Office preparedness for pediatric emergencies: A randomized, controlled trial of an office-based training program
Office preparedness for pediatric emergencies: A randomized, controlled trial of an office-based training program
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DOI：
10.1542/peds.112.2.291
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发表时间：
2003-08-01
期刊：
影响因子：
8
通讯作者：
Hohenhaus, S
中科院分区：
文献类型：
--
作者：
Bordley, WC;Travers, D;Hohenhaus, S
目标。许多儿童通过初级保健办公室进入紧急医疗系统，但这些办公室可能没有做好充分准备，以稳定病情严重的儿童。我们进行这项研究是为了评估一项以办公室为基础的教育计划的有效性，该计划旨在改善儿科急诊初级保健实践的准备工作。一项前瞻性、随机、对照试验从现有的北卡罗莱纳州实践数据库中招募初级保健实践（儿科、家庭实践和卫生部门）。同意参与的实践被随机分配到干预组或对照组。2名急诊医学临床医生（医生和/或注册护士）在干预实践中进行了未经宣布的模拟代码。实践被期望使用他们自己的人员、设备和当地的紧急医疗系统来响应模拟代码。演习结束后，急诊医学临床医生和当地急诊医疗系统小组主持了一次有组织的汇报会议，就工作人员的表现向他们提供建设性的反馈，审查了办公室的设备，并编写了一份为该项目设计的资源手册。主要结局指标是通过干预后3至6个月的调查获得的，包括1)购买新的儿科急救设备和药物，2)工作人员接受或更新基本生命支持/儿科高级生命支持/高级生命支持培训，以及3)制定书面儿科急救方案。对照组在试验期间没有接受任何干预，并完成了类似的结果调查。39例（干预组20例，对照组19例）完成了试验。两组患者的实践特征无显著差异。干预实践更有可能制定书面办公室协议（60%对21%）；干预实践中更多的工作人员在干预后3至6个月接受了额外的基本生命支持/儿科高级生命支持/高级生命支持培训（118对54）。在购买新设备或药物方面没有显著差异。90%的干预实践认为干预对他们的实践是有用的，95%的人认为该计划应该继续下去。研究结果表明，干预措施得到了很好的接受，并促使人们采取具体行动，为儿科紧急情况做好准备。
Objective. Many children enter the emergency medical system through primary care offices, yet these offices may not be adequately prepared to stabilize severely ill children. We conducted this study to evaluate the effectiveness of an office-based educational program designed to improve the preparation of primary care practices for pediatric emergencies.Methods. A prospective, randomized, controlled trial was conducted of primary care practices (pediatric, family practice, and health departments) that were recruited from an existing database of North Carolina practices. Practices that agreed to participate were randomly assigned to either the intervention or the control group. Unannounced mock codes were conducted in the intervention practices by 2 emergency medicine clinicians (medical doctor and/or registered nurse). Practices were expected to respond to the mock code using their own staff, equipment, and local emergency medical system. After the exercise, the emergency medicine clinicians and the local emergency medical system team led a structured debriefing session providing constructive feedback to the staff on their performance, a review of the office's equipment, and a resource manual designed for the project. The primary outcome measures were obtained by survey 3 to 6 months postintervention and included 1) purchase of new pediatric emergency equipment and medications, 2) receipt or updating of basic life support/pediatric advanced life support/advanced life support training by staff members, and 3) development of written emergency pediatric protocols. The control practices received no interventions during the trial and completed a similar outcome survey.Results. Thirty-nine practices (20 intervention, 19 control) completed the trial. There were no significant differences in practice characteristics between the 2 groups. Intervention practices were more likely to develop written office protocols (60% vs 21%); more staff in the intervention practices received additional basic life support/pediatric advanced life support/ advanced life support training 3 to 6 months after the intervention (118 vs 54). There were no significant differences in the purchase of new equipment or medications. Ninety percent of the intervention practices rated the intervention as useful for their practice, and 95% believed that the program should be continued.Conclusions. The findings suggest that the intervention was well received and motivated practices to take concrete actions to prepare for pediatric emergencies.