma, PECC was associated with decreased chest radiography rates among pediatric-resourced hospitals (AOR, 0.77; 95% CI, 0.66-0.91) but not non-pediatric-resourced hospitals (AOR, 0.93; 95% CI, 0.78-1.12).Conclusions and relevanceThe presence of a PECC was not consistently associated with quality-of-care measures. The presence of a PECC was variably associated with performance on imaging utilization measures, suggesting a potential influence of PECCs on clinical care processes. Additional studies are needed to understand the role of PECCs in driving adherence to clinical care guidelines and improving quality and patient outcomes.

Project description:ImportanceGiven the mortality disparities among children and adolescents in rural vs urban areas, the unique health care needs of pediatric patients, and the annual emergency department volume for this patient population, understanding the availability of pediatric emergency physicians (EPs) is important. Information regarding the available pediatric EP workforce is limited, however.ObjectiveTo describe the demographic characteristics, training, board certification, and geographic distribution of the 2020 clinically active pediatric EP workforce in the US.Design, setting, and participantsThis national cross-sectional study of the 2020 pediatric EP workforce used the American Medical Association Physician Masterfile database, which was linked to American Board of Medical Specialties board certification information. Self-reported training data in the database were analyzed to identify clinically active physicians who self-reported pediatric emergency medicine (EM) as their primary or secondary specialty. The Physician Masterfile data were obtained on March 11, 2020.Main outcomes and measuresThe Physician Masterfile was used to identify all clinically active pediatric EPs in the US. The definition of EM training was completion of an EM program (inclusive of both an EM residency and/or a pediatric EM fellowship) or a combined EM program (internal medicine and EM, family medicine and EM, or pediatrics and EM). Physician location was linked and classified by county-level Urban Influence Codes. Pediatric EP density was calculated and mapped using US Census Bureau population estimates.ResultsA total of 2403 clinically active pediatric EPs were working in 2020 (5% of all clinically active emergency physicians), of whom 1357 were women (56%) and the median (interquartile range) age was 46 (40-55) years. The overall pediatric EP population included 1718 physicians (71%) with EM training and 641 (27%) with pediatric training. Overall, 1639 (68%) were board certified in pediatric EM, of whom 1219 (74%) reported EM training and 400 (24%) reported pediatrics training. Nearly all pediatric EPs worked in urban areas (2369 of 2402 [99%]), and pediatric EPs in urban compared with rural areas were younger (median [interquartile range] age, 46 [40-55] years vs 59 [48-65] years). Pediatric EPs who completed their training 20 years ago or more compared with those who completed training more recently were less likely to work in urban settings (633 [97%] vs 0-4 years: 440 [99%], 5-9 years: 547 [99%], or 10-19 years: 723 [99%]; P = .006). Three states had 0 pediatric EPs (Montana, South Dakota, and Wyoming), and 3 states had pediatric EPs in only 1 county (Alaska, New Mexico, and North Dakota). Less than 1% of counties had 4 or more pediatric EPs per 100 000 population.Conclusions and relevanceThis study found that almost all pediatric EPs worked in urban areas, leaving rural areas of the US with limited availability of pediatric emergency care. This finding may have profound implications for children and adolescents needing emergency care.

