Emergency Department Recognition Program for Pediatric Services Does It Make a Difference?
Emergency Department Recognition Program for Pediatric Services Does It Make a Difference?
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DOI：
10.1097/pec.0000000000000205
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发表时间：
2014-09-01
影响因子：
1.4
通讯作者：
Meredith, Wayne
中科院分区：
文献类型：
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作者：
Ball, Jane W.;Sanddal, Nels D.;Meredith, Wayne
目的探讨儿科急救机构认可(PECFR)项目是否能改善15岁以下受伤儿童的护理流程。2009年，从特拉华州的8家医院和北卡罗来纳州的13家对照医院提取了急诊科(ED)的病历，并在PECFR实施一年后的2013年再次提取了急诊科(ED)的病历。收集的数据集中在儿科护理过程中，包括生命体征评估、疼痛评估和管理、治疗程序和诊断性放射治疗。结果1737名儿童(97%)的大多数伤害严重程度评分为9或更低。随着时间的推移，两家医院的队列都显著增加了最初的疼痛评估文件(P<；0001)。与北卡罗来纳州的医院相比，对于四肢瘫痪且疼痛评分在5或更高的儿童，特拉华州医院的疼痛评估和疼痛管理之间的间隔明显较短(P<；0.01)。与北卡罗来纳州的医院相比，特拉华州的医院(P<；0001)也显著减少了放射治疗(平板胶片和计算机断层成像)的使用。结论与PECFR计划相关的受伤儿童护理的改善仅限于肢体制动儿童疼痛评估和止痛药之间的间隔，以及PECFR计划实施一年后的放射治疗。
Objective This study aimed to determine if a pediatric emergency care facility recognition (PECFR) program improved care processes for injured children younger than 15 years.Methods A controlled pre-post study design was used. Emergency department (ED) medical records were abstracted from 8 Delaware hospitals and 13 comparison hospitals in North Carolina in 2009 and again in 2013, 1 year after PECFR implementation. Data collected focused on pediatric processes of care, including vital sign assessment, pain assessment and management, treatment procedures, and diagnostic radiation.Results A majority of 1737 children (97%) had an Injury Severity Score of 9 or lower. Both hospital cohorts significantly increased initial pain assessment documentation over time (P < 0001). For children with extremity immobilization and a pain score of 5 or greater, the interval between pain assessment and pain management was significantly shorter in the Delaware hospitals (P < 0.01) compared with hospitals from North Carolina. A significant reduction in radiation use (flat film and computed tomographic imaging) was also found in Delaware hospitals (P < 0001) compared with the hospitals in North Carolina.Conclusions Improvements in care to injured children associated with the PECFR program were limited to the interval between pain assessment and pain medication for children with extremity immobilization and to radiation use 1 year after the implementation of the PECFR program.