Abstract
Study objective
We sought to examine the frequency of pediatric critical procedures performed in a
national group of emergency physicians.
Methods
We performed a retrospective analysis of an administrative billing and coding dataset
for procedural performance documentation verification from 2014 to 2018. We describe
and compare incident rates of pediatric (age <18 years) patient critical procedure
performance by emergency physicians in general emergency departments (EDs), pediatric
EDs, and freestanding ED/urgent care centers. Critical procedures were endotracheal
intubation, electrical cardioversion, central venous placement, intraosseous access,
and chest tube insertion.
Results
Among 2290 emergency physicians working in 186 EDs (1844 working in 129 general EDs,
125 in 8 pediatric EDs, and 321 in 49 freestanding EDs/urgent cares), a total of 2233
pediatric critical procedures were performed during the study period. Many physicians
at general EDs and freestanding EDs/urgent cares performed zero pediatric procedures
per year (53.9% and 89% respectively). Per 1000 ED visits seen (All patient ages),
physicians working in general EDs performed fewer pediatric critical procedures than
physicians in pediatric EDs (0.12/1000 visits vs 0.68/1000 visits; rate difference = 0.56,
95% confidence interval [CI] 0.51–0.61). Per 1000 clinical hours worked, physicians
working in general EDs performed 0.26 procedures compared to 1.66 for physicians in
pediatric EDs (rate difference = 1.39; 95% CI 1.27–1.52).
Conclusion
Pediatric critical procedures are rarely performed by emergency physicians and are
exceedingly rare in general EDs and freestanding EDs/urgent cares. The rarity of performance
of these skills has implications for ED pediatric readiness.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A national assessment of pediatric readiness of emergency departments.JAMA Pediatr. 2015; 169 (Jun): 527-534
- Emergency care for children in the United States: epidemiology and trends over time.J Emerg Med. 2018; 55 (Sep): 423-434
- Emergency department children are not as sick as adults: implications for critical care skills retention in an exclusively pediatric emergency medicine practice.J Emerg Med. 2009; 37 (Nov): 359-368
- A is for airway: a pediatric emergency department challenge.Ann Emerg Med. 2012; 60 (Sep): 261-263
- How does one learn critical care procedures in a pediatric emergency department?.Ann Emerg Med. 2013; 61 (Mar): 279-280
- The spectrum and frequency of critical procedures performed in a pediatric emergency department: implications of a provider-level view.Ann Emerg Med. 2013; 61 (Mar): 263-270
- Pediatric out-of-hospital critical procedures in the United States.Pediatr Crit Care Med. 2015; 16 (Oct): e260-e267
- High risk, low frequency: optimizing performance of emergency intubation for children.Ann Emerg Med. 2017; 70 (Dec): 783-786
- Relationship between complications of pediatric anesthesia and volume of pediatric anesthetics.Anesth Analg. 1997; 84 (Jan): 234-235
- Bradycardia during anesthesia in infants. An epidemiologic study.Anesthesiology. 1994; 80 (May): 976-982
- Procedural experience with intubation: results from a national emergency medicine group.Ann Emerg Med. 2019; 74 (Dec): 786-794
- Congruence of disposition after emergency department intubation in the National Hospital Ambulatory Medical Care Survey.Ann Emerg Med. 2013; 61 (Apr): 423-426 e428
- Critical care FAQ.https://http://www.acep.org/administration/reimbursement/reimbursement-faqs/critical-care-faq/-question0Date accessed: February 22, 2020
- Emergency medicine defined key index procedure minimums.
- ACGME program requirements for graduate medical education in pediatric critical care medicine (subspecialty of pediatrics).
- Tracheal intubation practice and maintaining skill competency: survey of pediatric emergency department medical directors.Pediatr Emerg Care. 2008; 24 (May): 294-299
- Emergency department pediatric readiness and mortality in critically ill children.Pediatrics. 2019; 144 (Sep)
- Pediatric readiness in the emergency department.Ann Emerg Med. 2018; 72 (Dec): e123-e136
- Pediatric readiness in the emergency department.Pediatrics. 2018; 142 (Nov)
- Pediatric readiness in the emergency department.J Emerg Nurs. 2019; 45 (Jan): e3-e18
- EMS for children innovation and improvement center national pediatric readiness project.http://www.pediatricreadiness.orgDate accessed: January 29, 2020
- Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains.Acad Med. 2004; 79 (Oct): S70-S81
- Multidisciplinary simulation-based team training for trauma resuscitation: a scoping review.J Surg Educ. 2019; 76 (Nov - Dec): 1669-1680
- The role of simulation in teaching pediatric resuscitation: current perspectives.Adv Med Educ Pract. 2015; 6: 239-248
- Impact of simulation-based training on perceived provider confidence in acute multidisciplinary pediatric trauma resuscitation.Pediatr Surg Int. 2018; 34 (Dec): 1353-1362
- Memory: a contribution to experimental psychology.Ann Neurosci. 2013; 20 (Oct): 155-156
- Optimal training frequency for acquisition and retention of high-quality CPR skills: a randomized trial.Resuscitation. 2019; 135 (Feb): 153-161
- A survey assessment of perceived importance and methods of maintenance of critical procedural skills in pediatric emergency medicine.Pediatr Emerg Care. 2019; 35 (Aug): 552-557
- Preferred learning modalities and practice for critical skills: a global survey of paediatric emergency medicine clinicians.Emerg Med J. 2019; 36 (May): 273-280
Article Info
Publication History
Published online: June 05, 2020
Accepted:
June 1,
2020
Received in revised form:
May 30,
2020
Received:
April 27,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