Project description:BackgroundEmergency care in the United States faces notable challenges with regard to children. In some jurisdictions, available resources are not sufficient to meet local needs. Physicians with specialty training in pediatric emergency care are largely concentrated in children's medical centers within larger urban areas. Rural emergency facilities, which are more likely to face ongoing staffing shortages in all specialties, are particularly deficient in pediatric emergency medicine (PEM) physicians. This paper addresses challenges in distribution of pediatric emergency care specialists into suburban and rural health care facilities, and proposes potential local and regional solutions to improve pediatric emergency care capabilities as well as to enhance disaster response in children.ObjectivesThe American College of Emergency Physicians (ACEP) committee on PEM generated the objective to study and explore methods and strategies to address current challenges and shortcomings in the distribution of pediatric emergency physicians and to develop recommendations to improve access to emergency pediatric expertise in all care settings. A sub-committee was formed to generate a written report followed by full committee input. The content was reviewed by the ACEP Board of Directors.DiscussionPediatric emergency physicians are certified either by the American Board of Emergency Medicine or the American Board of Pediatrics (ABP) depending on whether their training occurred through the emergency medicine or a pediatric residency program. ABP-certified PEM that account for the majority of PEM physicians, remain largely concentrated in urban tertiary pediatric care centers, primarily children's hospitals. By contrast to the resources, the majority of pediatric patients receive emergency care in emergency departments (EDs) outside this setting. The goal of our recommendations is to help regionalize PEM expertise, allowing sharing of such resources with facilities that have traditionally not had access to PEM expertise. Financial or low number of pediatric cases likely contributed to lack of PEM resources in suburban and rural EDs, although a significant factor for lack of access to ABP-certified PEM physicians may be local privilege and practice restrictions. Expanding the scope of practice for ABP-certified PEM physicians beyond traditionally assigned arbitrary age limits to include selective adult patients has the potential to alleviate credentialing barriers and offset the financial and volume concerns while enhancing preparedness efforts, resource utilization, and access to specialized pediatric emergency care.ConclusionRecognition that the training of ABP-certified PEM physicians allows for these individuals to safely care for selective adult patients with common disease patterns that extend beyond traditionally assigned arbitrary pediatric age limits has the potential to improve resource dissemination and utilization, allowing for greater access to pediatric emergency physicians in currently underserved settings.

Project description:BackgroundTelehealth for emergency stroke care delivery (telestroke) has had widespread adoption, enabling many hospitals to obtain stroke center certification. Telehealth for pediatric emergency care has been less widely adopted.ObjectiveOur primary objective was to determine whether differences in policy or certification requirements contributed to differential uptake of telestroke versus pediatric telehealth. We hypothesized that differences in financial incentives, based on differences in patient volume, prehospital routing policy, and certification requirements, contributed to differential emergency department (ED) adoption of telestroke versus pediatric telehealth.MethodsWe used the 2016 National Emergency Department Inventory-USA to identify EDs that were using telestroke and pediatric telehealth services. We surveyed all EDs using pediatric telehealth services (n=339) and a convenience sample of the 1758 EDs with telestroke services (n=366). The surveys characterized ED staffing, transfer patterns, reasons for adoption, and frequency of use. We used bivariate comparisons to examine differences in reasons for adoption and use between EDs with only telestroke services, only pediatric telehealth services, or both.ResultsOf the 442 EDs surveyed, 378 (85.5%) indicated use of telestroke, pediatric telehealth, or both. EDs with both services were smaller in bed size, volume, and ED attending coverage than those with only telestroke services or only pediatric telehealth services. EDs with telestroke services reported more frequent use, overall, than EDs with pediatric telehealth services: 14.1% (45/320) of EDs with telestroke services reported weekly use versus 2.9% (8/272) of EDs with pediatric telehealth services (P<.001). In addition, 37 out of 272 (13.6%) EDs with pediatric telehealth services reported no consults in the past year. Across applications, the most frequently selected reason for adoption was "improving level of clinical care." Policy-related reasons (ie, for compliance with outside certification or standards or for improving ED performance on quality metrics) were rarely indicated as the most important, but these reasons were indicated slightly more often for telestroke adoption (12/320, 3.8%) than for pediatric telehealth adoption (1/272, 0.4%; P=.003).ConclusionsIn 2016, more US EDs had telestroke services than pediatric telehealth services; among EDs with the technology, consults were more frequently made for stroke than for pediatric patients. The most frequently indicated reason for adoption among all EDs was related to clinical care.

Dataset Information

Pediatric emergency care coordinator workforce: A survey study.

Objectives

Methods

Results

Conclusion

Publications

Pediatric emergency care coordinator workforce: A survey study.

Similar Datasets

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