Office Preparedness for Pediatric Emergencies: A Randomized, Controlled Trial of an Office-Based Training Program

Author:

Bordley W. Clayton1,Travers Debbie2,Scanlon Patricia3,Frush Karen1,Hohenhaus Sue4

Affiliation:

1. Department of Pediatrics, Duke University School of Medicine, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

2. Department of Surgery, Duke University School of Medicine, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

3. Children’s Primary Care Research Group, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

4. Office of Emergency Medical Services, North Carolina Department of Health and Human Services, Raleigh, North Carolina

Abstract

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.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference17 articles.

1. Institute of Medicine. Emergency Medical Services for Children. Washington, DC: National Academy Press; 1993

2. Heath BW, Coffey JS, Malone P, Courtney J. Pediatric emergencies and emergency preparedness in a small rural state. Pediatrics.2000;106:1391–1396

3. American Academy of Pediatrics. Periodic Survey 27. Elk Grove Village, IL: American Academy of Pediatrics; 1995

4. Schweich P, DeAngelis C, Duggan A. Preparedness of practicing pediatricians to manage emergencies in the office. Pediatrics.1991;88:223–229

5. Flores G, Weinstock DJ. The preparedness of pediatricians for emergencies in the office. Arch Pediatr Adolesc Med.1996;150:249–256

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